Access to pain treatment as a human right.

BACKGROUND: Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment. DISCUSSION: Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses. SUMMARY: According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.

Thailand: report analyses barriers to ART for people who inject drugs.

The HIV epidemic among people who use drugs mars Thailand's reputation as a success story in the global fight against AIDS. A new report has revealed that people who use drugs still face serious obstacles in obtaining needed health care

International Guidelines on Human Rights and Drug Control: A Tool for Securing Women's Rights in Drug Control Policy.

Discrimination and inequality shape women's experiences of drug use and in the drug trade and the impact of drug control efforts on them, with disproportionate burdens faced by poor and otherwise marginalized women. In recent years, UN member states and UN drug control and human rights entities have recognized this issue and made commitments to integrate a 'gender perspective' into drug control policies, with 'gender' limited to those conventionally deemed women. But the concept of gender in international law is broader, rooted in socially constructed and culturally determined norms and expectations around gender roles, sex, and sexuality. Also, drug control policies often fail to meaningfully address the specific needs and circumstances of women (inclusively defined), leaving them at risk of recurrent violations of their rights in the context of drugs. This article explores what it means to 'mainstream' this narrower version of gender into drug control efforts, using as examples various women's experiences as people who use drugs, in the drug trade, and in the criminal justice system. It points to international guidelines on human rights and drug control as an important tool to ensure attention to women's rights in drug control policy design and implementation.

Jamaica: report documents homophobia and violence.

In November 2004, Human Rights Watch (HRW) released a report documenting widespread violence and discrimination against people living with, and at high risk of, HIV/AIDS in Jamaica. The report alleges police use Jamaica's Victorian-era sodomy laws, which criminalize consensual sex between adult men, as a basis to harass and persecute people suspected of homosexual conduct and peer educators who provide HIV/AIDS information and condoms to them.

United States: Funding restrictions threaten sex workers' rights.

Recent developments concerning the US government's restrictive policies on HIV/AIDS funding have drawn attention to how the government's mandatory "anti-prostitution pledge" endangers the lives of sex workers and trafficking victims.

United States: challenges filed to anti-prostitution pledge requirement.

Two separate lawsuits were filed recently in US federal courts challenging a provision of US law requiring that non-governmental organizations have a policy "explicitly opposing prostitution" as a condition of receiving funding under the United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (US Global AIDS Act). US-based plaintiffs in both cases argue that the anti-prostitution pledge requirement in the Act violates US Constitutional guarantees of free speech and due process, and undermines proven, effective efforts to fight HIV/AIDS among sex workers.

Compulsory drug detention in East and Southeast Asia: evolving government, UN and donor responses.

According to official accounts, more than 235,000 people are detained in over 1000 compulsory drug detention centers in East and South East Asia. Individuals in such centers are held for periods of months to years, and can experience a wide range of human rights abuses, including violation of the rights to freedom from torture and cruel, inhuman and degrading treatment; freedom from arbitrary arrest and detention; a fair trial; privacy; the highest attainable standard of health; and freedom from forced labor. Since 2010, an increasing number of United Nations agencies, human rights experts, and others have expressed concerns about rights abuses associated with compulsory drug detention centers, and since 2012, called for their closure. Although they do not represent a complete break from the past, these calls mark a significant shift from past engagement with drug detention, which included direct and indirect funding of detention centers and activities in detention centers by some donors. However, the lack of transparent governance, restrictions on free speech and prohibitions on monitoring by independent, international human rights organizations make assessing the evolving laws, policies and practices, as well as the attitudes of key governments officials, difficult. Looking specifically at publicly announced reforms and statements by government officials in China, Cambodia, Vietnam and Lao PDR reveals possible improvements in respect for the rights of drug users, and on-going challenges.

Compulsory drug detention centers in China, Cambodia, Vietnam, and Laos: health and human rights abuses.

