At What Cost? Hiv and Human Rights Consequences of the Global “War on Drugs”

AT WHAT COST? HIV AND HUMAN RIGHTS CONSEQUENCES OF THE GLOBAL “WAR ON DRUGS” At What Cost? HIV and Human Rights Consequences of the Global “War on Drugs” March 2009 International Harm Reduction Development Program Copyright © 2009 Open Society Institute. All rights reserved. For more information, contact: International Harm Reduction Development Program Open Society Institute 400 West 59th Street New York, NY 10019 USA Telephone: 1 212 548 0600 Email: [email protected] www.soros.org/health Design: Andiron Studio Printing: GHP, United States Cover photo: Daniel Aguilar/Reuters A member of Mexico’s Federal Investigative Agency guards people arrested on suspicion of possess- ing drugs during an antinarcotics operation in Mexico City. Public Health Program The Open Society Institute’s Public Health Program (PHP) works to advance the health and human rights of marginalized persons by building the capacity of civil society leaders and organizations and advocating for accountability and a strong civil society role in health policy and practice. To advance its mission, the program supports the development and implementation of health-related laws, policies, and practices that are grounded in human rights and evidence. PHP utilizes five core strategies to advance its mission and goals: grantmaking, capacity building, advocacy, strategic convening, and mobilizing and leveraging other funding. PHP’s project areas include harm reduction, sexual health and rights, access to essential medicines, mental health, health policy and budget monitoring, pallia- tive care, Roma health, law and health, health media, and engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria. As of 2009, PHP worked in Central and Eastern Europe, Southern and Eastern Africa, certain countries of South East Asia, and China. International Harm Reduction Development Program The International Harm Reduction Development Program (IHRD), part of the Open Society Institute’s Public Health Program, works to reduce HIV and other harms related to injecting drug use and to press for policies that reduce stigmatization of illicit drug users and protect their human rights. Since 1995 IHRD has supported more than 200 programs in Central and Eastern Europe and Asia, and bases its activities on the philosophy that people unable or unwilling to abstain from drug use can make pos- itive changes to protect their health and the health of others. Since 2001, IHRD has prioritized advocacy to expand availability and quality of needle exchange, drug dependence treatment, and treatment for HIV; to reform discriminatory policies and practices; and to increase the participation of people who use drugs and those living with HIV in shaping policies that affect their lives. Contents Acknowledgements...................................................................................................................................4 Introduction...............................................................................................................................................5 Daniel Wolfe and Roxanne Saucier I. A War on Drug Users: Police Abuse in the Name of Drug Control...................................................17 1) Police Abuse of Injection Drug Users in Indonesia ..................................................................18 Sara L.M. Davis, Asia Catalyst and Agus Triwahyuono, Jangkar 2) Arbitrary Detention and Police Abuse of Drug Users in Cambodia .........................................35 International Harm Reduction Development Program 3) Forced Drug Testing in China: Public Humiliation and a Disruption of Daily Life..................53 International Harm Reduction Development Program 4) Drug Control Policies and HIV Prevention and ......................................................................62 Care Among Injection Drug Users in Imphal, India Venkatesan Chakrapani, M.D., & Kh. Jayanta Kumar, INP+ II. Superpower Influence: The Export of Russian and American Approaches ....................................77 1) Effects of UN and Russian Influence on Drug Policy in Central Asia ......................................78 Leah Utyasheva and Richard Elliott, Canadian HIV/AIDS Legal Network 2) The Impacts of the Drug War....................................................................................................111 in Latin America and the Caribbean Diana Rossi, Shana Harris, and Marcela Vitarelli-Batista, Intercambios Civil Association III. Drug Control, Drug Use, and HIV: Reports from South and Southeast Asia ..............................139 1) Civil Society Reflections on 10 Years of Drug Control in Myanmar, ......................................140 Thailand and Vietnam: A Shadow Report Asian Harm Reduction Network 