US pressure against harm reduction backfires at CND

US pressure against harm reduction backfires at CND
TNI Press Release, 9 March 2005

VIENNA, 9 March 2005 - The U.S. pressure against harm reduction measures to counter the
HIV/AIDS epidemic backfired at the thematic debate on the issue at
the second day of the 48th session of the Commission on Narcotic
Drugs (CND) that began on Monday, March 7th in Vienna.

The HIV/AIDS debate occurred amid widespread civil society concern
about U.S. pressure on CND delegates to withdraw support from needle
exchange and harm reduction approaches. According to Martin Jelsma
of
the Transnational Institute (TNI) the debate, however, resulted in a
straight and massive endorsement of harm reduction measures to
counter the HIV/AIDS epidemic. "The confrontation between
zero-tolerance ideologues and harm reduction pragmatists was
definitely won by the pragmatists," said Jelsma. "Efforts to discard
the overwhelming evidence that harm reduction measures are effective
against the spread of HIV/AIDS have been rejected plainly by most
member states."

In an open letter released on March 1 [PDF], over 200 organizations –
including TNI – and many individuals in 56 countries made an urgent
appeal to CND delegates: "As you gather this year to debate HIV/AIDS
prevention and drug abuse, we respectfully urge you to support
syringe exchange, opiate substitution treatment and other harm
reduction approaches demonstrated to reduce HIV risk; to affirm the
human rights of drug users to health and health services; and to
reject efforts to overrule science and tie the hands of those working
on the front lines. No less than the future of the HIV epidemic is at
stake."

Editorials in support of syringe exchange in the New York Times and
the Washington Post, and articles highlighting US efforts to pressure
the UN in the Guardian, the International Herald Tribune and other
major papers, also appealed to the delegates at the CND-session to
use their common sense and to not give in to ideological attacks. The
New York Times urged the US government to "call off their budding
witch hunt" and the Washington Post "to end this bullying
flat-earthism." (click here)

Open Society Institute president Aryeh Neier warned in an
International Herald Tribune editorial that opposing needle exchange
and other HIV-prevention measures would worsen the global AIDS
epidemic. "Having removed condom information from federal Web sites
and insisting on abstinence-only sex education at home and abroad, the
Bush administration is now poised to override the best available
evidence in deciding how best to fight HIV related to drug use,"
Neier stated. "What is needed at this year's Commission on Narcotic
Drugs is unanimous commitment to deploying the tools, including
needle exchange, known to reduce HIV among drug users."

According to Jelsma, "governments did stand up to defend harm
reduction practices proven to contain the spread of HIV/AIDS." He
added that "countries with long-standing experience with harm
reduction practices and less vulnerable to US pressures - Europe,
Canada and Australia - have a particular responsibility. The price for
avoiding confrontation will be paid in Asia, Latin America and the
former Soviet Union where the situation is most urgent. It is time to
be guided by the light of science, not by the darkness of ignorance
and fear." Jelsma said that "tensions in US-UNODC relations should be
resolved by more sustainable funding mechanisms, not by bowing to
pressure from the Republican right in the US."

Tensions on UN endorsement of harm reduction policies reached a peak
after a meeting between the Executive Director of the UN Office on
Drugs and Crime (UNODC), Antonio Maria Costa, and US Assistant
Secretary of State for International Narcotics and Law Enforcement
Affairs (INL), Robert Charles, on November 10, 2004. The US
government threatened to cut funding to UNODC unless Mr. Costa
assured that UNODC would abstain from any support for harm reduction,
including needle exchange programmes.

In a mea culpa response, Mr. Costa ensured that references to harm
reduction and needle exchange would be avoided in UNODC
statements. This position was in direct conflict with statements made by other UN
agencies and in UNODC documents in the recent past. More than ever,
inconsistency reigns within the UN around an issue all UN Member
States have pledged to achieve in the Millennium Development Goals:
Halt and begin to reverse the spread of HIV/AIDS. The General
Assembly Special Session in 2001 on HIV/AIDS adopted a Declaration
of Commitment saying that "harm reduction efforts related to drug use,"
and "expanded access to essential commodities, including [...]
sterile injecting equipment" should be ensured by 2005. Both WHO and
UNAIDS use the term harm reduction as a matter of course.

