ADVOCACY MESSAGES TO BE CONSIDERED BY THE UNODC

STIMULANT GUIDELINES DEVELOPMENT MEETING

UNODC HIV Team and Brazilian Government should be commended for their active engagement of people who use drugs in this development process SUB-MESSAGE #1

INPUD is happy to be present in the meeting and to bring through our virtual networks other peer stimulant experts who are also interested and supportive of this project.

People who inject drugs must remain the primary population of people who use drugs at risk from HIV. The world is far from achieving Universal Access to HIV Prevention for people who inject despite the evidence about prevention strategies being clearly established.

INPUD welcomes the additional focus on the HIV outbreaks among populations of high dose and highly marginalized groups of stimulant users. People who inject stimulants have particular vulnerabilities to blood borne viruses given the often rapid, repeated nature of injecting practice and the compulsive nature of some drugs.

We need to understand more about the outbreaks of HIV among stimulant smokers so we can most effectively design harm reduction interventions and access to HIV treatment, care and support.

However, this work cannot be pitted against the under-resourced and pressing needs of the wider injecting community. As this work needs to retain its tight focus and avoid becoming too expansive in its reach.

As such, the focus of this effort should be on investigating the context of HIV outbreaks among stimulant users. INPUD would recommend focused action research with clear peer support components to get in and understand what is going on. SUB-MESSAGE #3

It may be a bit premature to develop guidelines to address the issues when the underlying reasons for these HIV outbreaks are not known. Formative Research is needed in order to inform the development of guidelines of HIV prevention efforts targeting stimulant drug users.

Peer support is a key tool in investigating outbreaks and INPUD can provide the vehicle for matching these peer experts to country as well as contextual situations. There needs to be a comprehensive perspective on this issue.

Developing stimulant “substitution” therapies can be promoted for problem stimulant drug users. However, these “substitution” therapies may include the use of other pharmaceutical medications such as Xanax and Valium as well as anti-depressants, to help these abusers deal with their “withdrawal.” It is important to note that stimulants are not physically dependent drugs but psychologically dependent drugs and as such, should not be given other forms of stimulants to deal with their withdrawal, but medications that help with the craving, as well as the depression that often follows, along with psychotherapy, if desired.

Recreational stimulant drug users may need to be addressed with different messages regarding harm reduction and HIV prevention activities. Again, until formative data is collected and analyzed regarding this type of user, the type of messages and prevention programs targeting this group will need to be based on these data, which at this time, does not exist.

It is necessary to include the community in the HIV prevention efforts targeting stimulant drug users.

Mechanisms/Steps that may be used include: Community must be defined. Conduct community assessment Identify the risk associated within the community, Quantify the issues by examining existing data from

multiple sources. Determine what is known through scientific

literature, expert reviews, and community expertise Collect formative data to fill in the gaps that may

arise after reviewing the available data and literature.

Based upon all of these findings, we must develop an action plan for the program or policy being proposed.

Determine what is known through the scientific literature

Quantify the issue.

Develop program or policy options

Tools: meta-analysis, risk assessment, economic data, expert panels

Tools: rates and risks, surveillance data

Disseminate widely OR Discontinue the program or policy

Evaluate the program or policy

Develop an action plan

Implement

Develop a statement of the issue.

RetoolRefine the issue

It is important to examine the different type of stimulant users (e.g., crack cocaine users, cocaine users, methamphetamine users, amphetamine users) and to examine the factors (interpersonal, intrapersonal, contextual, environmental, cultural) that contribute to their increased HIV risk separately.

The UNODC and the expert team needs to determine which strategy they are going to employ in answering the questions that have been posed in the previous slides, meaning: Scientific approach – evidence-based, data-

based “Public Health” approach – based on

observation or one’s own opinion of the issues related to stimulant drug use.

**A multi-faceted approach – includes a combination of both of the above approaches, observational or opinion data that are supported by hard data.

**This is the strategy that INPUD supports and advocates.

INPUD want to be seen as a constructive and engaged partner, while finding the best methods and openings to secure a space for INPUD advocacy messages to be heard and given attention.