A Joint United Nations Programme on HIV/AIDS (UNAIDS) report, Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs, was published in March 2019.1 It recommends implementing evidence-informed approaches to drug policy that are grounded in human rights and which would reduce the spread of HIV and other diseases through injecting drug use. These include harm reduction services and the decriminalisation of the possession of drugs for personal use. The report was published in advance of the ministerial segment of the 62nd Commission on Narcotic Drugs (CND) session and its authors advocated that its recommendations be used to inform that process.2

UNAIDS

UNAIDS was established in 1996 and describes itself as ‘leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals’.3 It is at the core of the design, delivery, and monitoring of the global AIDS response, including shaping public policy on HIV. As part of its work, it leads on global data collection on HIV epidemiology, programme coverage, and finance. As a structure, UNAIDS is different from other elements of the UN system in that it is the only co-sponsored joint programme – it draws on the experience and expertise of 11 UN system co-sponsors, including the United Nations Office on Drugs and Crime (UNODC). It is also the only UN entity with civil society represented on its governing body. This more inclusive structure appears to contribute to UNAIDS’ position as an advocate for a human rights and public health led approach to drug policy.

Health, rights and drugs

Health, rights and drugs shows that people who use drugs are being left behind when it comes to ongoing HIV infection. Despite a 25% decline in the incidence of HIV infections globally (all ages) between 2010 and 2017, HIV incidence is not declining among people who inject drugs. The report argues that this reflects a failure on the part of policymakers and lawmakers internationally to protect the health and human rights of drug users. Users continue to be unable to access interventions that have been evidenced to reduce the risk of infection – harm reduction interventions such as needle exchanges and opioid substitution therapy. In the foreword to the report, the executive director of UNAIDS, Michel Sidibé, describes this situation as ‘unacceptable: people who use drugs have rights, and too often these rights are being denied’ (p. 1).

The report has four substantive chapters. The first presents the current global situation in which drug users tend to be criminalised and are heavily stigmatised. This contributes to a situation in which they are more vulnerable than other members of the population to drug-related infectious diseases; experience heightened levels of violence; and have higher rates of mortality. The second chapter argues that harm reduction is the foundation of a rights-based public health approach, and shows how it has consistently been found to reduce morbidity and mortality among people who use drugs.

Chapter 3 highlights the contradiction in current international drug policy. It is noted that the dominant approach continues to be one of criminalisation ‘despite countries agreeing again and again … that drug policy must be informed by human rights and committing to adopting a more balanced, integrated, evidence-informed and human rights-based approach’ (p. 33). The fourth chapter explores the role of civil society in promoting rights and health-based approaches to drug use, bringing about changes in attitudes and policies, and delivering harm reduction services.

Conclusion

The authors conclude that by taking an approach characterised by criminalisation and law enforcement, the global drug framework has failed to achieve the global target to ‘eliminate or reduce significantly and measurably’ (p. 45) the supply and demand for illicit drugs by 2019. Instead the situation has worsened. They argue for comprehensive harm reduction services and the decriminalisation of drug use and possession for personal use (see Box 1).4

1    Joint United Nations Programme on HIV/AIDS (UNAIDS) (2019) Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs. Geneva: UNAIDS. https://www.drugsandalcohol.ie/30409/

2    See accompanying article of this Drugnet issue: Dillon L (2019) Ministerial segment of 62nd session of Commission on Narcotic Drugs. Drugnet Ireland, 70: 00–00.

3    UNAIDS (2018) About UNAIDS: Saving lives, leaving no one behind. Geneva: UNAIDS. Available online at: http://www.unaids.org/en/whoweare/about

4    UNAIDS (2019) Press release: Promises to improve health outcomes for people who inject drugs remain unfulfilled as 99% do not have adequate access to harm reduction services. Geneva: UNAIDS. Available online at: http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/march/20190313_drugs_report