BOOST

 

On the 13th & 14th of February, with 45 participants from more than 20 organisations, the first meeting of the BOOST Project took place in the Fondazione Villa Maraini in Rome.

The main aim of the BOOST project is to enhance the implementation of high-quality community-based & community-led communicable disease services as part of a comprehensive, people-centred and integrated harm reduction approach. To ahieve its goal, over the next three years, together with our partners we will focus on four key areas:

INFORM – providing a collection of up-to-date information and data on current practice and quality of community-based and community-led services.
IMPROVE – supporting the organisation of capacity building activities in the field of communicable diseases, indluding the use of digital tools.
SUPPORT – enhancing the scale-up of integrated community-based good practices building up existing models of good practice.
CONNECT & ACT – strenghtening and consolidating existing civil society networks and fostering advocacy interventions for the improved implementation comunity-based and community-led good practices oriented towards the needs of people who use drugs at European, national and local levels.

BOOST Project is founded by the EU4Health programme of the European Union, under the Action Grants to support the implementation of best practices in community-based services for HIV, AIDS, viral hepatitis and sexually transmitted infections. Partners include the Eurasian Harm Reduction Association, EuroNPUD, Free Clinic, Podane Ruce, LILA Milano, Asociacion Bienestar y Desarrolo, IGTP/ICO, ISGlobal, Foundazinone Villa Maraini. Supporting the projects work, the project with count with Scientific Advisory Board and the collaboration of organizations such as DPNSEE, ReGeneration, ARAS Foundation, AIDS Action Europe, among others.

The Lighthouse Concept

This new publication discusses the need for scaling-up harm reduction services, and more information on our new BOOST project.

In 2023, C-EHRN will start to implement the European Union (EU) co-financed BOOST project, aiming to strengthen and support community-based and community-led harm organisations in providing high-quality communicable disease services to people who use drugs. These include the scaling-up of good practices in communicable disease awareness, prevention, screening/testing and linkage to care, delivered as an integrated part of people-centred harm reduction interventions. The project consortium includes, among others, the Eurasian Harm Reduction Association (EHRA) and the European Network of People Who Use Drugs (EuroNPUD).

The publication also contains information from the presentation by Roberto Perez Gayo (C-EHRN Policy Officer) on the BOOST project at INHSU 2022.

As well as this, Free Clinic in Belgium, Podane ruce in Czechia, Villa Maraini in Italy, and the A-Clinic Foundation in Finland are discussed as examples in harm reduction for an integrated HIV/HCV approach.

Call for Rights-Affirming Drug Policies

For the third year in a row, 100+ NGOs urge UNODC Director to mark International Human Rights Day by calling for rights-affirming drug policies.

CEHRN have co-signed the below letter directed to Ms Ghada Waly (Executive Director, United Nations Office on Drugs and Crime), ahead of International Human Rights Day;

To: Ms Ghada Waly, Executive Director, United Nations Office on Drugs and Crime

30th November 2022

Dear Ms. Waly

Subject: Open letter on occasion of International Human Rights Day 2022

We urge you to mark International Human Rights Day 2022 by calling on Member States to change drug policies and practices to fulfil the Universal Declaration of Human Rights, and to place human rights at the centre of all dimensions of UNODC’s work

We are writing to you ahead of International Human Rights Day on 10th December 2022, which will celebrate the legacy and relevance of the Universal Declaration of Human Rights ahead of its 75th anniversary. For the past two years, dozens of civil society and community organisations have called on you to issue a statement on International Human Rights Day urging Member States to change drug laws and practices that undermine health and human rights. We reiterate this petition once again, as we call on you to mainstream human rights into all dimensions of UNODC’s work.

The human rights catastrophe brought about by punitive drug policies is well documented by the United Nations system. Every year, UN human rights experts pay increasing attention to the human rights consequences of drug policies, and more are announced to come soon. The recent and unprecedented joint statement released on 26th June 2022 (UN World Drug Day) by 13 UN human rights special mandates, in particular, notes that ‘the UN system, the international community and individual Member States have a historical responsibility to reverse the devastation brought about by decades of a global “war on drugs”’. The joint statement calls on all UN agencies to ‘ground their drug policy responses in international human rights law and standards’, and to ensure that their ‘financial and technical assistance on drug policy’ promotes responses that are ‘gender responsive’ while ‘actively seeking to protect human rights and fundamental freedoms’.

