Human rights and HIV prevention, treatment, and care for people who inject drugs: Key principles and research needs
ABSTRACT Efforts to provide HIV prevention, treatment, and care to injecting drug users (IDU) are shaped by tensions between approaches that regard IDU as criminals and those regarding drug-dependent individuals as patients deserving treatment and human rights. Advocates for IDU health and human rights find common cause in urging greater attention to legal frameworks, the effects of police abuses, and the need for protections for particularly vulnerable populations including women and those in state custody. Arbitrary detention of drug users, and conditions of pretrial detention, offer examples of how HIV prevention and treatment are adversely impacted by human rights abuse. National commitments to universal access to prevention and treatment for injecting drug users, and the recognition that users of illicit substances do not forfeit their entitlement to health services or human dignity, offer a clear point of convergence for advocates for health and rights, and suggest directions for reform to increase availability of sterile injection equipment, opiate substitution treatment, and antiretroviral therapy. For IDU, protection of rights has particular urgency if universal access to HIV prevention and treatment is to become an achievable reality.
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- "FuturestudiesoftheRODSshouldalsoexamineitsvalidityacrosspopulationsandcultures, incorporateinter-raterreliabilitytesting,andassessitsuseamongalargersampleofHIVnegativeindividuals .SuchstudiesshouldalsobeconfirmedinEasternEuropeandAsia,where opioidabuseisgrowingexponentially(Mathersetal.,2008)andMATisurgentlyneededandbegin- ningtoexpand(Wolfeetal.,2010). "
ABSTRACT: The Rapid Opioid Dependence Screen (RODS) is an 8-item measure of opioid dependence designed for quick, targeted screening in clinical and research settings. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, criteria, the RODS has an average administration of less than 2 minutes and can easily be administered as a stand-alone instrument or as part of a compre- hensive interview. This study reports on the initial validation of the RODS among a sample of 97 newly incarcerated, HIV-positive individuals. Using the Mini International Neuropsychiatric Inter- view as the primary measure of opioid dependence, the RODS showed good-to-strong sensitivity (.97), specificity (.76), positive predictive value (.69), and negative predictive value (.98), while con- cordance analysis revealed moderate diagnostic agreement (k 1⁄4 .67). Psychometric properties revealed strong internal consistency (a 1⁄4 .92) and inter-item correlations (.66 to .87).Journal of Correctional Health Care 01/2015; 21(1):12-26. DOI:10.1177/1078345814557513
- "These punitive policies have been associated with elevated risk behaviors and detrimental health outcomes among PWID (Degenhardt et al., 2010). Human rights elements of these policies (Wolfe & Cohen, 2010) are addressed in the thematic paper by Kamarulzaman and colleagues in this issue. "
Article: HIV, drugs and the legal environment[Show abstract] [Hide abstract]
ABSTRACT: A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs’ behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs’ risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.International Journal of Drug Policy 09/2014; 26. DOI:10.1016/j.drugpo.2014.09.001 · 2.40 Impact Factor
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- "Access to HIV-related information and services is known to be impeded among men who have sex with men (MSM) where sodomy statutes exist, particularly where police and other authorities can harass men who have sex with men with impunity. Sex workers have been driven underground and avoided services for fear of losing their livelihood where sex work is criminalized, especially where health services share personal information with the police and other authorities [6–9]. As the impact of impediments to effective HIV prevention efforts are increasingly recognized, attention to improving the legal and policy context within which HIV interventions to support key populations are implemented is gaining traction at global and national levels. "
ABSTRACT: Introduction Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention. Conclusions Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.Journal of the International AIDS Society 04/2013; 16(1):18000. DOI:10.7448/IAS.16.1.18000 · 4.21 Impact Factor