Next week in New York, 190 odd United Nations member States will descend on New York City and sign a new political declaration on HIV/AIDS for the international community. Previous blogs will have provided you background information to this story, and more detail about the current political declaration, which was originally created in 2001, and added to in 2006. This year, the expansion or rather the upscaling, of the health, social and financial commitments from the international community on HIV/AIDS, is in a fragile way. In a global environment where there are serious financial constraints, the world is apparently suffering from (what has been appallingly termed) as HIV ‘Fatigue’, a quiet irritation emerging at civil societys insistence that, to revert the trajectory of the virus we need more money, more political will, a virus with its prevention, treatment, care and support grounded in human rights and accessible to all who need it..
It has been 30 years this year since the epidemic began and in many instances, we have a very good understanding of what works in terms of reducing the impact of HIV. For the drug using community, we certainly know harm reduction works, that needle exchanges and the distribution of sterile syringes for people who use drugs are one of THE most incredibly effective ways to prevent HIV transmission we have, with countries where NEPs have been firmly entrenched since the beginning of the epidemic (Australia, Netherlands, UK) showing rates of infection in the injecting community at 0.5%. This is in stark contrast to countries like Russia where, with virtually no access to needle exchanges, infection rates run at up to 60/70% (80% of those newly infected with HIV are injecting drug users). For further details on the situation in Russia, click here http://ipsnews.net/news.asp?idnews=51245. We also know how essential OST is (Opiate Substitution Therapy such as methadone / buprenorphine) is in the lives of people opiate dependent, and how this impacts significantly on their ability to protect themselves from HIV. And we know that by putting people in prison for using drugs, you can increase the HIV risk factors they are exposed to, whether that is through the dire conditions, abuses and drug use found in many prisons across the world, or through the criminalisation, stigmatisation, and marginalisation encountered by ex-inmates on their release. However, these 3 areas, harm reduction, OST and decriminalisation and consistently fought over in international declarations and most of the time, sadly, the more conservative (and often downright dangerous) views dominate. In the UN, resolutions are made by consensus – that is full consensus –with every single member state having to agree to every word, every line, every commitment. In all honesty it is quite incredible that anything gets agreed at all, and it say a lot for the incredible backroom negotiations that occur in these diplomatic limbo-lands with politicians often out of touch with reality and operating in a very different world.
The involvement of people who use drugs in the decisions that impact on their lives is something that as INPUD members, we have talked up and advocated for for many years. Since INPUD began (in its official capacity) around 4 years ago, members have worked really hard to find ways to ensure the voices of people who use drugs, particularly those who inject and those with HIV, are heard and that room is made to ‘meaningfully involve’ our community in the global political arena. As I sit here with less than 24 hours to go before I catch a plane to New York for the weeks signing of the HIV/AIDS declaration, I can reflect on a conversation a colleague and I had last night about this very thing. Our discussion, true to the subject itself of whether people who use drugs (PUDs) are really being heard at these events, oscillated between outright irritation at our issues rarely being discussed let alone embraced, to a sigh of amazement reflecting at ‘junkies’ in central roles actually at the United Nations! Currently we have a handful of some really talented senior drug user activists ready to arrive in New York any day. For example, Annie Madden chief exec from AIVL, has for the 2nd time come on the Australian Government’s delegation, a very coveted role, representing the PUD community and she is also our rep on the HIV and Law Technical Working Group. Annie is there to try and advise the Australian government to not back down on certain commitments as they pertain to PUDs, to stay firm on particular wording and terminology, and to be kept knowledgeable about PUD issues. Yes, there are junkies in the United Nations and a very good job they are doing too!