 

As the lead UN agency on drug-related matters, this call concerns UNODC most of all.

Furthermore, both the 2016 UNGASS Outcome Document and the 2019 Ministerial Declaration – alongside the UN System Common Position on drugs – commit the international community to ensure that drug policies are aligned with human rights obligations. As explained by the INCB on the occasion of the 2020 International Human Rights Day, ‘Human rights are inherent and inalienable. The world drug problem cannot be lawfully addressed without ensuring the protection of human rights’. The recent intersessional meeting of the Commission on Narcotic Drugs showcased the growing centrality of human rights at the Commission, as well as the increasing presence of human rights bodies and experts in Vienna.

 

Taking into consideration the theme of this year’s International Human Rights Day, we urge you once again to mark this occasion with a strong statement, calling on states to reform drug laws, policies and practices in order to align them with the Universal Declaration of Human Rights. To be credible, such a statement should call on Member States to:

  • Abolish the death penalty in all circumstances. Imposing capital punishment for drug offences has been found to be contrary to international human rights law by the Human Rights Committee, and the Human Rights Council.
  • Put an immediate end to extrajudicial killings committed in the name of drug control, as has been repeatedly called for by the Human Rights Council and UN human rights experts.
  • Acknowledge the disproportionate impact of drug laws and drug control on people marginalised on the basis of their gender, race, ethnicity, and socio-economic status.
  • Promote the end of all criminalisation and punishment for drug use and related activities, as called for by the UN System Common Positions on drugs and on incarceration, OHCHR, UNAIDS, and UN human rights bodies
  • Permanently close compulsory drug detention centres, including those that masquerade as ‘rehabilitation’, and implement voluntary, evidence-informed, and rights-based health and social services, as recently called for by sixteen UN agencies, including UNODC.
  • Stress the urgent need to provide accessible, affordable, and adequately funded harm reduction services– including by well-funded peer-led services –, to fulfil the right to health and the right to life of people who use drugs. This is also central to UNODC’s core role as lead UNAIDS co-sponsor regarding prisons and HIV amongst people who use drugs.
  • Take immediate measures to address prison overcrowding, as already recommended by your own agency, the UN Common Position on incarceration and the UN High Commissioner for Human Rights in the wake of the COVID-19 pandemic, in line with the basic principle that prisons should only be used as a last resort in all circumstances.
  • Ensure that people who use drugs are not subject to arbitrary detention, torture, or ill-treatment – whether in state custody or in public or private drug services.
  • Make sure that drug policies incorporate a gender-sensitive perspective, by tailoring drug services to the specific needs of women, and by ensuring that criminal laws take into account the circumstances of women involved in drug offences, as most of them come from backgrounds of poverty, marginalisation, and oppression.

As the lead UN agency in drug-related matters, UNODC has the responsibility to promote drug policies that respect, protect, and fulfil human rights, including where appropriate to clearly speak out for their reform, in line with the commitments made in the UN System Common Position on drugs.

 

In that regard, we also call on you to use your leadership at UNODC to place human rights at the centre of all dimensions of the agency’s work. This should include not only providing technical guidance to member states, but also:

  • Ensuring that UNODC’s operations do not contribute to, fund or facilitate the implementation of policies in contravention of international human rights laws and standards
  • Mainstreaming reporting on the human rights consequences of drug policies, including by remedying the current absence of human rights in the World Drug Report;
  • Stepping up UNODC’s involvement in human rights cases that require urgent action, in close cooperation with civil society and with other UN entities, including where appropriate through public statements and diplomatic interventions;
  • Working as the lead of the Task Team responsible for the implementation of the UN System Common Position on drugs to update the Task Team’s excellent 2019 report as a key contribution to the 2024 mid-term review of the 2019 Ministerial Declaration.

We look forward to your response, and to discuss these concerns and recommendations with you.

 

Yours sincerely,

Ann Fordham
Executive Director
International Drug Policy Consortium

INHSU 2022 Day 1 – Key Reflections

 

We are excited to be attending the INHSU 2022 conference in Glasgow, and want to share some key reflections and images from day 1 (October 18th) as shared by Graham Shaw and Roberto Perez.

