The IDUIT offers practical guidance on implementing HIV programs for people who inject drugs

Written by Brun Gonzalez, Chair of Board of Directors of the International Network of People who Use Drugs (INPUD) and Judy Chang, INPUD Executive Director

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Photos provided by: Brun Gonzalez

The Injecting Drug User Implementation Tool (IDUIT), jointly developed by INPUD and the United Nations Office on Drugs and Crime (UNODC), was released this April and is the fourth publication in a series of tools on implementing HIV programs with key populations. It offers practical guidance on implementing HIV programs for and with people who inject drugs (PWID) across the HIV care continuum and contains examples of best practices from around the world that can be used to support efforts to plan programs specific to the PWID community. The tool covers prevention, care, treatment, and support interventions and focuses on partnerships with or by PWID organizations.

The IDUIT is the product of a collaborative process between PWID, advocates, service providers, researchers, government officials, UN agencies, development partners, and nongovernmental organizations. The tool provides a strong platform for emphasizing the importance of community empowerment in reaching PWID with HIV services.

 

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“The IDUIT is the result of a very positive and important collaboration between the United Nations and the international community of people who use drugs that reflects… high-level participation and engagement that answers the affirmation ‘nothing about us without us’ in a meaningful and constructive way,” said Brun Gonzalez.

A multidisciplinary group of people came together for a consultation meeting in Bangkok to elucidate optimal approaches for designing, developing, and implementing comprehensive services that meet the real needs of the PWID community. When developing the tool, it was also important to maintain a broad focus on issues that other key populations most at risk for HIV often face.

The sessions were attended by representatives from the UNODC, the Joint United Nations Programme on HIV/AIDS, the World Health Organization, civil society specialists, and members of the PWID community. Individuals working on health and harm reduction service provision, community organizing, and advocacy campaigns brought their unique experiences to the table to discuss best practices and efficient models based on community involvement and strengthening.

The convergence of “top-down” and “bottom-up” perspectives allowed for a rich, comprehensive process that brought together the best of both worlds to develop the IDUIT: the evidence-based, biomedical model and the pragmatic, rights-based model derived from what was referred to as “community wisdom” during the consultation.

It is essential to seek representation of and participation from the people who are immediately affected by the decisions being made when looking to improve harm reduction services and implementation tools. The IDUIT is one step in a long process of fine-tuning and updating the mechanisms set in place at an international level.

Reducing Gender-Based Violence Against Women Who use Drugs: The Right to be Free

Written by Judy Chang, Board Member, International Network of People who use Drugs

Globally, it is estimated that one out of three women experiences gender-based violence (GBV) in her lifetime. Data on women who use drugs and their experiences of violence are scarce; this is not surprising given our status as an invisible population. As a result of criminalization, discrimination, and stigmatization, women who use drugs are disproportionately affected by violence. Women who use drugs commonly experience violence at the hands of state actors, notably the police, and when violence comes from intimate partners and the wider community, it is often perpetrated with impunity.

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Tanzanian Network of People who use Drugs. Photo by Ruth Birgin.

GBV against women who use drugs manifests as a result of a range of interrelated structural, systemic, and sociocultural drivers. Our experiences of GBV are both driven and compounded by stigma and discrimination and inequality. In 2015, the International Network of Women Who Use Drugs (INWUD), along with Women and Harm Reduction International Network, released a statement for the International Day for the Elimination of Violence against Women. The statement included a number of testimonials from women who use drugs and have been affected by violence. One woman shared her story.

“The insidious creep of abuse of domestic violence makes it hard to speak out. But when police fail to act on a charge, it becomes a double act of injustice. The neighbours called the police to my house, after I had just gone through a window. Under questioning he [my partner] told the police officer I was a drug user. Tearful and shaken, I found the tables turned on me. Rather than pursue a clear case of domestic violence, he chose to search me for drugs. It only took those two little words of ‘drug user’ for the police officer to see me not as a victim of domestic violence, but as a woman not deserving of equal protection under the law. At a time when I felt the most broken, I had to bear the force of a broken system which treats women who use drugs as undeserving of the same rights as other women.” (INWUD Virtual Consultation, 2015)

Our current value system that embraces prohibition places an inordinate amount of focus and effort on regulating and controlling what a woman puts into her body, rather than what is being inflicted on her body, more often than not by those with more power. Driven by political ideology and moral attitudes, the damage that the war on drugs wages on women’s bodies needs a political solution. INPUD argues that community organizing, community mobilization, and solidarity building remain the most effective and protective barriers against abuses and violations. Historically, we have seen these used as political tools to make critical gains in labor rights, civil rights, liberties, and in the HIV movement.

