World Hepatitis Summit: No Elimination Without Decriminalization!

ENDORSE THE DECLARATION

Declaration of the Hepatitis Community: no elimination without decriminalization!

We, members and representatives of the viral hepatitis community - a community that includes people living with viral hepatitis, doctors, nurses, social workers, researchers, public health experts, and people who use drugs - are concerned over the growing gap between the enormous impact of hepatitis B and hepatitis C over people who use drugs and their almost non-existent access to prevention, diagnosis and treatment services around the world.

Sharing unsterile drug injecting equipment puts people at high risk of hepatitis B and hepatitis C infections. Globally it is estimated that among the 15.6 million people who currently inject drugs 52% are hepatitis C antibody positive, and 9% are living with chronic hepatitis B infection [1] ; From a public health and human rights perspective, improving access to prevention and treatment for people who use drugs is crucial to reducing hepatitis C incidence and eliminating the epidemic, as sharing of needles, syringes and other injecting equipment is estimated to account for 23% of new infections [2].

Ensuring access to interventions such as low-threshold needle and syringe programmes, opioid substitution therapy, hepatitis C treatment and other harm reduction interventions are essential to reduce hepatitis C incidence and prevalence among people who inject drugs [3], [4], and these interventions are cost-effective [5], [6]. In 2016, the Member States of the World Health Organization (WHO) adopted the first ever Global Health Sector Strategy (GHSS) on viral hepatitis [7]. It identified harm reduction as one of five core interventions needed to reach the goal of viral hepatitis elimination by 2030.

Despite the evidence and WHO recommendations, comprehensive harm reduction services are inaccessible for most people who use drugs worldwide. In 2017, among the 179 countries and territories where injecting drug use has been reported, just 86 (48%) have implemented opioid substitution therapy and 93 (52%) have needle and syringe programmes [8]. Furthermore, the regional and national coverage varies substantially and is most often below WHO indicators, with less than 1% of people who inject drugs living in countries with high coverage of both services8. Even where services do exist, people who use drugs face more difficulties in accessing hepatitis C prevention and treatment due to poor access to health services, their exclusion through treatment criteria, threats of violence and abuse when disclosing status as drug users, and universal stigmatization. As a result, the hepatitis C epidemic continues to grow among people who use drugs [9].

This lack of access to hepatitis care for people who use drugs is deeply rooted in and driven by our laws and policies which criminalize drug use, drug possession and, ultimately, people who use drugs themselves [10], [11]. Punitive drug law enforcement is a direct barrier to harm reduction services in many ways:

• The prohibition of drug paraphernalia possession impedes harm reduction service delivery and uptake;
• Many national laws impose severe and disproportionate custodial sentences for minor, non-violent drug offenses (such as drug use, possession and low-level supply);
• People who use drugs are frequently incarcerated or extra-judicially detained, often leading to interruption of medical treatments, without access to prevention and other harm reduction services, and at heightened risk of hepatitis infection;
• Policies criminalizing drug use fuel stereotypes and negative assumptions of people who use drugs, ultimately reinforcing stigmatization and discrimination.
  Even in countries that have integrated harm reduction into domestic public health policies, criminalization remains a glass ceiling – as the fear of arrest continues to drive people away from prevention and care services.

A number of countries, such as Portugal and the Czech Republic, decriminalized minor drug offenses years ago with significant public health benefits [12], [13]. These policy changes have proven very successful and have led to an increase of access to harm reduction and health services by people who use drugs – contributing to decreased new HIV infections, and reduced harms associated with drug use and drug dependence [14]. While our laws and policies that prohibit drugs are portrayed and defended as necessary to preserve public health and safety, the evidence overwhelmingly demonstrates that they have driven unnecessary and disproportionate human rights violations including violence, disease, discrimination, and the undermining of people’s right to health. Growing recognition of the need for evidence-based drug policy reform has led several world leaders, public health experts, the WHO and other United Nations Agencies to recommend the decriminalization of minor, non-violent drug offenses, and a strengthening of health-oriented alternatives to criminal sanctions [15], [16], [17], [18], [19], [20], [21], [22].