2) Twin Epidemics—Drug Use and HIV/AIDS in Pakistan.........................................................165 Gul Shamim, Heller School for Social Policy and Management, Brandeis University Appendix: Beyond 2008 Declaration ....................................................................................................181 Acknowledgements This book would not have been possible without all of the people who bravely shared their own experiences, through participating in interviews, focus group discussion, and surveys. We would like to acknowledge the contribution of Dr. Fabio Mesquita, for helping to conceptualize the volume and select the chapters, and for his expert advice and general contributions to the book. Thanks also go to Kasia Malinowska-Sempruch, Sophie Pinkham, and Peter Sarosi who served on the committee to select the contributors. A special debt of gratitude goes to Elizabeth Keeney, who chose the pictures for this volume, provided extensive help with research, and edited the text. Paul Silva also edited the book, and we appreciate his keen eye. Finally, we thank others who shared their expertise: Nick Bartlett, Francisco Inacio Bastos, Luciana Boiteux, and Marcus Day. This volume is dedicated to all those who have lost their lives to the global “War on Drugs,” through AIDS, overdose, violence, or other results of stigma, discrimination, and violations of human rights precipitated by harmful drug policies. 4 AT WHAT COST?: HIV AND HUMAN RIGHTS CONSEQUENCES OF THE GLOBAL “WAR ON DRUGS” Introduction A decade ago, the member states of the United Nations gathered for a special session of the General Assembly to address the question of how to respond to the world’s drug prob- lems. Convened under the motto “A Drug-free World: We Can Do It!” the nations pledged to achieve significant progress toward total elimination of the opium poppy, the coca bush, and the cannabis plant, and to take “appropriate measures aimed at eliminating or reducing illicit demand for narcotic drugs and psychotropic substances.”1 They also agreed to convene another high-level meeting ten years later to assess how these efforts were progressing. This volume, which focuses on the experiences of people who use drugs and those who work with them, offers a partial answer. While drug control policies have indeed been strengthened in many countries of the world, there is little evidence that they have suc- ceeded in significantly reducing supply of illicit drugs or the numbers of people who use them. Abundantly evident, however—and now acknowledged by the Executive Director of the United Nations Office on Drugs and Crime, as well as virtually every credible inde- pendent authority on the subject—is that drug control has had multiple, unintended neg- ative consequences. Whether you are talking about Pakistan or Phnom Penh, Manipur or Moscow, the “war on drugs” has frequently devolved into a war on drug users, resulting in increased incarceration, human rights violations, and disease. After reading the stories contained here of suspected drug users in Indonesia strip-searched on public streets; former drug users in China humiliated in front of their families and friends and hauled in handcuffs to police stations for urine tests; or newly incarcerated drug users in India hav- ing their withdrawal symptoms treated by prison authorities with “the stick,” the question is not just whether a drug-free world is possible, but how many violations of human dig- nity and ethical conduct are seen as acceptable in the effort to achieve it. How can drug control conventions aimed at “reducing human suffering”2 be permitted to excuse so much hardship and humiliation? Today, and in the next decade, the goal should be to achieve total elimination or significant reduction in these unconscionable abuses committed in the name of drug control. The costs and scars of the war on drug users are carried on the bodies and minds of those interviewed here. In China, a mother who used drugs for a brief time and stopped still remembers the look on her daughter’s face as they were pulled from a line to process papers so her daughter could attend university, and she was ordered by police in front of all the other families to submit to a urine test. In Cambodia, women accused of drug use tell of being rounded up, locked together in former Khmer Rouge torture facilities where they were subjected to beatings and rapes, and denied food or medicines to alleviate the painful symptoms of withdrawal. They were allowed only two bathroom breaks a day, and INTRODUCTION 5 A woman watches as a policeman conducts an antinarcotics operation in Mexico City. Daniel Aguilar/ Reuters those who defecated on themselves received more beatings. One woman who escaped these tortures vows to never

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