HEALTH RIGHTS OF DRUG USERS IN PAKISTAN UNDER INTERNATIONAL PROJECT OF BRIDGING THE GAPS

INTRODUCTION & BACK GROUND:

The human rights of Drug Users have too often been a casualty of the global “war on drugs.” Around the world, harsh National and International drug laws and repressive drug policies are implemented in a manner that makes the violation of drug user’s human rights inevitable. Undue repression of drug users by states not only represents bad human rights practice but also, in the area of HIV and AIDS, is potentially lethal as it drives drug users away from HIV prevention and AIDS treatment and care. Protection of the rights of Drug Users is thus both an urgent public health concern and a human rights imperative. Human rights abuses, denial of care, police surveillance, and violence directed at Drug users have been found to impact HIV prevention efforts due to decreased attendance in harm reduction programs. In Pakistan, drug control laws are often in conflict with harm reduction policies, thus increasing the likelihood of rights abuses against Drug Users.

Policy-makers and programmer at the Community and National levels and International donors have paid increasing attention to the Drug Users considering them major driving factor of the HIV&AIDS. Efforts have been made within the United Nations to harmonize policies on global drug control and HIV&AIDS prevention and to build interagency collaborative mechanisms due to financial constraints and more coverage of harm reduction services; however, country-level capacity to address HIV&AIDS among Drug Users remains low. Prevention services remain limited. Care and support services frequently remain unavailable and are not tailored to their specific needs. In Pakistan, Global Fund is supporting a Nationwide Program for PWID community to support harm reduction services, which is being implemented by Nai Zindagi, but the element to make a strong Drug User community to protect their rights is still missing.  HIV&AIDS epidemics among Drug Users tend to manifest themselves very differently from epidemics in which sexual transmission is the main risk factor. Although sexually transmitted HIV may remain virtually invisible for several years until the burden of disease slowly increases, sharing of injection equipment is a much more efficient mode of transmission, and drug-related epidemics therefore spreads more rapidly.

As per the Global AIDS Response Progress Report 2012 (Pakistan), Pakistan continues to face an expanding concentrated epidemic with people who use / inject drugs as the driving force exhibiting an HIV prevalence of 27.2% across urban centers. The high prevalence of HIV infection amongst PWIDs/PIDs/PUDs is consistent with their frequent and risky injection practices: 71.5% report having 2-3 injections per day with 39% always using a new syringe in 2011. Linkages with sex workers exist with around 14% and 7.1% reporting paying for sex with FSWs and M/HSW respectively in the past six months, but only around 16% used a condom in their last sexual act. The programmatic response in Pakistan encompasses HIV prevention, treatment, care and support, with a priority focus on reaching Key Affected Populations (KAPs). Injecting drug users are now found across the country with large concentrations in key cities, such as Karachi, Faisalabad, Rawalpindi and Lahore, the largest metropolitan areas. Based on the 2011 data, PWIDs/PIDs/PUDs are overwhelmingly male (98.4%) with an average age between 25-40 years old, 57.1% have no formal education, 81.2% live with their families or friends, and 33.8% are married.

Being a national network of the HIV community this background is not a source of satisfaction for the APLHIV and there is a dire need to address the needs of our PUD/PID/IDU community in general and that of the major driving force of IDUs/PIDs/PUDs in particular, to educate our PID/PUD Community members about their rights available to them for treatment, care and support services and to sensitize them to reduce the new infections and ultimately to make them a productive member of the society. Under the umbrella of the UNO the global community has acknowledged the increasing need for cooperation by the International community to enable the individuals to live in a dignified and human manner, which needs to be advocated.

Noting the alarming scale of HIV infection among PUDs/PIDs, repressive drug policies, the implementation of these policies and violation of drug user’s human rights it is essential that urgency be given to this issue. Thus, there was a dire need to collaborate with potential partners to generate an evidence to highlight and address the above mentioned issues and to provide the Drug users with a platform to raise their voices and seek the solutions to their issues tailored to their own needs. Thus the APLHIV found some workable collaboration with its western partners for the 1^st time in its history. An agreement was reached in 2013 with a project to be implemented by the APLHIV focusing on the Drug Users.

Under the project/agreement the APLHIV agreed to undertake a Research study across the country focusing the Drug Users- to assess their needs, document their issues, assess the access to HIV treatment, care and support services and analyzing their human rights. This Research is intended to serve as an invaluable tool to assess the obstacles faced by Drug User’s community, to sensitize the community with fundamental human/legal rights, enable the community to unify its voices, organize themselves within the fold of the APLHIV and carry out lobbying and advocacy for empowerment of our PID community and to influence the policy and decision making authorities as the result of this assessment.

The Research study was completed in 2014 by involving 545 Drug Users from thirteen [13] Districts across the country. Twelve [12] trained from within Drug User’s Community were used to conduct the Research Study. To read the report please click the Tab “Reports” on main page.

As historic mile stone the APLHIV based on the recommendation of the Study launched 1^st ever Drug User’s Network [DUNE] in presence of over 40 stakeholders from across the country on 5^th May 2014. The DUNE is a semi-independent Network which is working under the APLHIV and is expected to take an independent role by 2020. The DUNE envisions a platform/mechanism where the Drug Users exercise their rights for healthy, dignified and respectful lives, and are leaders in addressing their issues tailored to their needs and rights, free of stigma, discrimination and violence through advocacy. Whereas the Mission of the DUNE has been set as to Mobilize community leadership to influence policies, laws, programs and funds, to promote actions that empower the community of people who use drugs and Meaningful involvement of the Drug User community to make a positive change for themselves.

The APLHIV is engaged in capacitating the Drug Users’ Community and its leadership and also to educate them for a positive living. During the implementation of the project the APLHIV developed 1^st ever handout in English and Urdu languages which covers the Rights of Drug User’s community under the law of the land. Similarly a booklet on HIV/HCV Co-Infection has been published to manage the co-infection efficiently through peer educators. Guidelines for community documentation have been produced; guidelines on the rights of drug users and guideline to drug treatment have been developed and published by the APLHIV and DUNE. Approximately 400 community members have been educated on their fundamental rights, HIV/HCV Co-Infection and its management. The community leadership has been trained on Advocacy Skills, Research, Monitoring Skills and Organizational Management so as to prepare them to take the lead role in DUNE. Under the Project the DUNE leadership has been effectively engaged in monitoring the services being provided to the community to identify the gaps and recommend the action to improve the services.