We, the viral hepatitis community, whole-heartedly support Member States’ commitment to the goal of eliminating viral hepatitis by 2030. In order to achieve that goal, we call on world political leaders to remove all barriers to the uptake of the full range of prevention services by people who use drugs by reforming laws, law enforcement procedures and discrimination that hinder access, including the criminalization of minor, non-violent drug offences and to adopt an approach based overwhelmingly on public health promotion, respect for human rights and evidence.

Signatories :

Acción Semilla – Bolivia
AIDES – France
AIDS Foundation East West (FEW) – Netherlands
Aidsfonds – International
Alliance for Public Health – Ukraine
APDES – Portugal
Apoyo Positivo – Spain
Asia Catalyst – Asia
Asian Network of People who Use Drugs (ANPUD) - Thailand
Asociacion Costarricense de Estudios e Intervencion en Drogas (ACEID) – Costa Rica
Association for Humane Drug Policies – Norway
Association Guyanaise de Réduction des Risques – France
Association of HIV Affected Women and Their Families "Demetra" – Lithuania
Association pour la Lutte contre les Hépatites Virales"ALHV" - Burundi
BrugerForeningen/The Danish Drug Users Union – Denmark
Bus 31/32: CSAPA & CAARUD – France
Canadian HIV/AIDS Legal Network – Canada
Coalition PLUS – International
Conectas – Brazil
Correlation Network – Europe
Danish AIDS-Foundation – Denmark
Drug Policy Alliance – United States
Drug Reform Coordination Network (DRCNet) – United States
European AIDS Treatment Group (EATG) – Europe
European Network of People Who Use Drugs – Europe
Eurasian Harm Reduction Association – Lithuania
FAAAT Think & Do Tank – Paris/Barcelona
Fedito Bxl - Drugs & Addictions in Brussels – Belgium
Foundation for Social Policy PREKURSOR – Poland
Georgian Community Advisory Board (GeCAB) – Georgia
Georgian Network of People Who Use Drugs (GeNPUD) – Georgia
Global Network of People Living with HIV (GNP+) – International
Groupe Sida Genève – Switzerland
Grupo de Ativistas em Tratamentos (GAT) – Portugal
Harm Reduction International (HRI) – International
Hepatitis C Mentor and Support Group (HCMSG) – United States
Hepatitis Education Project – United States
Intercambios Asociacion Civil Argentina – Argentina
International AIDS Society (IAS) – International
International Centre for Science in Drug Policy – International
International Committee on the Rights of Sex Workers in Europe (ICRSE) – International
International Drug Policy Consortium (IDPC) – International
International HIV Partnerships (IHP) – International
International HIV/AIDS Alliance – International
International Network for Hepatitis in Substance Users (INHSU) – International
International Network of People Who Use Drugs (INPUD) – International
International Treatment Preparedness Coalition (ITPC) – International
Italian League for Fighting AIDS (LILA) – Italy
ITPC MENA – Middle East and North Africa
Kirby Institute for Infection and Immunity – Australia
Life Quality Improvement Organisation (FLIGHT) – Croatia
Mainline – Netherlands
Médecins du Monde (MdM) – International
Mistlestoes Community Health and Right Initiatives – Nigeria
National Viral Hepatitis Roundtable - United States
New Vector – Georgia
Open Society Foundation (OSF) – International
Pacific Hepatitis C Network - Canada
Plateforme Stop1921 – Belgium
Positive Malaysian Treatment Access & Advocacy Group (MTAAG+) – Malaysia
Positive Voice – Greece
Prévention Information Lutte Contre le Sida (PILS) – Mauritius
Release – United Kingdom
Romanian Association Against AIDS (ARAS) – Romania
Spark of Hope - Ukraine
Stephen Malloy Training & Consultancy Ltd – Scotland
Students for Sensible Drug Policy Australia – Australia
Treatment Action Group (TAG) – United States
Unión de Asociaciones y Entidades de Atención al Drogodependiente (UNAD) – Spain
World Hepatitis Alliance (WHA) – International
Youth RISE – International

ENDORSE THE DECLARATION

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Notes:

