Human Rights Advocacy for IDU Treatment Access

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• Human Rights Advocacy for IDU Treatment Access
• Karyn Kaplan
• Thai AIDS Treatment Action Group (TTAG)
• IAC 2006

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ARV changed the face of AIDS

• Reduced mortality, incr. QOL
• Record funding and commitment
• Treatment as unprecedented opportunity for
  national responses where care/prevention/impact
  mitigation efforts delivered in comprehensive
  and mutually reinforcing manner (UNGASS progress
  report)
• Universal access and equity 80 coverage

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but not for IDU/DU

• Minimization of importance and even existence of
  IDU
• approaches that improve quality of life under
  attack (harm reduction denialists)
• Irony of exclusion HIV reservoir (IDU, Burma)
  
• -- IDU have sexual partners (!!) (so do or
  dont heroin addicts have sex, b/c IEC )
• -- Burma source of 4/5 chinas hiv/aids cases,
  most of worlds new strains

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Human Rights Conundrum

• Equal in dignity and rights
• Response not reflect this
• Harm reduction v. HIV
• Obligation to eradicate illegal drug use NOT
  balanced against other rights (health care, etc.)
• Political and moral opposition to evidence-based
  approaches, UN failure to counter
• Punitive approaches undermine good public health
  incr. HIV, MDRTB in jail
• Positive steps to respect, protect, fulfill rights

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Unpopular Issues Require Extra Attention and
Advocacy

• No money/interest/capacity in health
• No money/interest/capacity in HIV/AIDS
• No money/interest/capacity in drug issues
• Political mileage from tough on drugs stance
  money/intl. alliances for national security
  (drugs, not hiv/aids)
• Left with unchecked abuses b/c of the moral/legal
  panic leading to violence and abuse
• Discrimination family, community (AIDS too),
  health care setting, legal/policy

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Comprehensive Approach includes

• Low threshold approaches
• Quality evaluated drug treatment
• Substitution therapy/options
• User-friendly services designed to maintain not
  punish
• Medical criteria for health care ONLY
• Review adherence assessments (Fear-based
  denial doctor look bad, not want to treat/
  waste budget, dont deserve, spread infection
  (excuse of assumed non-adherence)
• Policy and legal reform
• No forced, punitive services
• Targeted services (women, trans, youth)
• Decriminalization (ex. Arrest/intimidation at
  places of care)
• Empowerment/involvement of users

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Urgent issues

• Knowledge Attitudes Education and Advocacy
  (govt/media/public/stakeholders)
• Environment and Programs Human rights and
  comprehensive harm reduction
• Also
• Better ARV regimens with less hepatotoxicity
• Generic Hep C tx
• Trials to promote Hep C tx access
• Community-driven research
• Better TB/HIV services and tx
• Human Rights documentation training, education
  and advocacy

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Ways forward

• support for user organizing and advocacy
• UN knowledge and capacity to advocate
• government positive steps to address user rights
• NGO harm reduction education and partnerships
• donor governments and GFATM prioritization of
  rights-based approaches implemented by affected
  communities
• vocal admonishment/documentation of worst
  practices

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HUMAN RIGHTS NOW MORE THAN EVER!