At the opening, the Scottish Government’s Minister for Public Health, Women’s Health and Sport, Maree Todd, stated that Scotland was close to halving viral hepatitis C (HCV) prevalence and by as much as 60-70% in some parts of the country. However, she also noted that HCV incidence remains high.

Jason Wallace of the Scottish Drugs Forum (SDF), speaking on behalf of the community of people with lived and living experience, outlined the main points from the statement developed by the community forum the previous day. Of particular note was that research must be controlled by the community, including the early involvement of the community in developing all aspects of a research proposal, as well as ownership of research data. He also stressed that poly drug use is the norm, not the exception. The community also demands a defined role of volunteers as well as to be paid equally for being employed in research work, as well as a clear pathway for peer workers to progress in drug-related programmes, together with proper supervision and support within such organisations.

In Andrew McAuley’s presentation, he spoke of the increasing global trend in drug-related deaths (DRD) which have roughly doubled over the past 30 years and exponentially increased since 2014 and that this trend has further climbed since the COVID-19 pandemic, with the USA and Scotland the stand-out leaders in the rate of DRD. Medically Assisted Therapy (MAT), also known as Opioid Agonist Therapy (OAT), Take-Home Naloxone (THN) were notable responses to opioid-related prevention of deaths and Direct Acting Antivirals (DAA) for the treatment of HCV. Drug Consumption Rooms (DCRs) and Drug Checking Services (DCS) are also key to the prevention of DRD but that there are gaps in evidence.

Niamh Eastwood of Release UK outlined the various aspects of how the war on drugs has failed and how non-white people were clearly being targeted by law enforcement agencies who use the war on drugs as an excuse to stop-and-search non-white people around nine times more often than they do with white individuals. However, advocacy continues to push for the decriminalisation of drug use and possession for personal use, including the cost savings arising from decriminalisation. A picture from the presentation is included below.

Impact of the Russian invasion on ART and OAT access by PWID in Ukraine

Jack Stone of the University of Bristol outlined the impact of disruptions to services for people who inject drugs due to the Russian invasion of Ukraine. Modelling shows that short-term closures of interventions could have a substantial impact on the increase in HIV infections even though OAT and ART access continued to increase outside of conflict areas but reduced in the areas invaded by Russia, partly a result of a drop-off of NGO service provision in such Russian-controlled areas of Ukraine. Images from the presentation are included below.

‘What the fresh hell is this?’

Presented by Garth Mullins, the producer of the Crackdown podcast based in the USA. The session discussed the ever developing emergence of new substances promoted through the consequences of prohibitionist policies, as seen originally in the early 20th century in the USA with alcohol. Particular focus was given to ‘benzo-dope’ and how naloxone responses to overdose only impact the ‘dope’ component and not the benzo’s, leaving people with severe memory loss from a few hours to several days. Contributors provided their own ‘benzo-dope’ overdose experiences, including Jason Wallace of the Scottish Drugs Forum who said that Benzos were implicated in an ever increasing number of drug-related deaths. Angela McBride of the South African Network of People who Use Drugs outlined the impact of alcohol and cigarette prohibition in South Africa during COVID-19 lockdowns but that such experience has been easily forgotten. Sione Crawford of Harm Reduction Victoria, Australia as well as Mat from the Canadian Association of People who Use Drugs (CAPUD) all noted the need for a safe supply to reduce overdose events and continued failure to provide a safe supply of substances will allow the black market to prevail and the resultant high levels of drug-related deaths.

HCV care models

Several different examples of HCV care models were presented from South Africa, Iran and Scotland. In all three countries, services were based within the community through building relationships and keeping each step as simple as possible; such an approach helps to reduce the level of stigma and discrimination experienced by people who inject drugs. In Dundee, Scotland, building such relationships helped move from confrontation to cooperation, such as in interactions with a local pharmacy, as well as the inclusion of other health interventions, such as wound care. In Rafsanjan, Iran, a local entrepreneur helped to fund a local response to provide HCV testing and treatment, with the local community identifying an unused bus that was repurposed and used as a mobile HCV unit. The local service was linked with the University of Medical Sciences and this model of micro-elimination of HCV is now being considered for implementation throughout the country. In South Africa, it was noted that advocacy can result in positive change in service provision and SANPUD capacitates fellow networks and organisations to pressure decision-makers for change to allow improved access to HCV testing and treatment services.