[1] Degenhardt et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health 2017. In Press. www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30375-3.pdf
[2] World Health Organization (WHO). Global hepatitis report, 2017. Geneva, Switzerland; 2017. http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1
[3] Platt L et al. Needle syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis. Addiction. 2017 Sep 11. http://onlinelibrary.wiley.com/doi/10.1111/add.14012/abstract
[4] Hagan H et al. A Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject Drugs. J Infect Dis. 2011 Jul 1; 204(1):74-83. academic.oup.com/jid/article/204/1/74/2192163/A-Systematic-Review-and-Meta-Analysis-of
[5] Martin NK et al. Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. J Hepatol. 2016 Jul; 65(1):17-25. www.journal-of-hepatology.eu/article/S0168-8278(16)00086-6/pdf
[6] Wilson DP et al. The cost-effectiveness of harm reduction. Int J Drug Policy. 2015 Feb; 26 Suppl 1:S5-11. www.ijdp.org/article/S0955-3959(14)00311-9/pdf
[7] World Health Organization (WHO). Global health sector strategy on viral hepatitis 2016-2021. Geneva, Switzerland; 2016 www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/
[8] Larney S et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017. In Press. www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30373-X.pdf
[9] Global Commission on Drug Policy. The Negative Impact Of The War On Drugs On Public Health: The Hidden Hepatitis C Epidemic; Geneva, Switzerland; 2013. www.globalcommissionondrugs.org/wp-content/uploads/2016/03/GCDP_HepatitisC_2013_EN.pdf
[10] Wolfe D et al. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet. 2010 Jul 31; 376(9738):355-66. www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60832-X.pdf
[11] Wood E et al. Vienna declaration: a call for evidence-based drug policies. Lancet. 2010;376 (9738):310–12. www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60958-0.pdf
[12] Csete J et al. Public health and international drug policy. Lancet. 2016 Apr 2; 387(10026):1427-1480. www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00619-X.pdf
[13] Release. A Quiet Revolution: Drug Decriminalisation Across the Globe. London, United Kingdom; 2016. www.release.org.uk/sites/default/files/pdf/publications/A%20Quiet%20Revolution%20-%20Decriminalisation%20Across%20the%20Globe.pdf
[14] Gagnon F. Synthèse des connaissances : actions novatrices en matière de substances psychoactives « illicites ». Québec : Institut National de Santé Publique du Québec ; 2016 www.inspq.qc.ca/pdf/publications/2133_synthese_connaissances_substances_psychoactives.pdf
[15] Grebely J et al. Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there? J Int AIDS Soc. 2017 Jul 28; 20(1):22146. http://onlinelibrary.wiley.com/doi/10.7448/IAS.20.1.22146/epdf
[16] Global Commission on Drug Policy. Advancing Drug Policy Reform: a new approach to decriminalization. Geneva, Switzerland; 2016 www.globalcommissionondrugs.org/wp-content/uploads/2016/11/GCDP-Report-2016-ENGLISH.pdf
[17] Joint United Nations Programme on HIV/AIDS (UNAIDS). Do no harm: health, human rights and people who use. Geneva, Switzerland; 2016. www.unaids.org/sites/default/files/media_asset/donoharm_en.pdf
[18] UN Women. A Gender Perspective on the Impact of Drug Use, the Drug Trade, and Drug Control Regimes. New York, United Nations; 2014. www.hr-dp.org/files/2014/12/02/Gender_and_Drugs_-_UN_Women_Policy_Brief.pdf
[19] United Nations Human Rights Council (UNHRC). Study on the impact of the world drug problem on the enjoyment of human rights, Report of the United Nations High Commissioner for Human Rights. Geneva, Switzerland; 2015. www.unodc.org/documents/ungass2016//Contributions/UN/OHCHR/A_HRC_30_65_E.pdf
[20] World Health Organization (WHO). Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva, Switzerland; 2014. apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1&ua=1
[21] United Nations (UN). Joint United Nations statement on ending discrimination in health care settings, Joint WHO/UN statement. 2017. www.who.int/mediacentre/news/statements/2017/discrimination-in-health-care/en/
[22] United Nations Office on Drugs and Crime (UNODC). Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs: Practical Guidance for Collaborative Interventions. Vienna, Austria; 2017. www.inpud.net/sites/default/files/IDUIT%205Apr2017%20for%20web.pdf