In his Report to the Commission on Narcotic Drugs (CND) in Vienna last
year, UNODC Executive Director Costa clarified the position of UNODC
on the issue of harm reduction for HIV/AIDS prevention. "Taking into
account that drug use is a chronically relapsing condition, policies
governing HIV/AIDS prevention must follow pragmatic approaches and
therefore must address high-risk behaviour first before striving to
achieve long-term goals such as total abstinence from drugs. Effective
programmes typically include a wide variety of measures, ranging from
drug dependence treatment, including drug substitution treatment,
outreach providing injecting drug users with information on risk
reduction and referral to services, clean needles and syringes, and
condoms." (1)

The shift of the UNODC towards the broader UN consensus on basic
harm reduction practices forms the background to the US pressure on the
agency. The combination of two resolutions seeking CND acceptance
for such a consensus at the March 2004 CND session, from Brazil on
HIV/AIDS and the Pompidou Group on substitution treatment, and
Costa's position paper on HIV/AIDS quoted above and one on
substitution treatment by WHO/UNAIDS/UNODC was the prelude to the
current crisis in US-UNODC relations. An angered US delegation made
blunt statements during the session like that needle exchange
programmes in fact might accelerate the spread of HIV instead of
preventing it.

In his opening remarks at the CND session Costa, did not directly
criticize or distance UNODC from harm reduction. He urged the
Commission to continue to give UNODC guidance on interventions such
as needle exchange, whose importance he acknowledged as long as
they did not encourage drug abuse, and said "we must not deny addicts with
a genuine opportunity to remain HIV negative."

US drug czar John Walters, who addressed the delegates after Costa,
made no mention of either harm reduction or needle exchange in his
speech. His remarks on HIV focused on the fact that the US was the
world’s largest donor to global AIDS relief and steered clear of
discussing specific interventions. At a press conference later in the
day, reporters asked him to respond to the open letter and the NY
Times editorial critical of US pressure on UNODC to withdraw support
from needle exchange. While denying any covert effort to pressure
UNODC, Walters noted that U.S. donations to the agency would reflect
Washington’s priorities. (2)

During the thematic debate on HIV/AIDS most delegations voiced
explicit support for harm reduction, notably the EU and several of
its member states (France, Germany, Netherlands, Finland, Spain, and
Portugal, e.g.), the European Council, Australia, Norway,
Switzerland, and Brazil. Even Sweden – a renowned hard-liner on drug
policy issues that usually follows the US zero-tolerance approach –
"fully associated itself" with a pro-harm-reduction statement by the
EU. Another hard-liner, Italy, supported both needle exchange
strategies and strong information campaigns.

Only the United States and Japan criticized harm reduction or needle
exchange directly. The United States, while supporting substitution
treatment and avoiding explicit mention of needle exchange,
nevertheless stated that harm reduction encompassed strategies that
promoted or encouraged drug use and was thus a term "best avoided."
The U.S. Representative, Joe O'Neill, noted that helping addicts
become drug-free should be the priority, and appealed forcefully for
expansion of substitution treatment (methadone, naltrexone and
buprenorphine), which represented what he described as "the most
effective strategy to reduce HIV/AIDS among drug users." Japan, which
reported having virtually no HIV via injection, expressed concern
that needle exchange would encourage drug use and recommended that
it should be sharply limited.

Canada emphasized the importance of addressing stigma and
discrimination against injection drug users. Several Muslim nations,
in contrast to years past, supported harm reduction. Iran cited
efforts in prison and primary care clinics, while Morocco cited their
new partnership with Iran in forging a response to injection drug use.
China stated that methadone pilot programs were underway and that
"exchange of needles and syringes is expanding step by step."
Numerous countries with significant injection-driven HIV/AIDS
epidemics, including Russia and Ukraine (who were present), remained
completely silent during the HIV/AIDS debate.

Both the UNAIDS (represented by Peter Piot, who moderated the
debate) and WHO recommended access to sterile syringes and condoms as
part of a comprehensive approach to HIV prevention. WHO did so forcefully,
listing six evidence-based interventions that should be scaled up in
all countries with injection-driven epidemics: needle exchange,
substitution therapy, HIV testing and counselling, outreach and peer
education, services for preventing sexual transmission (including
condom distribution), and HBV vaccination. Peter Piot stressed
prevention of drug use as the first line of defence against
injection-driven HIV. He concluded the debate by noting a lack of
consensus on needle exchange, which surprised many observers given
that only two countries that spoke (the U.S. and Japan) had
explicitly opposed it.

On March 9th, delegates are expected to debate a draft resolution
introduced by Brazil on "HIV/AIDS and the Right to Health."

Notes

1. E/CN.7/2004/3 Strengthening strategies regarding the prevention of
HIV/AIDS in the context of drug abuse, report of the UNODC Executive Director for the 47th session of the Commission on Narcotic Drugs [PDF], 12 January 2004

2. Information taken from updates from Vienna by the Open Society
Institute and Human Rights Watch, as well as Martin Jelsma of TNI.

Contact Martin Jelsma, TNI’s drugs programme coordinator: mobile
+31-6-5571 5893, email mjelsma@tni.org

Martin Jelsma will be at the CND meeting in Vienna from March 7-11,
but can be contacted via mobile and email.