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International AIDS Conference: Policy Update/政策改革

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Key Topics 关键话题

New evidence that criminalization of drug use fuels HIV/AIDS

 

A special issue of the medical journal The Lancet, produced for the International AIDS Conference, published a ground-breaking series of articles and commentaries on the global HIV epidemic among people who use drugs. Drawing on their comprehensive examination of hundreds of studies, the journal's editors called for an evidence- and rights-based response to HIV among people who use drugs: "Criminalization has reduced access to health care for people at risk of drug use...Put simply, locking people up does not work."  The journal's articles provide evidence showing that the most neglected strategy, a human rights-based approach, is the the most effective tool in reversing the epidemic. Some highlights of the journal:

 

  • Steffanie Strathdee and colleagues documented the effectiveness of "triple therapy" in preventing HIV among drug users: opioid substitution therapy (such as methadone), needle and syringe exchange, and antiretroviral treatment (ART).  In support, the authors points to studies in Pakistan and Kenya, where changes in policy and access to healthcare have contributed to reversal of the epidemic. 
  • Daniel Wolfe and colleagues examined access to ART for people who use drugs in low-income and middle-income countries, and found that nearly half (47%) of all injection drug users (IDUs) infected with HIV are in five nations - China, Vietnam, Russia, Ukraine and Malaysia - where policies on drug use make it difficult for IDU to access ART. They found that criminalization of drug use, including imprisonment, compulsory detoxification and the maintenance of registries of the names of drug users, create barriers to the fight against AIDS.
  • Ralf Jurgens and colleagues reviewed over 900 studies on human rights and IDU and found that abuses of human rights increase vulnerability to HIV infection and negatively affect delivery of HIV programmes. These abuses include denial of harm-reduction services, discriminatory access to antiretroviral therapy, abusive law enforcement practices, and coercion in the guise of treatment for drug dependence. Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs.
  • Finally, Chris Beyrer and colleagues, including Michel Sidibe (head of UNAIDS) and Michel Kazatchkine (head of the Global Fund) called on states to expand rights-based approaches to providing treatment and care to IDU with HIV/AIDS.  

 

Because of their scientific methodology, the articles in this issue of the journal will be valuable tools for advocacy in countries where drug use is criminalized. This includes a number of countries in Asia, such as Indonesia, Thailand and China.

 

新证据表明,毒品利用有罪化加剧艾滋病传播

 

医学期刊《柳叶刀》上有期为国际艾滋病大会制作的专门话题,围绕话题发表了一系列有关全球艾滋病在吸毒者之间的感染情况的论文和评论,颇具开拓性。通过对这数百项研究进行综合考察,期刊的编辑呼吁,对吸毒人群艾滋病的回应应当有据且符合其正当权益,"有罪化,使得容易受到感染的吸毒人群接触健康治疗的途径减少......简单地说,将人锁起来是没有用的。"期刊的论文用相关证据说明,在对抗艾滋病时,最容易被人们忽视的方式,也就是以人为本的方式,其实是最有效的方式。期刊上的重点亮点如下:

 

l  斯蒂夫尼·斯初资蒂和他的同事探讨了在吸毒人群内预防艾滋病时,"三方疗法"的有效性。"三方疗法"包括类鸦片替代疗法(例如美沙酮),肌肉注射和静脉点滴交换以及抗逆转录疗法(ART)。作者以在巴基斯坦和肯尼亚的研究为依据,这两个国家的政策和获取健康护理的途径都有了相应变化,在对抗艾滋病的过程中有极大的贡献。

 

l  丹尼尔·沃尔夫和他的同事考察了在低收入与中低收入的国家中,吸毒人员获取抗逆转录疗法的途径。研究发现,在所有针注射毒品的人员(IDUs)中,将近一半(47%)的感染者分布在五个国家----中国、越南、俄罗斯、乌克兰和马来西亚。这些国家在毒品使用方面的政策,使得IDU很难获得ART的治疗。研究者们发现,吸毒的有罪化,包括关押、强制戒毒和对毒品使用者名字记录的保存等,给对抗艾滋病的战役设置了屏障。

 

 

l  如阿夫·舟梗斯和他的同事回顾了有关人权和IDU人群的900项调查后发现,人权侵犯成为对抗艾滋病传染战役中的薄弱处,并对艾滋病项目的移交有着负面影响。这些侵权行为包括否认减低伤害(harm-reduction)服务,区别提供获取抗逆转录治疗途径,法律强制性措施的泛滥以及以治疗药物依赖为名的强制性措施。一方面,由于吸毒者的人权必须得到尊重、保护和满足,另一方面,作为提高吸毒人群健康素质的必要前提因素,保护吸毒者的人权显得非常重要。

 

l  最后,克里斯·贝尔和他的同事,包括迈克尔·斯蒂本(联合国艾滋病规划署署长)和迈克尔·科茨特凯恩(全球基金会会长)向各国政府呼吁,扩大以人为本的治疗渠道,关照感染艾滋病的IDU人群。

 

由于这些论文采用的是科学方法,它们将在以后向将毒品使用有罪化的国家----包括亚洲的许多国家,如印度尼西亚、泰国和中国----进行呼吁时,成为有用的工具。

 

Global Fund chief calls for closure of compulsory detoxification centers

Echoing a speech he made in Toronto in June, Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, again called for the closure of compulsory detention centers, where drug users are detained for months or years without trial or due process, under the guise of drug treatment.