Trying to get a Hearing
As previous blogs will show, I was put forward by INPUD to be on the Civil Society Task Force, a group of 12 individuals that represent various key populations and stakeholders in civil society, affected by HIV (eg, PUDs, sex workers, faith based rep, women, youth, trade unions, private sector, etc). Click here to see the role of the Task Force. In a nutshell we had to formulate the way we wanted to see the recent Civil Society Hearings on HIV/AIDS in new York to be structured, who should speak, and on what, and in what format and the same for the civil society components of the High Level Meetings next week. Divided into 2 lots of work (the Hearings in April and the HLM in June) our first role was to put together a one day hearing for civil society to discuss what is considered by the TF to be the most important issues of the day regarding HIV. Over 400 civil society representatives came together at the United Nations in New York for this one-day Hearing on HIV and Member States got an opportunity to engage with people living with HIV and civil society representatives who are provoking real change in the response. The aim was to create a format where civil society participants could share some of the challenges, achievements and aspirations in responding to HIV, and as a person from the PUD community, it was important that the massive problems my peers across the world face in terms of HIV and risk, had an airing at the Hearing. The outcome of the debates will form the basis of a summary report which will be issued by the President of the General Assembly which will be instrumental in providing civil society input into the negotiations on the declaration of commitment from Member States at the High Level Meeting on HIV, the one which is taking place next week from 8-10 June. Still following?
In terms of the Hearings, which have now since passed (April), I can talk now more about how I felt about the experience. For a full report of the hearings, see part 1 and part 2 of the video diaries in the right hand column of this blog. Regarding the process to develop the event I had actually found the process quite overwhelming, and for weeks I struggled with why I felt I was hampered from wholly contributing. At times I felt like a broken record mentioning PUDs and the pressing issues that affect us, when together with everyone else I was repeatedly reminded on just how many pressing issues there are when it comes to HIV and people; the millions of AIDS orphans left to fend for themselves, the mass rape of women as a tool of war, HIV and womens rights to sexual reproductive health, the crucial importance of opening up HIV dialogues with religious leaders and agencies so they can communicate the right messages to their followers, the plight of transgender people who are criminalised and brutalised by ignorance and exposed to a life where simply being who you are means facing huge personal risk, gay men in certain African and Caribbean countries who are murdered or imprisoned for being gay….It was extremely moving and a difficult process to decide just what issues should come to the fore over one day of these hearings. We were told the outcome document could indeed influence the final processes which made it all the more important that we got it right. But with all the issues of vying to be heard it is almost certain that some of our constituencies would lose out.
I think I felt repeatedly hamstrung by the repeated inference that we couldn’t discuss drug policy. Tragically, the criminalisation of our community is just too controversial an issue and risked upsetting too many member states. Behind so many of the environments conducive to HIV transmission is criminalisation. The idea that junkies are criminals and can’t be trusted runs extremely deep. The huge societal stigma of being a PUD drives people away from normal health services – indeed our issues rapidly worsen because even where we can receive treatment (whether for HIV or drug use) we often find it unpleasant, brutal and/or discriminatory, so we avoid it, rarely resurfacing or engaging again until we are very sick. We can speak of stigma and HIV, but for us the cruellest blow comes from the stigma of being a junky with HIV. So we need to talk about criminalisation. We need to talk about the barriers to access, and the conflicts with public health policy, such as AIDS policies that will permit people to access needle exchanges but the criminal policies that haven’t been tackled only to arrest them on the way out the door.
UN negotiations are an extremely delicate process so I’m told, and countries that are supportive of more progressive approaches (Christ its mostly all evidenced based for godsake!) and always hand wringing in the background, worried they might upset the tetchy conservatives who will storm out and not play ball at all. Meanwhile, people are dying, people are becoming infected with HIV, are being denied treatment, are being imprisoned for having a drug problem. I sincerely hope that one day in the future we will look back at the dark old days where we had it all wrong and used to lock people with drug problems up in prison! Imagine that!
