Legal and Policy Concerns related to IDU harm reduction in SAARC
countries'
_
UNODC, through its regional project RAS/H13 "Prevention of
transmission of HIV among drug users in SAARC countries" has
commissioned a report entitled the "Legal and Policy Concerns
Related to IDU Harm Reduction in SAARC Countries". The report
examines the interface between law, policy and IDU harm reduction
practices in Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan
and Sri Lanka. This report was released at Hotel ITC Sonar Bangla,
JBS Haldane Avenue, Kolkata, at 6:30pm on 10 April 2007.

• Over the last two decades, South Asia has witnessed a significant
increase in HIV prevalence among drug using populations,
particularly those who inject drugs. To stem the twin epidemics of
HIV and drug injecting, several countries in the region have
introduced needlesyringe and oral substitution programmes for
injecting drug users (IDUs). Besides reducing HIV transmission,
these interventions bring IDUs in contact with drug treatment and
recovery with the aim of eventually overcoming dependence.

• The positive outcomes of such `harm reduction' measures have been
endorsed by the World Health Organisation (WHO) and the Joint United
Nations Programme on HIV i.e. UNAIDS, of which the UNODC is a co-
sponsor. However, these interventions are sometimes challenged as
not falling within the bounds of narcotics and/or penal laws.

• South Asian governments can exercise several legal and policy
options to initiate and scale up IDU harm reduction to reduce
individual risk and promote public health.

These are among the findings of the report, titled "Legal and Policy
concerns related to IDU Harm Reduction in SAARC Countries", released
today in Kolkata, India by the Honourable Shri Oscar Fernandes,
Convenor of the Parliamentary Forum on AIDS, in collaboration with
the United Nations Office on Drugs and Crime (UNODC), the Ministry
of Social Justice and Empowerment, India (MSJE) and the National
AIDS Control Organization, India (NACO).

Commissioned by UNODC to the Lawyers Collective HIV/AIDS Unit, a non-
government organisation (NGO) working on Public Health, HIV and Law
in India, the report examines the interface between law, policy and
IDU harm reduction practices in Bangladesh, Bhutan, India, Maldives,
Nepal, Pakistan and Sri Lanka. It also suggests potential measures
to harmonize IDU harm reduction with law.

The report relies on primary and secondary sources of information.
It combines a review of international and regional drug conventions
and country-specific laws, policies and programmes on drug use and
HIV with site visits and stakeholder interviews including with
health and narcotics law officials, NGOs, lawyers and
representatives from concerned ministries, UN and international
agencies. Preliminary findings from the report were peer-reviewed
individually by country experts and jointly at a Regional Tripartite
Review Meeting organized by UNODC from 30-31 March 2006 at Colombo,
Sri Lanka.

Across South Asia, narcotics laws proscribe inter alia possession,
use/consumption and supply of prohibited drugs. Notwithstanding
stringent penalties, no country has seen a diminution in drug use.

On the contrary, drug consumption is reportedly on the rise. In some
countries, legislative and enforcement action have coincided with a
shift towards riskier use, particularly injecting pharmaceuticals
with the attendant threat of HIV and blood borne infections. The
report cites studies that attribute the phenomenon of injecting
pharmaceuticals to non-availability of heroin.

According to the report, interventions to reduce risk of HIV
transmission among drug injecting populations through provision of
sterile needle and syringes, Methadone and/or Buprenorphine oral
substitution, treatment for drug dependence, outreach and peer
support, drug safety education and condoms have been initiated by
NGOs in Bangladesh, India, Nepal and Pakistan. Though critical to
prevent HIV among IDUs and their sexual partners, these programmes
have not been implemented at scale and have found only partial
acceptance in national drug policies.

The report documents statutory hurdles to IDU harm reduction in all
countries. Provision of sterile syringes to IDUs is open to
prosecution under penal and/or narcotics law as abetment of drug
consumption. Though punishable, most country laws allow consumption
of prohibited drugs strictly for medical reasons. Oral substitution
is, however, not considered treatment as in most jurisdictions since
treatment is often seen as `giving up drugs'. The report finds
varying legal controls on Methadone and Buprenorphine that impact
affect availability and access. Furthermore, absence of protocols
for prescription and supervision has hindered policy on oral
Methadone and Buprenorphine therapy. Across South Asia, treatment
for drug dependence is offered through complex penal and civil
arrangements leaving a vast majority of drug users without medical
and/or social assistance.

Information on safe injecting and drug use is scant, and, if
offered, would be in contravention of law.

Though available, condoms are not supplied in prisons in any country
on account of anti-sodomy laws. The report outlines types of legal
interventions that national governments may adopt to bring IDU harm
reduction in conformity with law. One such way is to read harm
reduction within the rubric of medical treatment. Another option is
to offer immunity to heath and harm reduction staff under the good
faith exception, ordinarily available to the prosecution. Protecting
harm reduction interventionists from penal and civil liability by an
overriding `non obstante' clause is yet another strategy. The report
recognizes that the choice to make amendments vests with individual
countries given their particular legal regimes and interpretation of
laws by judicial bodies.

The report could be down loaded from the following url

http://www.unodc.org/pdf/india/reports/h13_report_0407/h13_report_040
7.pdf