 

The detentions usually take place without a clinical assessment. The drug users are often denied access to evidence-based drug treatment and other basic health services. In some countries, they are forced to perform gruelling labor for no pay. Drug users in these facilities may be tested for HIV without their knowledge or consent. Torture and inhuman or degrading treatment have also been documented.

 

In his speech in Toronto, Kazatchkine said, "All compulsory drug detention centres should be closed and replaced by drug treatment facilities that work and that conform to ethical standards and human rights norms. At the same time, as long as such centres exist, I strongly believe that detainees should at least be provided with access to effective HIV prevention and treatment, provided in an ethical manner and respectful of their rights and dignity."

 

Sessions at the conference specifically discussed abuses in forced detoxification centers in China, Thailand and Vietnam. NGOs in those countries could continue to push the Global Fund to work with them in addressing the concerns of drug users about these facilities.

 

全球基金会会长呼吁关闭强制戒毒所

 

7月在多伦多的演讲相呼应,全球抗击艾滋病、肺结核和疟疾基金会的首席执行官迈克尔·科茨特凯恩又一次呼吁关闭强制戒毒所。强制戒毒所以对药物治疗为名,在没有经过审讯或其他合适程序的情况下,将吸毒人员关押数月甚至数年。

 

 

这些关押通常没有临床评估,吸毒者也通常缺乏有依据的药物治疗和其他基础医疗服务。在一些国家,他们被强迫无酬劳地做高强度工作。这些关押所里的吸毒者通常在不知情或未经自己同意的情况下便被进行艾滋病的检测,相关记录显示他们还受到折磨和非人或者侮辱性对待。

 

科茨特凯恩在多伦多的演讲中说:"所有强制戒毒所都应当被关闭,我们应当根据各地的习俗标准以及人权,建立有效的毒瘾治疗中心。同时,如果这样的戒毒所还存在,那么我本人强烈建议,在押人员至少应当有艾滋病防治的途径,而且应当是以一种地区礼仪并且是尊重他们权利和尊严的方式提供给他们。"

 

本次大会的一些会议专门讨论了中国、泰国和越南国内,强制戒毒所的暴力现象,这些国家的非政府组织应当继续推进和全球基金会的合作,处理吸毒者对这些机构的忧虑。

 

Analysis: Legalization vs. Decriminalization

 

The International AIDS Conference also launched the Vienna Declaration, (中文http://www.viennadeclarationchinese.com/), a statement signed by hundreds of doctors, experts and NGOs calling for decriminalization of drug use.  A number of speakers, panels and protests at the conference also called for the decriminization of HIV transmission and commercial sex work.  A growing body of scientific evidence presented at the meeting shows that decriminalization would be consistent not only with a rights-based approach to the epidemic but also with science-based public health principles. 

 

However, there is some confusion regarding the differences between "decriminalization" and "legalization" - so here is a brief explanation.

 

Decriminalization refers to the repeal or removal of existing laws which criminalize certain activities.  In the context of sex work, decriminalization could entail repealing laws which criminalize being present in a sex work venue, taking another person to a sex work venue, or communicating with another person for the purpose of engaging in sex work.  Decriminalization of sex work, for example, would bestow upon sex workers the same rights and responsibilities as any other self-employed worker and would provide for the same types of legal protections as well. 

 

In contrast, legalization is a proactive legislative step, where the activities that were previously illegal are not only decriminalized but also regulated by government.  In countries where sex work is legalized, regulations include the imposition of special taxes, designations of specific work zones, or the requirement of special work permits.  Regulations may also include specific registration and physical examination requirements. 

 

Many AIDS experts and organizations are calling for decriminalization and not legalization, as decriminalization creates less opportunity for governmental corruption or police abuse.

 

分析:合法化与除罪化

国际艾滋病大会上共有数百名医生签署了新发起的《维也纳宣言》,专家们和非营利性组织呼吁取消对使用毒品定罪。出席会议的许多发言人、专门小组和抗议者也呼吁取消对传播艾滋病与性工作的定罪。会上,越来越多的证据表明除罪化不仅和从权力角度出发抗击疾病的方式相一致,也与从科学的角度出发的公众健康规则相一致。

 

然而,在合法化与除罪化之间仍然有些令人困惑的地方,下面是对此的简单解释:

 

除罪化,是指废除或移除已有的对相关行为定罪的法律。以性工作为例,法律将参与性交易,携带他人参加性交易或者以性交易为目的与他人谈话定为有罪,除罪化则意味着对这些法律的废除成为必要。对性工作的除罪化,将授予性工作者与其他雇员同样的权利和责任,向他们提供和其他雇员同样的法律保护。

 

而与之形成对比的是,合法化是指一个前摄的立法过程,通过立法,原先非法的活动不仅没有除罪化,而且还要接受政府部门的约束。在一些性工作被合法化的国家,缴纳专门税,划出专门工作区或者是获取专门的工作执照等都被列入法律中,相关的规定也可能包括专门的登记和体检。

 

许多艾滋病专家和组织呼吁除罪化而不是合法化,除罪化将为政府腐败和警察暴力提供更少的机会。

 

评论(1)

I suppose that is right bout that. Nice info with thankfulness. require on the road to get in google feed.

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