Ruth Birgin, INPUD’s Women’s Policy Officer has been catalyzing women who use drugs in countries in Asia and across Africa. She has been working with women from national drug user networks and supporting them to come together, develop plans and strategies to meet their community-defined needs, and create mechanisms for collective support. In Indonesia, for instance, INPUD supports the activities of PKNI, the national drug user network, that contributes to broader goals of increasing understanding and awareness of violence against women who use drugs and developing elements of protection. In Tanzania, INPUD’s Women’s Policy Officer is coordinating with women from the Tanzanian Network of People who use Drugs (TANPUD), who will be running their own activities, including a public event on December 10. A women’s advocacy team comprised of TANPUD members has been formed.  They are currently developing a statement on violence against women who use drugs, which is to be presented to the Ministry of Community Development Gender and Children on the 2016 International Day for the Elimination of Violence against Women.

The upcoming years are crucial. As we prepare for increasing onslaughts on the rights of women worldwide—including sexual and reproductive health rights, the right to bodily integrity and self-determination, and the right to be free from violence and sexual assault—women who use drugs need to come together to organize and strengthen our networks and communities. This is the first, crucial step to challenging damaging political realities. Now more than ever, the status quo will no longer suffice.


Judy Chang (MIntDev) is a board member of INPUD; a consultant with Coact, which is a technical support agency specializing in HIV and drug use; and an MPhil Candidate at the National Drug Research Institute (NDRI) in Australia.

INPUD is a global peer-based organization that seeks to promote the health and defend the rights of people who use drugs. INPUD challenges stigma, discrimination, and criminalization of people who use drugs and the impact they have on the drug-using community’s health and rights. The International Network of Women Who Use Drugs is a subnetwork comprised of those who self-identify as women and who use drugs.

Key Population Hero: Human rights for drug users in Nepal

Written by Anjay Kumar, drug user activist in Nepal 

There were an estimated 52,174 people who inject drugs (PWID) in Nepal in 2013 with an annual growth rate of 11.36% (Government of Nepal Ministry of Home Affairs).1 Drug use in Nepal is paired with domestic social, economic, and political issues. Nepal is one of the poorest countries in the world and, as a result, it is ill-prepared to deal with many of the health issues that drug users face, including multi-drug-resistant tuberculosis, HIV and AIDS, and the new threat of hepatitis C.

Drug users in Nepal are often from lower-income and marginalized communities. They are too often stopped, searched, arrested, prosecuted, convicted, and incarcerated with inequitable treatment by the criminal justice system. Some drug users have been detained in prison-like conditions and forced to do unpaid labor. Others have been subjected to physical and psychological abuse in the name of “drug treatment.” Most of the drug users I’ve known have never been out to hurt anybody, but they have their rights taken away, face violence, and are ostracized.  Negative social perceptions, stigma, and discrimination all help to fuel this inhumane treatment toward drug users. Drug use is not recognized as a health issue but instead is seen as a moral depravity, marginalizing a substantial proportion of drug users and depriving them of access to treatment and care.

anjay-speech-rbbIn my opinion, the focus should be on whether a drug user is stable and capable of carrying out their social duties and responsibilities. As a drug user living with HIV, a family man, and a working man, I have been forced to discipline myself after stumbling many times in the past. For me this has been the key to holding my own life together.

The Coalition of Drug Users in Nepal (CDUN) advocates for the attainment of the highest standard of quality health care in a nondiscriminatory and dignified manner for all drug users. We advocate for a human-rights-based approach, substantiated by evidence, to inform policies related to drug use.

We want to change society’s perception of drug users by empowering them to lead noble and productive lives and to contribute to society.

We are also in the process of consolidating lessons learned from former drug users who later became care providers for their peers. These individuals provide care to drug users when others will not, due to discrimination. CDUN endeavors to promote these best practices and other emerging evidence to create a larger social impact for drug users. We envision a world where every person with a history of drug use is equipped to make informed, personal choices without fear of being denied their health, human rights, or prospect for a fulfilling social existence.


Anjay Kumar KC, aka ‘The Impactivist’ (for impact + activist), is a drug user activist and advocate for health, human rights, and harm reduction for drug users and HIV related policy in Nepal and globally. Anjay is also a person living with HIV and Hep C co-infection and a proud family man supporting a wife and child who are also living with HIV. He has been fighting against social injustice and working with most at risk, vulnerable and key affected populations such as PWID, LGBT, FSWs, migrants and AIDS orphans since 2002.