The Battle for Harm Reduction

Wednesday, January 21, 2009

The issue of harm reduction continues to be controversial during the negotiations in Vienna for the Political Declaration that has to be adopted in March 2009 at the High Level Segment of the Commission on Narcotic Drugs (CND). There is severe pressure on delegates to drop their insistence on incorporating the language and principles of harm reduction in the political declaration, or to accept some watered down version.

The International Harm Reduction Association (IHRA) prepared a useful overview of UN endorsement of harm reduction measures; the legality of harm reduction services under the Drug Conventions; the obligation in human rights law to ensure access to harm reduction services and the global state of harm reduction, listing 82 countries and territories worldwide that presently support or tolerate harm reduction.

The overwiew, International Support for Harm Reduction, demonstrates beyond doubt that it is those member states resisting this language that are out of step with the global evidence base, successive reports from the competent multilateral agencies, and the policy positions of other UN bodies (including ECOSOC and the General Assembly, of which the CND is a subsidiary body).

There is strong and consistent evidence that harm reduction interventions which include access to sterile injecting equipment, opioid substitution therapies, and community-based outreach, are the most effective and cost effective means of reducing HIV-related risk behaviours and therefore preventing transmission of HIV, hepatitis C and other blood borne viruses among people who inject drugs.

Allowing the CND to pass language that pretends that this is not the case will, in the view of TNIs and the IDPCs opinion, leave it out of step with the rest of the UN system, undermining any concept of evidence-based policy, or system-wide coherence in tackling global drug problems.

Last month, in December 2008, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment – Professor Manfred Nowak – and the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – Mr Anand Grover – have written a letter to the Chairperson of the UN Commission on Narcotic Drugs (CND) to “offer guidance” regarding human rights issues that have arisen during the UN’s ten-year drug strategy review.

On harm reduction they wrote: “Harm reduction is an essential HIV prevention measure endorsed by the General Assembly in the Declaration of Commitment on AIDS in 2001 and in the Political Declaration on AIDS in 2006. We have reviewed the Chairperson’s draft annex, dated 4 November 2008. Given the General Assembly’s endorsement and the global HIV pandemic, we are, however, concerned that it fails to include any reference to harm reduction services. In order for member states to live up to their human rights obligations, and to ensure UN system-wide coherence, we believe that the annex should be amended to include specific language supporting comprehensive harm reduction services.”

The Special Rapporteurs are independent experts appointed by the United Nations Human Rights Council to address specific human rights themes or contexts. Their letter was circulated to the CND delegations in Vienna to address issues such as (1) harm reduction; (2) ensuring protection against torture in law enforcement measures - extradition and the principles of non-refoulement; (3) ensuring access to essential medicines for pain relief; and (4) access to treatment consistent with human rights. The letter was intended to ensure “consistency with international commitments and obligations relating to human rights” in a new political declaration to be adopted at a High Level Meeting taking place in Vienna March 2009.