As it was, we did get some representation in the Hearings, a terrific couple of women from Eastern Europe spoke for several minutes each, not nearly enough space given to such important issues. Everyone seemed to think the day went well except for the drug community who thought we didn’t get nearly enough time or focus on our issues in relation to the amount of problem. I think people who represented children were pretty upset about the lack of focus on their subject…then there was some upset from the disability sector at again being invisible…Oh dear, there must be a better way to do these things! Everyone affected wants to be heard, and everyone affected should have that right, but who is listening? In a way though, that is not always the primary focus– sometimes it is the empowering process of speaking, of being heard, of meeting other people and networking with civil society etc, that is always an amazing journey and to witness a range of people speaking about such important issues that affect them, is incredibly interesting and important. It is a highly professional environment, and people have to be able to speak clearly to be heard in a room like the GA hall (see previous blogs). Ideally they should carry the points across for their entire constituency (eg if they were speaking on women, HIV and reproductive rights, they need to be ‘on message’ and reflect the issues that the movement has decided are most pertinent). And so it was that many speakers got through because people had heard them speak before. Bearing in mind that the task Force was made up of people very experienced in their field, amongst all of us we knew a large amount of the 250 odd people who had applied to speak. It has only been fairly recently that our PUD community has known we were able to really stand up and speak at these events so hope to see many more of us apply for such things in future.
INPUD and an International Position on HIV
It was clear that the Task Force was task focused, and as a representative I needed to have been able to bring with me, as the women’s rep did, the collective voices of hundreds/thousands of our members/constituents. INPUD needs a working group on HIV, that is able to pull together the issues of importance. The difficulty is, we KNOW what WORKS to prevent HIV transmission to PUDs. So we have to focus on what is preventing effective prevention. Yet it seems there is not much appetite to discuss this because the ball keeps bouncing back into the need for law reform. Could we not then focus on the good news? What is really working well to keep HIV down in order to encourage governments that way? Perhaps. However, and again this is the difficulty, how people respond to drugs is not based on good sense, or evidence, its based on emotion. And good news about what is working in some countries will not do anything to change the minds of the zealots who are the corrupt, neo conservative, fundamentally religious, or prefer being ignorant. I don’t know what the answer is. But I do know, that the UN has to try and be braver. That they must allow us at the UN to discuss how certain laws and policies – including criminalisation – impacts on HIV. And next week, with wonderful synchronicity I’m not sure if it’s on purpose or not, but the Global Commission on Drug Policy will sign off a report which will be delivered to Ban ki Moon the UN Sec Gen. Instead of punishing users who the report says “do no harm to others,” the commission argues that governments should end criminalization of drug use, experiment with legal models that would undermine organized crime syndicates and offer health and treatment services for drug-users in need. The 19-member commission includes former U.N. Secretary-General Kofi Annan and former U.S. official George P. Schultz, who held cabinet posts under U.S. Presidents Ronald Reagan and Richard Nixon. Others include former U.S. Federal Reserve chairman Paul Volcker, former presidents of Mexico, Brazil and Colombia, writers Carlos Fuentes and Mario Vargas Llosa, U.K. business mogul Richard Branson and the current prime minister of Greece which all argue that the decades-old “global war on drugs has failed, with devastating consequences for individuals and societies around the world.” The 24-page paper will be released Thursday, in New York on the last day of the political declaration signing off in New York.
Today in 2011, as a new HIV declaration gets drawn up, just where are governments positioning themselves when it comes to people who inject drugs and HIV? What will the new HIV Declaration have in store for us? I’ll keep you posted on the next part which will be around the actual political negotiations and what it means for our community…
- The Civil Society Hearings on HIV/AIDS at the United Nations April 2011 – Part 1 (inpud.wordpress.com)
- IP negotiations at the UN High-Level Meeting on HIV/AIDS (donttradeourlivesaway.wordpress.com)
- Laurie Garrett: AIDS at 30: The Real Story (huffingtonpost.com)
- UN urges more funds for early HIV treatment (seattletimes.nwsource.com)
- Former Presidents Denounce Drug War As Failure (stephenleahy.net)
- ‘More money needed’ for HIV cure (bbc.co.uk)
- Why Young People Want to Be Involved in the Global HIV Response (iywg.wordpress.com)
- INPUD News on the Move (inpud.wordpress.com)