Human Rights Watch Report Summary:

Human Rights WatchReport Summary:

We Know What to Do:

Harm Reduction and Human Rights

in North Carolina

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President ObamaJuly, 2010, on the National HIV/AIDS Strategy

[T]he question is not whether we know what to do, but whether we will do it. Whether we

will fulfill those obligations; whether we will marshal our resources and the political will to

confront a tragedy that is preventable.

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What do needles have to do with HIV/AIDS prevention?

Access to clean needles prevents

HIV transmission

Hepatitis C infection

Providing clean needles and works is an evidenced-based approach used in the US and globally.

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How are needles and harm reduction connected?

Providing clean needles is part of the harm reduction approach.

The goal of programs and policies based on harm reduction is to make risky behaviors less risky.

Harm reduction makes injection drug use the only mode of HIV transmission to show long-term, consistent decline.

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How can a risky behavior be less risky?

An example would be comprehensive sex education for youth and young adults

Risky behavior unprotected sex w/o birth control

Risks pregnancy, STIs including HIV

Prevention education, proper condom use, access to another form of birth control

Result possibility of engaging in sexual activity, but with tools to prevent risks

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What else can harm reduction do?

Lower HIV risk

Lower hepatitis C transmission

Prevent accidental overdose

Provide a gateway to health care and treatment

Reduce law enforcement needle stick injuries

Reduce the number of contaminated needles in the community

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Doesnt this encouragedrug use and crime?

There is no evidence that clean needles increases drug use or drug-related crimes.

However harm reduction programs can provide a link to drug treatment and other health services.

In Seattle, for example, participants in a syringe exchange program were

five times more likely to enter drug treatment than non-participants

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Where can I learn more about harm reduction?

Harm reduction information:

North Carolina Harm Reduction Coalition

www.nchrc.net

Project Lazarus

www.projectlazarus.org

Harm Reduction Coalition

www.harmreduction.org

Harm Reduction Journal

www.harmreductionjournal.com

Project Lazarus

address the alarmingly high rate of unintentional drug overdose death in Wilkes County,

North Carolina.

Why so high?

-moonshine activity during the prohibition era cultivated a tradition of

substance use at the margins of the law

-The primary industries in Wilkes County include

logging, textiles, manufacturing, and chicken and cattle farming pain management Rx opiods

Provides

Naloxone

Education and training

Pain management referrals

Treatment referrals

Project Lazarus efforts have helped to reduce overdose rates in Wilkes County by 42

percent, and emergency room admissions for overdose have dropped by 15 percent.

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What does this have to do with North Carolina?

The Southern US ranks the highest in

Number of people living with HIV

Number of people dying of AIDS

Rates of new infections

North Carolina has an estimated 35,000 people with HIV/AIDS

The rate of new infections in NC is 41% over the national average

One in three people diagnosed with HIV already have AIDS

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One in five persons with AIDS acquired the disease through injection drug use

4% of NCs new HIV cases in 2009 can be traced back to injection drug use

Est. 50,000 IDUs in NC

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Needles and Pharmacies

A person can purchase needles at pharmacies

BUT

It is a class A misdemeanor to possess or distribute syringes or other paraphernalia that may be used for injection of illegal substances

North Carolina has an estimated 35,000 people with HIV/AIDS

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Accessing health care and treatment

Medicaid

Covers some dependence treatments, but limited eligibility

Patient refusal

Many health programs and services refuse drug users

Health of drug users

Multiple health problems drug dependence, mental illness, HIV, HCV

Non-elderly and non-disabled adults without children are regularly excluded

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Overdose

Drug overdose is the second leading cause of injury death

How many North Carolinians died in 2009 due to overdose?

Prevention can be taught via harm reduction programs

What is the first? Motor vehicle accidents

1000, nearly half under 40

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Funding of clean needle programs

Federal ban lifted in 2009

State law restricts the access of these programs

Cost effectiveness

ER care for overdose - $20million a year in NC

Each prevented overdose saves $20,000 to $30,000 in medical expenses and lost productivity

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Harm reductionand human rights

Universal Declaration of Human Rights

International human rights law

Appropriate health care

Racial disparities

Drug dependence is a disability

International Covenant on Economic, Social and Cultural Rights

All persons have the right to adequate means to protect their health and well being, and

governments must protect these rights without discrimination

everyone has the right to appropriate health care, including drug users

and people living with HIV/AIDS and hepatitis

US is also obligated to address racial disparities in the public health and to ensure that

minority communities have equal access to HIV prevention, care, and treatment

Laws and policies that are likely to result in bodily harm,

unnecessary morbidity and preventable mortality are considered violations of the right to

the highest attainable standard of health

Condoms and needles reduce HIV

Therapy

Reduce illicit opioid use

Reduce Ods

Prevent HIV and HCV

Medication adherence

That treaty has been interpreted to require that

governments ensure, at a minimum, a range of harm reduction interventions including

syringe programs, opioid substitution therapy, overdose prevention, and harm reduction

services for youth, prisoners and other vulnerable groups

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Law Enforcement

Needle stick injuries

30% of police officers experience a needle stick

27% experience 2 or more injuries

Why?

Needle decriminalization

In Connecticut, there was a 66% drop in injury

Similar reductions shown in international prison settings

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If I carry a condom, does that make me a sex worker?

There is anecdotal evidence that this can happen.

Afraid to carry condoms reduced condom usage

Similar practices documented in places like Miami and Washington, DC

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HRW recommendations for NC

Government of North Carolina

Legalize the possession and distribution of sterile syringes.

Enact a 911 Good Samaritan or Medical Amnesty law to protect those who seek help for an overdose victim from arrest for drug offenses.

Ensure that police and prosecutors do not use condoms as evidence of prostitution.

Ensure access to affordable drug treatment that includes opioid substitution therapy and provides harm reduction education and information.

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HRW recommendations for NC

City and County Governments

Work with state health officials and harm reduction experts to implement and support syringe access programs.

Ensure that safe disposal of used syringes and police protocols for safely handling syringes are part of these programs.

Work with police departments to ensure that individuals are not arrested, harassed, searched, detained or otherwise punished based on their possession of syringes or condoms.

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HRW recommendations for NC

State Public Health Officials

Promote harm reduction education and information throughout the state.

Promote syringe decriminalization and apply for federal funding to support syringe distribution programs.

Work with harm reduction experts to promote increased access to Naloxone to prevent overdose among drug users by authorizing and supporting its distribution through trained peer counselors and other outreach workers.

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Full Report

We Know What to Do:

Harm Reduction and Human Rights in North Carolina

http://www.hrw.org/news/2011/09/13/we-know-what-do

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Thanks so much!

Melicia Laroco-Molter, MPH

Melicia.laroco@gmail.com

Tonya Del Soldato

Peaceogreen@gmail.com