Thai Aids Treatment Action Group

Good afternoon, sister and fellow delegates, and thank you to the conference organizers for the honor of being asked to speak about this critically important issue. I know I don’t look much like an Asian person who uses drugs, but in fact the barriers to their participation in this conference were extraordinarily high; and, in my opinion, we did not do enough to ensure their participation.

The absence of people who use drugs at this conference, which aspires to bring “diverse voices” together for “united action” on HIV/AIDS, only further compromises our ability to truly achieve universal access to HIV prevention and treatment; for without the rich contributions of people most affected by HIV, namely people who inject drugs, people in prison, undocumented citizens and migrants and ethnic minorities, men who have sex with men, sex workers, transgender people, and women, by not actively promoting their involvement in the response, we are denying them a right and we are perpetuating the bad practices of discrimination and denial that we deplore in others. I do hope that from the outset, the next conference will take concrete steps such as ensuring on-site access to medical care including opiate substitution therapy for people who use drugs as a matter of course and that a conference that does not provide this is not allowed to happen.

Here in Asia, where more than half the world’s opiate users live, home to over 16 million drug users and at least 6.5 million injectors, where HIV prevalence among injectors is among the highest in the world, where the HIV epidemic is largely driven by unsafe injecting practices, where less than 10% of heroin injectors are on methadone, and where injectors can access an average of just 2 sterile syringes per month, we also lack 90% of the resources necessary to provide the essential harm reduction services necessary for realizing the right to health. But while resources are a significant challenge, I would argue that even when we have the resources, it does not ensure access.

Unless and until we address and remove the legal and policy barriers to accessing services for people who use drugs, investing in harm reduction is tantamount to flushing your money down the toilet. No smart investor in harm reduction would ignore the repressive legal and policy environments in which harm reduction services in Asia take place. A good investor would want to understand and invest in interventions that work against the ways in which criminalization, strict law enforcement practices, and the failure to respect, protect and fulfill human rights for marginalized groups, collude to undermine and even undo the benefits of all the harm reduction services we are providing.

The constant threat of police arrest, violence, and incarceration at harm reduction drop-in centers, methadone clinics and other places where PWUD receive services minimizes the impact of these services. Failing to provide comprehensive harm reduction services in prisons, which are largely filled with drug offenders, ensures the perpetuation of unsafe injection and sex practices and disease transmission among prisoners and their sex and injecting partners. WE WOULD NEVER EXPECT SOMEONE HAVING SEX TO REUSE A CONDOM, BUT EVERY DAY WE FORCE INJECTORS TO DO THE EQUIVALENT WITH DIRTY NEEDLES. WE WOULD NEVER REQUIRE A DIABETIC TO VISIT A CLINIC DAILY IN ORDER TO OBTAIN THEIR INSULIN, NOR DENY THEM INSULIN FOR EATING A PIECE OF CAKE; HOWEVER, WE DO THE EQUIVALENT WITH PWUD WHEN WE DEMAND DIRECTLY-OBSERVED METHADONE AND DENIAL OF ART IF THEY DO NOT QUIT DRUGS OR EVEN METHADONE. Government laws and policies in this region are allowing this discriminatory treatment.

As activists, local and regional network members, policymakers, and others here at this conference, it is our job to document and help remove these barriers in order to make universal access real. The brilliant South African judge and AIDS activist, Justice Edwin Cameron, said, “Just like faulty condoms or unsafe medical supplies, bad laws can spread the virus.”

In June of this year, world leaders including the former Secretary-General of the United Nations, Kofi Annan, Dr. Michel Kazatchkine, the head of the GFATM, and 5 former presidents and prime ministers, formed the Global Commission on Drug Policy, and released a report after reviewing the global body of evidence. The report’s very first sentence succinctly describes their findings: “The Global War on Drugs has failed, with devastating consequences for individuals and societies around the world.”

The Commission concludes that we must stop the war on drugs, and replace drug policies and strategies driven by ideology and political convenience with policies and strategies grounded in science, health, and human rights; and we must adopt appropriate criteria for their evaluation. They suggest governments hold open debates on alternatives to these failed policies and experiment with humane approaches that do not undermine human rights but rather recognize that drug use is a complex health condition with underlying social, psychological, physical and other causes for which treatment, and not punishment, is required.

Unfortunately, human rights abuses rather than treatment are characteristic of the dominant approaches used by governments to control drugs in this region. Documentation reveals police harassment and interference at health services accessed by DU; arrest and forced detention at compulsory drug detention centers; a lack of due legal process, unreasonably long pre-trial detention, and other breaches of fair trial standards including false or forced confessions… forced labor and torture in the name of healthcare is meted out through beatings, chaining, and electric shock; denial of information, prevention tools, ART and also food are also reported.

Not only are massive human rights violations taking place under the aegis of public security and drug control, but these methods are also failing to achieve their own goals of reducing and deterring drug use. There are more people using different drugs than ever; however we have less capacity to effectively address their harms.

The findings of the Global Commission on Drug Policy are not new. For decades, people who use drugs all over the world have been shouting this very same message as they watched their friends die untreated of HIV, overdose, and hepatitis, as they were arrested and beaten and had money extorted and drugs planted on them by the police, as they were detained and imprisoned without enjoying respect of their basic rights, as they were denied information and prevention tools, ART and humane drug treatment. People who use drugs were bravely and publicly imploring their government leaders to heed their call for an end to the drug war and human rights abuses, but their message fell on deaf ears. It is a tragedy that we have already lost so many beautiful people who were ignored and despised and misunderstood by their governments and communities. Who is accountable? Antonio Maria Costa himself, the former ED of UNODC, said that governments have a legal obligation to put human rights at the center of their drug policies, and that, “too often, law enforcement and criminal justice systems themselves perpetrate human rights abuses and exclude and marginalize from society those who most need treatment and rehabilitation.” This may sound ironic, given the fact that the UNODC is part of a global drug control system that promotes confusion and misunderstanding about the drug conventions, and actively fights against humane approaches to drug control, bullying countries and creating barriers to change.

Drug law reform activists are often encouraged by those in power, to take the long view on policy change. In meeting rooms, we are asked to be patient, even to forget about legal reform, or to just wait. Society isn’t “ready,” we are told. The government isn’t “ready.” But, as my hero, the African- American anti-oppression leader, the Reverend Martin Luther King, Jr., wrote in a letter from an Alabama jail, this word, “Wait,” which he too heard for years, has almost always meant “Never.” “Justice too long delayed,” he wrote, “is justice denied…Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed.”

He also said that we have a moral responsibility to disobey unjust laws. I would posit that if in our country the provision of life-saving prevention tools, such as clean needles or opiate substitution therapy, is found illegal, it is our moral obligation to not comply.

Thankfully, we have strong examples of ways that countries are moving away from punitive, abstinence based approaches to drugs and experimenting with legal and policy reform; countries in Latin America, North America, and Europe have promoted:

These progressive countries are finding that their reforms do not result in increased drug use as their opponents feared but rather lead to increased uptakes in drug treatment, reduced harms from drug use, and also reduced drug use. Countries such as Australia and Switzerland, where criminalizing laws have been reformed or removed, boast low HIV prevalence and countries where governments have failed to remove these outdated and ineffectual laws have extraordinarily high prevalence rates, such as Thailand, China or Vietnam.

As Rev. King reminds us, there is no time to wait. Let us advocate fearlessly to reform our drug laws to achieve universal access in Asia. The time is now.