UNAIDS: We are failing people who use drugs

28 March 2019

UNAIDS reiterates its message around health and human rights for people who use drugs in a new report.

Image of the words harm reduction saves lives on back of hoodie

The number of new HIV infections among people who use drugs is rising, bucking the worldwide trend that has otherwise seen HIV rates fall. Between 2011 and 2017, global HIV infections across all ages fell by 22%. During the same period, HIV incidence among people who injected drugs rose from 1.2% to 1.4%.

But this trend can be reversed, say UNAIDS in a new report, with the decriminalisation of drug use and full provision of comprehensive harm reduction services. These include needle and syringe exchange programmes (NSP), opioid substitution therapy (OST), overdose prevention with naloxone, sexual health support, and prevention, testing and treatment for HIV, tuberculosis, and hepatitis B and C.

Lifetime drug use is relatively prevalent globally, with one in 18 adults reporting using drugs in their lifetime. Despite this, people who use drugs are subject to stigma, discrimination, violence and poor health outcomes. Outside of sub-Saharan Africa, around a quarter of new HIV infections are among people who inject drugs and their sexual networks.

Rates of hepatitis C, hepatitis B and tuberculosis are also high among this group. Over half (51.9%) of people who injected drugs in 2016 had hepatitis C, and an estimated 7% of people living with HIV who inject drugs have hepatitis B.

Yet there remains a global discrepancy on how to manage problem drug use, with some countries opting for a punitive approach, including criminalisation and/or the death penalty for drug-related offences. UN Member States, on the other hand, have repeatedly agreed to a public health and human rights approach that focuses on reducing harm for drug user populations. People who use drugs need support, not incarceration.

But too few countries have sufficiently rolled-out these services despite a large body of evidence that says that harm reduction improves the health of people who use drugs, that it’s safe, and that it’s cost-effective. People who use drugs and access harm reduction services are more likely to take an HIV test, access and adhere to antiretroviral treatment – protecting not only themselves but also their networks.

Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs reiterates messages that UNAIDS made in a previous landmark HIV and drugs report in 2016. This report, Do no harm: health, human rights and people who use drugs, revealed how the world was failing to protect the health and human rights of people who use drugs and provided a roadmap for countries to follow. Sadly, three years on, few improvements have been made.

UNAIDS now recommends the full implementation of harm reduction services; access to health services for people who use drugs; the securing of their human rights and dignity to end stigma; and to employ a people-centred approach to services delivery.

“The time is overdue to revisit and refocus the global approach to drug policy, putting public health and human rights at the centre,” said UNAIDS Executive Director Michel Sidibé. “I’ve said it before and I will say it again: if we are to end AIDS by 2030, we can’t leave anyone behind. And that includes people who use drugs.”


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Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health