This is a presentation I made to the NC Statewide Community Planning Group, HIV Group. The Human Rights Watch performed a study entitled "We Know What to Do: Harm Reduction and Human Rights in North Carolina."
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Human rights watch scpg presentation 11.10.11
1. We Know What to Do:
Harm Reduction and Human Rights
in North Carolina
2. “[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.”
3. 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.
4. Providingclean needles is part of the harm
reduction approach.
Thegoal 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.
5. 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
6. 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
7. Thereis 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.
9. 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
10.
11. A person can purchase needles at
pharmacies
BUT
Itis a class A misdemeanor to possess or
distribute syringes or other paraphernalia
that may be used for injection of illegal
substances
12.
13. 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…
14. Drugoverdose is the second leading
cause of injury death
How many North Carolinians died in 2009
due to overdose?
Preventioncan be taught via harm
reduction programs
15. 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
16. 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
17. 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
18. There
is anecdotal evidence that this can
happen.
to carry condoms reduced
Afraid
condom usage
Similarpractices documented in places
like Miami and Washington, DC
19. 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.
20. 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.
21. 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.
22. 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
In Seattle, for example, participants in a syringe exchange program werefive times more likely to enter drug treatment than non-participants
Project Lazarusaddress 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 ofsubstance use at the margins of the law-The primary industries in Wilkes County includelogging, textiles, manufacturing, and chicken and cattle farming – pain management Rx opiodsProvides NaloxoneEducation and trainingPain management referralsTreatment referralsProject Lazarus’ efforts have helped to reduce overdose rates in Wilkes County by 42percent, and emergency room admissions for overdose have dropped by 15 percent.
One in five persons with AIDS acquired the disease through injection drug use4% of NC’s new HIV cases in 2009 can be traced back to injection drug useEst. 50,000 IDUs in NC
North Carolina has an estimated 35,000 people with HIV/AIDS
Non-elderly and non-disabled adults without children are regularly excluded
What is the first? Motor vehicle accidents1000, nearly half under 40
All persons have the right to adequate means to protect their health and well being, andgovernments must protect these rights without discriminationeveryone has the right to appropriate health care, including drug usersand people living with HIV/AIDS and hepatitisUS is also obligated to address racial disparities in the public health and to ensure thatminority communities have equal access to HIV prevention, care, and treatmentLaws and policies that “are likely to result in bodily harm,unnecessary morbidity and preventable mortality” are considered violations of the right tothe highest attainable standard of healthCondoms and needles – reduce HIVTherapy – Reduce illicit opioid useReduce OdsPrevent HIV and HCVMedication adherenceThat treaty has been interpreted to require thatgovernments ensure, at a minimum, a range of harm reduction interventions includingsyringe programs, opioid substitution therapy, overdose prevention, and harm reductionservices for youth, prisoners and other vulnerable groups