Individual choice

The choice of which opioid maintenance approach is appropriate for the individual was discussed within the context of Switzerland and Australia. A relatively wide range of options are available in Switzerland. The process of supporting an individual includes the person’s preferences as to which opioid agonist should be tried, with examples given for various substances available in Zurich and Arud. The future directions beyond medical treatment were also outlined within the context of the changing legislative environment. Key elements of effective OAT were presented together with approaches to the continued use of other substances by an individual.

In Australia, choice is often associated with not being chained to a pharmacy as well as the endemic stigmatisation of people who use drugs. In addition, there are social aspects to using substances and the medicalisation of treatment often negates this component and options also include the continued use of drugs. Also stressed during the discussion was the apparent fear held by prescribes of being held liable if an individual overdoses and the belittling view of people who use drugs held by legislators that results in unreasonable and excessively tight controls being in place for opioid maintenance.

The social sciences perspective of individual choice was reviewed and the key factors that influence individual preferences were outlined. Considerations that ‘professionals’ can make to facilitate choice by the individual were also provided.

Differentiated choice of the best suitable agonist were discussed. The first priority has to be the preference of the person in treatment; subjective experience and side effects are often overlooked and not addressed.

Long acting full agonsists include;

Long acting partial agonist;

Key elements of effective OAT;

On Top Use of other Substances;

“How can professionals enable choice in OPT decision making?”

To the extent possible;

Key factors influencing patient preferences;

Testing and care of viral hepatitis among migrant populations in the EU/EEA

On Tuesday, the ECDC hosted their webinar on testing and care of viral hepatitis among migrant populations in the EU/EEA; aiming to strengthen EU/EAA countries’ capacities and capabilities to prevent and control viral hepatitis among migrant populations.

Chronic HCV/HBV in European migrant populations

Milosz Parczewski [European AIDS Clinical Society – EACS]  presented data on chronic HCV/HBV in European migrant populations. Milosz shared multiple figures on the data such as the one below.

Milosz emphasised the urgent need to collect current data from this target group, including updated vaccination data from the refugee population. He also highlighted the need for more outreach testing programmes as these numbers are still too small.

Novel model of care for testing HBV

Next, Camila Picchio presented a novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain. The model consists of two field visits; firstly, information regarding hepatitis b is provided by a community coordinator before the screening takes place with a blood extraction. During the second visit, the participants are given their blood results, offered their HBV vaccine, and those with past-resolved infection or prior vaccination are offered post-test counselling.

“This  community-based HBV screening program provides an effective model for identifying and providing care to migrant populations at high risk of HBV infection, who may otherwise not engage in care”

Take away messages from the model were;

Testing and management of viral hepatitis for refugees from Ukraine

The final presentation was by Mojca Matičič, MD, PhD. A pre-war data set of the situation in Ukraine was presented, with data showing Ukraine was second largest HIV epidemic in the WHO EU Region, second highest prevalence of HIV/TB coinfection, and the fourth highest TB incidence rate among WHO EU region countries. HBV and HCV infections were identified as key public health issues in Ukraine.

“By October 11 2022, 4,350,995 refugees from Ukraine registered for temporary protection (or similar national protection schemes in Europe)”

Mojca reinforced the need for community healthcare providers to ensure access to services and continuation of vaccination programmes for Ukranian refugees, and highlighted the harm reduction services across Europe for refugees from the Ukraine which are described in the C-EHRN Ukranian snapshot.

Rapid Assessment on Pre-exposure Prohylaxis (PrEP) in EU/EEA Countries

AIDS Action Europe is conducting a rapid assessment on the availability, accessibility, affordability, and acceptability of PrEP in the EU/EEA countries as part of their activities in their core thematic areas of sexual and reproductive health and rights (SRHR), affordability, and addressing legal and policy barriers to HIV services.

 
Based on the information provided from the survey, they are publishing a report on the main findings, and a policy brief with recommendations for the European Union and its Member States to support advocacy efforts, at the national and regional level towards universal access to PrEP. 
 

Please fill in this short survey to the best of your knowledge on the information from the EU/EEA country that you are based in.

