This month, the World Health Organisation (WHO) – the UN agency that coordinates international health responses – launched a new set of guidelines for HIV prevention, diagnosis, treatment and care for key populations. The new document is the culmination of months of consultation and review, and pulls together existing guidance for five groups: men who have sex with men, people in prisons and other closed settings, sex workers, transgender people, and people who inject drugs. These key populations are the most-at-risk of HIV, yet the least likely to access services – a fact that "threatens global progress on the HIV response" according to WHO. By consolidating previous guidance, the document is able to highlight common barriers and needs – including recommendations for legal reforms to support service delivery.
The guidance puts forward a "comprehensive" package of interventions that governments should provide:
a) Essential health sector interventions:
- Comprehensive condom and lubricant programming
- Harm reduction interventions for substance use, in particular needle and syringe programmes and opioid substitution therapy
- Behavioural interventions
- HIV testing and counselling
- HIV treatment and care
- Prevention and management of co-infections and other comorbidities, including viral hepatitis, TB and mental health conditions
- Sexual and reproductive health interventions
- Supportive legislation, policy and financial commitment, including decriminalization of behaviours of key populations
- Addressing stigma and discrimination
- Community empowerment
- Addressing violence against people from key populations
As well as reaffirming the previous WHO, UNODC and UNAIDS guidance on harm reduction (and particularly the importance of needle and syringe programmes and opioid substitution therapy), the new WHO Guidance goes further to explicitly recommend, for the first time, that people who use drugs should have access to naloxone – the WHO Essential Medicine designed to reverse opioid overdose. This endorsement is a major step forward by WHO, and hundreds of thousands of lives will be saved if this recommendation is followed by governments.
Crucially, the WHO Guidance also recommends that "Laws, policies and practices should be reviewed and, where necessary, revised by policymakers and government leaders, with meaningful engagement of stakeholders from key population groups". Within this so-called 'critical enabler' (see graphic) is an explicit calls for the decriminalisation of drug use in order to reduce incarceration – as well as calls to reform laws and policies that block harm reduction services, and the end of compulsory treatment for people who use drugs. The Guidance also cites the experience of Portugal in terms of decriminalisation – citing successes such as the increase in people accessing treatment, the fall in HIV cases among people who use drugs (from 907 cases in 2000 to 267 in 2008), reductions in drug use and less overcrowding within the criminal justice system. According to the press release accompanying the Guidance, "Bold policies can deliver bold results".
The new WHO Guidance therefore represents the latest high-level, evidence-based call for the end of criminal sanctions for people who use drugs – and one of the most prominent calls from within the United Nations itself. The Guidance will be launched and disseminated at the International AIDS Conference 2014 in Melbourne, calling on governments to strengthen their HIV responses so that all key populations are included.
Jamie Bridge is the Senior Policy and Operations Manager for the International Drug Policy Consortium (IDPC). Prior to joining IDPC, Jamie was the Technical Officer for Scientific Communications at the Global Fund to Fight AIDS, Tuberculosis and Malaria in Geneva, where he was an integral part of the Fund's harm reduction working group. From 2006-2009, Jamie was the Programme and Communications Officer at Harm Reduction International. He's also the Chair of the UK National Needle Exchange Forum, and an active member of the UK Harm Reduction Alliance.