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Substance use is a medical, public health and social issue – institutionalized stigma has no place and drug policies need to evolve

The following text was delivered by the International AIDS Society President-Elect Adeeba Kamarulzaman at opening of Ministerial Segment of Session 62 of the Commission on Narcotic Drugs.

Of the 13 million people who inject drugs globally, about 10% or 1.7 million are living with HIV. The risk of HIV is 23 times higher for people who inject drugs than the general population.

In 2019, we have the tools to prevent people who inject drugs from becoming HIV positive. Comprehensive evidence-based programmes include substitution treatment, needle syringe exchange and voluntary HIV testing and counselling.

Advances in antiretroviral therapy mean that people who use drugs who are living with HIV and are successfully on treatment will not transmit HIV to their partners. Undetectable = Untransmittable.

However, criminalization and stigma and discrimination prevent the implementation of these effective evidence-based programmes the world over. In most countries, only between 17% and 40% of people who inject drugs who are living with HIV are engaged in the treatment cascade – against the global goal of 90-90-90.

A person who uses drugs is subject to multiple layers of stigma: as a person who uses drugs, as a person living with HIV, as a prisoner. They suffer from internalized stigma. They suffer from stigma and discrimination by their families, community and healthcare workers. They suffer from institutionalized stigma from their governments in the form of laws and policies that criminalize drug use.

To prevent new HIV and hepatitis C infections among people who use drugs, we must view substance use as a medical, public health and social issue. We must expand HIV prevention and treatment programmes and look for alternatives to incarceration in dealing with substance use disorder.

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