BACKGROUND: According to official accounts, in 2012 more than 235,000 people were detained in over 1,000 compulsory drug detention centers in East and Southeast Asia. METHODS: Between July 2007 and May 2013, in-depth interviews were conducted with 195 individuals recently released from drug detention centers in China, Cambodia, Vietnam, and Laos. RESULTS: Individuals reported being held for up to five years in drug detention centers without clinical determination of drug dependency or due process, and being denied evidence-based drug treatment as well as other basic health services. Many individuals reported being forced to perform arduous physical exercise or military-style drills. Forced labor was reported by all individuals having been detained in Vietnam, and some held in Cambodia and China. Physical­and less often, sexual­abuse was reported among those held in each country. CONCLUSIONS: Long-term, compulsory detention for treatment of drug dependency is counter to established principles of medical care and violates a wide range of human rights, including the right to health. Individuals held in drug detention centers in China, Cambodia, Vietnam, and Laos are subject to torture and cruel, inhuman, and degrading treatment.

Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention.

Opioid dependence is a complex medical condition affecting neurocognitive and physical functioning. Forced or abrupt opioid withdrawal may cause profound physical and psychological suffering, including nausea, vomiting, diarrhoea, extreme agitation and/or anxiety. Opioid-dependent individuals are especially vulnerable at the time of arrest or initial detention, when they may, as a result of their chemical dependency, be coerced into providing incriminating testimony, or be driven to engage in risky behaviour (such as sharing needles in detention) in order to avoid painful withdrawal symptoms. Upon incarceration, many opioid-dependent prisoners are forced to undergo abrupt opioid withdrawal (both from legally prescribed agonist therapy such as methadone as well as illicit opioids). Physical and psychological symptoms attendant to withdrawal may impair capacity to make informed legal decisions, and cause prisoners to risk HIV and other blood-borne diseases by sharing injection equipment. Although prisons must provide at least the standard of care to prisoners that is available in the general population, medication-assisted treatment, endorsed by international health and drug agencies as an integral part of HIV prevention and care strategies for opioid-dependent drug users, is unavailable to most prisoners. Medication-assisted treatment is a well-studied and validated pharmacological therapy for the medical condition known as opioid dependence. The failure to ensure prisoner access to this medical therapy threatens fundamental human rights protections against cruel, inhuman or degrading treatment and rights to health and to life. It also poses serious ethical problems for health care providers, violating basic principles of beneficence and non-maleficence (i.e., do good/do no harm). Governments must take immediate action to ensure access to opioid substitution to prisoners to ensure fulfilment of ethical and human rights obligations.

Abstinence and abstinence-only education: a review of U.S. policies and programs.

Abstinence from sexual intercourse is an important behavioral strategy for preventing human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and pregnancy among adolescents. Many adolescents, including most younger adolescents, have not initiated sexual intercourse and many sexually experienced adolescents and young adults are abstinent for varying periods of time. There is broad support for abstinence as a necessary and appropriate part of sexuality education. Controversy arises when abstinence is provided to adolescents as a sole choice and where health information on other choices is restricted or misrepresented. Although abstinence is theoretically fully effective, in actual practice abstinence often fails to protect against pregnancy and STIs. Few Americans remain abstinent until marriage; many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Although abstinence is a healthy behavioral option for teens, abstinence as a sole option for adolescents is scientifically and ethically problematic. A recent emphasis on abstinence-only programs and policies appears to be undermining more comprehensive sexuality education and other government-sponsored programs. We believe that abstinence-only education programs, as defined by federal funding requirements, are morally problematic, by withholding information and promoting questionable and inaccurate opinions. Abstinence-only programs threaten fundamental human rights to health, information, and life.

ABC approach not enough, reports show.

Reports released recently by Human Rights Watch reveal that many women in Africa remain extremely vulnerable to HIV infection because of the violence practised against them, and because of legal systems that do not take the issue of violence seriously or that discriminate against women.