Summary/Abstract

The third edition (2012) of the Global State of Harm Reduction Report, produced by Harm Reduction International, examines the Global incidence, prevalence and etiology of HIV/AIDS and Hepatitis C and current prevention policies .

Content

The Global State of Harm Reduction 2012
Towards an integrated response

The entire report due to its size has been separated into three sections (pdf)

Part One                 Part Two                      Part Three       

This report was produced by the Public Health, Research and Policy Programme
of Harm Reduction International.

Acknowledgements
This report was made possible by the collaborative input of numerous harm reduction networks, drug user organisations, research institutes and advocates. HRI would like to acknowledge the invaluable contribution of these individuals and organisations in providing information on their specific countries or regions: Asia: Asian Harm Reduction Network; Pascal Tanguay, Population Services International, Thailand; Tasnim Azim, International Centre for Diarrhoeal Disease Research, Bangladesh; Ravindra Rao, United Nations Office on Drugs and Crime, India Caribbean: Caribbean Harm Reduction Coalition, Saint Lucia; Eurasia: Umed Ibragimov, Tajikistan; Larisa Abrickaja, Harm Reduction International, UK; Latin America: Pablo Cymerman, Agostina Chiodi, Intercambios Association Civil, Argentina; Middle East and North Africa: Middle East and North Africa Harm Reduction Association (MENAHRA), Lebanon; North America: Harm Reduction Coalition, US; Walter Cavalieri, Canadian Harm Reduction Network; Canadian Drug Policy Coalition, Canada; Oceania: Australian Injecting and Illicit Drug Users League, Australia; Sub-Saharan Africa: David Kuria Mbote, Kenya; Bronwyn Myers, Medical Research Council, South Africa Western Europe: European Monitoring Centre on Drug Use and Drug Addiction

Introductory comments from Michel Sidibé
Executive Director, UNAIDS
The third edition of the Global State of Harm Reduction report comes at a pivotal time in the HIV epidemic. Thirty per cent of HIV infections outside sub-Saharan Africa, representing approximately 3 million people, are attributed to injecting drug use. New infections among people who use drugs account for an increasing share of global HIV incidence. In Eastern Europe and Central Asia, injecting drug use accounts for up to 80% of HIV infections, with the annual rate of new HIV infections in the region having increased by more than 250% between 2001 and 2010.a In several countries in sub Saharan Africa including Kenya, Tanzania and South Africa a new wave of infections due to drug injecting has emerged in recent years. This reality serves as an urgent reminder of the commitment made by all United Nations Member States in the 2011
Political Declaration on HIV/AIDS to reduce transmission of HIV among people who inject drugs by 50% by 2015. Achieving this target demands a cohesive response to HIV from UN agencies, states, civil society and affectedcommunities alike based on the strongest available public health evidence and human rights principles. UNAIDS is unequivocal in its message to Member States about what works to reduce HIV transmission among
people who inject drugs. The evidence is clear and decisive: sufficient provision and coverage of needle and syringe programmes, opioid substitution therapy and antiretroviral
therapy as part of the nine key interventions outlined in the WHO, UNODC, UNAIDS technical guide work to effectively reduce HIV transmission among people who inject drugs, as well as providing other measurable benefits to individuals’
health and their communities.

Despite the existence of these evidence-based and cost effective harm reduction interventions, their coverage remains shockingly low. As this report highlights, fewer
than two clean needles per month are distributed globally per person who injects drugs, under 13% of people who use drugs are enrolled in opioid substitution therapy, and
only 4% of people who inject drugs living with HIV are on antiretroviral treatment. 

Most alarming is that a significant number of countrieswith reported injecting drug use continue to restrict accessto these services. Punitive laws and policies, whether via
prohibiting the provision of sterile injecting equipmentand opioid substitution therapy, criminalising drug use, possession of injecting paraphernalia, or denying HIV treatment to people who use drugs, violate people’s right to health and harm the community. Such punitive policies not only fail to reduce HIV transmission but create unintended harms – for instance, by driving people who inject drugs away from prevention and care and resulting in prison overcrowding. Responses to HIV should transcend ideology and be based on scientific evidence and sound human rights principles; they should support, not punish, those affected.

UN Secretary-General Ban Ki-Moon stated that “No one should be stigmatised or discriminated against because of their dependence on drugs” and called on UN Member
States to ensure that people who use drugs have equal access to health and social services. An important function of UNAIDS is to highlight the adverse human rights and public health impacts of restrictive laws and policies, and “to create
protective social and legal environment that enable access to HIV programmes.”c Further, in its 2011–2015 Strategy, Getting to Zero, UNAIDS is explicit about reducing by half
the number of “countries with punitive laws and practices around HIV transmission, drug use or homosexuality that block effective responses”.

The need for legal reform aligned with HIV prevention and treatment, complemented by the meaningful involvement of people who use drugs in service and policy formulation
and implementation, has never been more imperative than it is now for achieving the goal of universal access.

On behalf of the UNAIDS Secretariat and our co-sponsors, I am proud to say that UNAIDS is committed to playing the leading role in a coordinated, unambiguous and bold UN response to HIV among people who inject drugs. In an increasingly hostile policy climate, we must replace dangerous complacency with decisive action when it comes to HIV-related harm reduction. Without firm global leadership, evidence and human rights-based national policies, bold resource replenishment for harm reduction and urgent scale-up of harm reduction interventions, there will be no “getting to zero”.

The original Global State of Harm Reduction report, published in 2008, provided the first global snapshot of harm reduction service availability and coverage, reflecting the contributions of civil society organisations, multilateral agencies and researchers in the drug-related HIV response. Since then, the biennial reports have become an indispensable reference tool and authoritative resource for a wide range of agencies and individuals engaging in advocacy for harm reduction worldwide. The latest edition of the report includes important data on viral hepatitis, and a timely focus on intersections between drug use, HIV and harm reduction services among other key affected populations, including women, children and men who have sex with men. These sub-populations of people who inject drugs are often the most marginalised in the global AIDS response, requiring immediate services and a proportionate allocation of HIV prevention resources. The promotion of harm reduction as part of a bolder, more united and more comprehensive global effort will be essential to halving HIV infections among people who inject drugs by 2015.

Michel Sidibé
Executive Director, UNAIDS

© 2012 Harm Reduction International
ISBN 978-0-9566116-6-6