 
The survey will be open until 31 August 2022.

 

Production of Long Acting PrEP

ViiV have agreed to enable generic production of long acting PrEP to 90 countries.

ViiV and the Medicines Patent Pool have enabled access to generic formulation of long acting Cabotegravir for PrEP to 90 low- and lower-middle income countries.

This comes as progress in the global HIV response has slowed, and a rise in infections in many countries has been identified.

UNAIDS Deputy Executive a.i. Dr Matthew Kavanagh said;

“We urge all companies developing long-acting HIV medicines to commit to sharing technology through the Medicines Patent Pool, and all governments to act rapidly to secure affordable access to the newest technologies for all who would benefit from them. There must be no repeat by any company of the deadly delays in rolling out HIV products that we saw early on in the AIDS epidemic and that has recently been repeated with COVID-19 vaccines and therapeutics. Sharing technology is essential for stopping pandemics.”

 

Read the full announcement on the UNAIDS site here.

 

New UNAIDS Data on HIV Response During COVID-19

The data from UNAIDS of the global HIV response has shown that progress has faltered and resources have shrunk during the last two years of COVID-19 and other global crises.

As a result, millions of lives are now at risk. Communities that were already at a greater risk of HIV are now even more vulnerable due to an increase of 75 to 95 million people being pushed into poverty.

The data shows that the progress against HIV is slowing, with the smallest drop in new HIV cases being reported in 2020 since 2016.

 

 

The report also shows how UNAIDS responded to the unjust war in the Ukraine, with US$ 250 000 being disbursed to preserve key HIV services.

 

Read the full report here.

Updates from the AIDS 2022 Conference

The AIDS2022 conference is taking place in Montreal, with experts in the field of HIV/AIDS sharing knowledge and experience related to the virus.

Advocation for people who use drugs was present during the conference, with the stigma and judgement faced by people who inject drugs being addressed as barriers to seeking care; it was reinforced that everyone should be able to access affordable, quality care irrespective of their drug use status. Virginia Macdonald of the World Health Organisation strongly recommended the implementation of needle & syringe exchange programs and overdose prevention care.

As well as this, activists demanded stronger action to be taken from the world health organization against Monkeypox, through urgent scaled up and equitable vaccine access. The activists emphasized lifting intellectual property barriers, and the need for a plan for prevention, treatment and care.

Click here for more information on the conference.

NGOs call for implementation of measures to ensure continuity of HIV and opioid dependency treatment for people displaced by the war in Ukraine

On 21 April, NGOs working with and representing the interests of communities of people living with and affected by HIV, tuberculosis, viral hepatitis and drug dependence in Europe addressed a letter to governments in the EU and EU institutions. The organisations report on the great will of various partners to accommodate the needs of people escaping the war but also major obstacles, especially regarding access to opiod agonist therapy. Therefore, the NGOs call on governments in the EU and EU institutions to implement a set of urgent measures:

  1. Facilitate GDPR-proof medical data exchange 
  2. As a good clinical practice, ensure that previous diagnoses are accepted, people are prescribed the same regimens and take-home dosages of OAT as in Ukraine as much as possible 
  3. To promote and follow the recommendations being set in the Standardized Protocol for clinical management and Medical Data-Sharing for people living with HIV among refugees from Ukraine and to collaborate with WHO on the development of a similar protocol for the refugees from the Ukraine who are OAT patients 
  4. Support EU member states with emergency procurement and exchange of medications, as needed, to ensure methadone (tables), buprenorphine, dolutegravir-based antiretroviral therapy, pediatric antiretroviral medications and similar Ukraine-prevalent treatments are made available for continuation in all border and other neighbouring countries 
  5. Establish a pool of translation support for clinicians and Ukrainian refugees and utilise automated translation services to overcome barriers in refugee services and clinical settings 
  6. Support outreach and contacts by HIV and drug treatment experts and NGOs in refugee centres, including the sensitization of staff and urgently identify people in need of uninterrupted daily treatment 
  7. Introduce simplified initiation of essential treatment to all Ukrainians with or without refugee status based on their passport data 
  8. Ensure that monitoring systems and hotlines are available to clinicians and other service providers to immediately solve the health issues affecting Ukrainian refugees.

Download and read the letter here