The urgent need for evidence-informed and rights-based drug dependence treatment in Asia
The continued existence of compulsory drug detention and rehabilitation centres across Asia remains a serious concern. People who are suspected of using drugs or being dependent on drugs, people who have engaged in sex work or children who have been victims of sexual exploitation are often detained in these centres without due process in the name of treatment or rehabilitation.
There are serious human rights issues concerned with compulsory drug detention and rehabilitation centres and they threaten the health of the detainees, including through increased vulnerability to HIV and tuberculosis infection.
Physical and sexual violence, forced labour, substandard conditions, denial of health care and other forms of human rights violations have been documented in many centres. Although reported in many parts of the world, compulsory drug detention and rehabilitation centres are most prevalent in Asia. According to official accounts reported in 2012, more than 235 000 people were detained in over 1000 compulsory drug detention centres in East and South-East Asia.
HIV prevalence among people who inject drugs is estimated to be 28 times higher than among the general population. Stigma, discrimination and punitive laws greatly contribute to the high HIV prevalence among people who use drugs and prevent the provision of evidence-informed drug dependence treatment and HIV services.
In a 2012 joint statement on drug detention and rehabilitation centres, 12 United Nations entities noted that there is “no evidence that these centres represent a favourable or effective environment for the treatment of drug dependence.” The statement further calls on those states that maintain these centres to close them without delay, to release the people detained and to provide appropriate voluntary health care and drug dependence treatment for people in need, at the community level.
There has been coordinated and concerted action by the United Nations system at the country, regional and global levels to engage governments on the issue. These efforts have supported a series of intergovernmental dialogues in Asia that have promoted emerging best practices in implementing evidence-informed and rights-based drug dependence treatment.
However, progress at the country level has remained largely insufficient. Some countries in the region have recently been reported to be planning to increase the capacity of their drug detention centres, or to consider legislation to further entrench them.
During a recent visit to Asia, UNAIDS Executive Director Michel Sidibé called for accelerating reform towards voluntary and community-based drug treatment programmes as a human rights and public health imperative. “Now is the time for pragmatism and evidence. Countries must expand rights-based policies and programmes that work in addressing drug dependence and vulnerability to HIV,” said Mr Sidibé.
The urgent need to expand evidence-informed and rights-based drug dependence treatment in Asia is clear and needs to be a central part of upcoming discussions on drug policy and health, such as the third intergovernmental dialogue on compulsory drug detention centres in Asia in 2015 and concrete advances made ahead of the 2016 United Nations General Assembly Special Session on Drugs.
At its 35th meeting, in December 2014, the UNAIDS Programme Coordinating Board will hold a series of discussions on reducing HIV transmission among people who inject drugs as a critical component of efforts to end the AIDS epidemic by 2030.