Wednesday, November 22, 2023 (Geneva, Switzerland)—Ahead of this year´s World AIDS Day, a new report published by the Global Commission on Drug Policy has sent a timely reminder that talk of ending the HIV (and hepatitis) epidemics is premature unless there are significant reforms to drug policies that continue to discriminate against and criminalise the community of people who use drugs (PWUD) which results in them being unable to access prevention, diagnostics, treatment and care services.
The report, HIV, Hepatitis & Drug Policy Reform, finds that despite the extraordinary progress made for instance, over the past two decades in getting people living with HIV on antiretroviral treatment (ART), tripling globally from some 10 million to almost 30 million today, the situation for people who inject drugs (PWID) living with the virus had improved little over the same period. Globally, an estimated 14·8 million people inject drugs.
Sparse data is available to estimate ART access among PWID living with HIV. The most recent data taken across 18 countries estimates the uptake of current HIV treatment ranging from 2·6% to 81·9%.
The same data takin g in 23 countries estimates that the uptake of ever having HCV treatment ranges from 1·8% to 88·6% across countries.
Based on the UN agencies’ definitions, the proportion of people who inject drugs living with HIV who receive therapy was low (<25%) in four countries, moderate (25–75%) in 12 countries, and high (>75%) in two countries. Similarly, HCV treatment coverage was low (<25%) in 14 countries, moderate (25–75%) in eight countries, and high (>75%) in one country. The paucity of data is matched by the paucity of treatment coverage with one study noting that is insufficient to prevent, halt or reverse the HIV and HCV epidemics amongst PWID.
“Ending AIDS by 2030 will remain a pipedream if we do not double down on our efforts to effectively reach and engage with the community of people who inject drugs who are at extremely high risk of acquiring HIV,” said Michel Kazatchkine, a member of the Global Commission on Drug Policy and the former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
“And that will require in many countries an overhaul of their drug policies that continue to legally punish and incarcerate people for using drugs as opposed to attending to them in the public health system like other members of the community.
“It is disquieting that millions of people are still being unnecessarily placed at an extreme risk of acquiring HIV or Hepatitis and those who are living with viruses are being denied the fundamental human right to health, in terms of receiving accessible and appropriate treatment and care. It is no coincidence that countries like Portugal, Switzerland, Spain and Germany – who treat drug use as a public health threat, and not a criminal one – have some of the lowest rates of HIV and Hepatitis infection in the world. The lack of sufficient progress in the face of overwhelming evidence is shameful and is ruining and costing lives.”
The three International Drug Control Conventions of the United Nations – which serve as the basis for the current international drug control regime – are outdated and contradict the latest recommendations and positions of the United Nations, e.g. the UNGASS Declaration (2016) and the UN Common Position on Drugs (2018), as well as the recent and forward looking OHCHR report.
Epidemiology of injecting drug use in Eastern Europe, Western Europe, North America and Central Asia
- In Eastern Europe, the population prevalence of IDU is 1.08 %. The estimated number of PWID (95% UI) is: 2 282 500, 581 500 of whom are women.
- In Western Europe, an estimated 991 000 people inject drugs (population prevalence rate of 0.35%)
- In North America, 3.316 million people are estimated to inject drugs, (with a population prevalence rate of: 1.38%).
- In Central Asia, 241 000 people are estimated to inject drugs (with a population prevalence of IDU of 0.51%).
HIV, HCV, HBV among PWID in Eastern Europe
- Prevalence of HIV among PWID in Eastern Europe: 34.2%, representing 780 000 PWID living with HIV.
- Prevalence of HCV among PWID in Eastern Europe is: 48.4%, with over 1 million (1 105 000) estimated PWID who are HCV-antibody positive.
- Prevalence of HBV among PWID in Eastern Europe is: 7.5% (172 000 PWID who are HBsAg positive).
HIV, HCV, HBV among PWID in Western Europe
- Prevalence of HIV among PWID in Western Europe is: 5.1% (i.e. 51 000 PWID living with HIV) in Western Europe.
- Prevalence of HCV among PWID in Western Europe: 38.1% (377 500 PWID who are HCV-antibody positive).
- Prevalence of HBV among PWID in Western Europe: 2.7% (26 500 PWID who are HBsAg positive).
HIV, HCV, HBV among PWID in North America
- Prevalence of HIV among PWID in North America: 5.9% (194 000 PWID who are HCV-antibody positive).
- Prevalence of HCV among PWID in North America: 42.5% (1 409 000) persons, so nearing 1.5 million.
- Prevalence of HBV among PWID in North America: 4.5% (150 500 PWID who are HBsAg positive).
HIV, HCV, HBV among PWID in Central Asia:
- Prevalence of HIV among PWID in Central Asia: 10.2 % (24 500 persons).
- Prevalence of HCV among PWID in Central Asia: 39.3% (94 500 PWID who are HCV-antibody positive).
- Prevalence of HBV among PWID in Central Asia: 8.1% (19 500 PWID who are HBsAg positive).
HIV, Hepatitis & Drug Policy Reform highlights several critical challenges in addressing HIV and viral hepatitis among people who use drugs: efforts to prevent HIV or Hepatitis B or C acquisition amongst PWUD are being driven underground by barriers imposed by laws, violence, stigma, and discrimination which limit access to healthcare services. This has resulted in a higher prevalence of HIV, HCV, and HBV among people who use drugs, compared to the general population.
The report highlights that, even in instances where treatment is available, some countries condition access to medication on the cessation of drug use, a condition that is not medically warranted and creates additional barriers to care. Vaccination for HBV is highly effective but might not be widely available among people who inject drugs. Preventive measures, such as vaccination, are crucial to control the spread of these viruses.
Recommendations
The report underscores the urgent need for drug policy reform that includes the decriminalization of drug use and the implementation of harm reduction strategies.
The key recommendations of the report are:
The Global Commission on Drugs calls on the United Nations to:
- Fully and effectively implement the UN Common Position on Drugs (2018), which calls for changes in laws, policies and practices that threaten the health and human rights of people.
The Global Commission on Drugs calls on member States to:
- Decriminalize drug use, drug possession for personal use, and the possession of drug paraphernalia.
- Protect people who use drugs from stigma or discrimination in accessing benefits or services, including education, housing, healthcare, social benefits, and employment.
- Fully resource and scale-up HIV and viral hepatitis prevention (harm reduction), diagnosis and treatment programs, including in prisons and other closed settings.
- Ensure the availability of drug dependence treatment.
- Encourage, expand and evaluate innovative harm reduction approaches—including drug consumption rooms, drug checking, heroin-assisted treatment and safe supply initiatives.
- Involve people who use drugs in the development, design, implementation and monitoring and evaluation of all HIV and viral hepatitis programs.