The Global STaTe HARM REDUCTION INTERNATIONAL | Reports of harm reducTion Injecting Drug Use Among Under-18s A Snapshot of Available Data DECEMBER 2013 Damon Barrett, Neil Hunt, Claudia Stoicescu www.ihra.net Injecting Drug Use Among Under 18s: A Snapshot of Available Data Damon Barrett, Neil Hunt, Claudia Stoicescu | December 2013 © 2013 Harm Reduction International ISBN 978-0-9927609-1-5 Designed by Anne Heasell Copy-edited by Kathryn Perry Published by Harm Reduction International Unit 2D12, Southbank Technopark 90 London Road London, SE1 6LN United Kingdom [email protected] | www.ihra.net The Global STaTe HARM REDUCTION of harm reducTion INTERNATIONAL Harm Reduction International is an The Global State of Harm Reduction is international non-governmental organisation that Harm Reduction International’s flagship works to reduce drug-related harms by promoting programme of work to monitor global situations evidence-based public health policy and practices, and responses to drug related health harms. and human rights-based approaches to drug Resources produced within this programme policy through an integrated programme of inform evidence-based advocacy for increasing research, analysis, advocacy and civil society the commitment to scaled-up, quality harm strengthening. Our vision is a world in which reduction responses around the world. individuals and communities benefit from drug laws, policies and practices that promote health, dignity and human rights. www.ihra.net Acknowledgements There is a long list of people to thank for helping to put together this report, which was made possible by a grant from the Open Society Foundations. It would not have been achieved without the assistance and support of many people over a long period of time, from initial advice to reviewing the report and through various stages. In particular: Nina Ferencic, Paul Nary, Ruslan Malyuta, Teltchik (International HIV AIDS Alliance); Susan Rachel Odede, Paula Bulancea, Pierre Robert, Sherman (Johns Hopkins School of Public Health); David Alnwick, Gudrun Nadoll, Bolorchimeg Carol Strike (University of Toronto); Evan Wood Dagva, Etiene Poirot, Muthu Maharajan, Robert and Dan Werb (International Centre for Science Gass, Verity Rushton, Annefrida Kisesa, Maya in Drug Policy); Marcus Day (Caribbean Harm Fachrani Faisal, Kazutaka Sekine, Mini Bhashkar, Reduction Coalition); Professor Irwanto (Atma Juliet Attenborough, Pragya Shah Karki, Ivonne Jaya University, Jakarta); Pascal Tanguay and Camaroni, Ameena Mohamed Didi, and Dr. M Rob Gray (PSI Thailand); Ashish Sinha and Scott Ziya Uddin, Gina Apolzan, Jelena Zajeganovic McGill (Save the Children, Nepal); Safiqul Rezaul Jakovljevic, Alketa Zazo, Jadranka Mimica Islam (Care Bangladesh); Siphokazi Dada and (UNICEF); Alison Crocket, Celeste Sandoval, Charles Parry (Alcohol & Drug Abuse Research Iuliana Stratan, Bai Bagasao, Ela Aktürkoğlu, Unit, South African Medical Research Council); Roman Gailevich, Jamila Jarrakhova, Amandine Dr Sharon Stancliff (Harm Reduction Coalition); Oleffe (UNAIDS); Fabienne Hariga, Anne Dr Alex Wodak; Tony Trimmingham (Family Drug Bergenstrom and Monica Beg (UNODC); Justine Support); Charles Henderson (Needle Exchange Sass (UNESCO); Simona Merkinaite (Eurasian New Zealand); John Howard (NDARC); Ruth Birgin Harm Reduction Network); Bojana Kostic and (Women’s International Harm Reduction Network); Jovana Arsenijevic (NGO Veza); Valentin Simionov Timothy Ross (Fenix); Diana Rossi (Intercambios (Romanian Harm Reduction Network); Ioana and University of Buenos Aires); Aram Barra and Tomus (ALIAT); Aran Boci (STOP AIDS); Milica Lisa Sanchez Ortega (Espolea); Tim Bingham and Vasilijic and Snezana Dzekulic (Center for Youth Daithí Doolan (Irish Needle Exchange Forum); Integration); Joanna Busza (London School of Michael Donmall (University of Manchester); Hygiene and Tropical Medicine); Murtaza Majeed Josie Smith (Public Health Wales); Xavier Majó I and Olivier Maguet (Medicines du Monde); Dave Roca (Public Health Agency of Catalonia); María Burrows (AIDS Projects Management Group); Bravo (National Epidemiology Centre, Carlos III Arshak Papoyan (National AIDS Centre, Armenia); Institute, Madrid). Jamie Bridge (IDPC); Anita Krug (Youth RISE); Alan Neaigus (Institute for International Research on Thanks also to our colleagues at Harm Reduction Youth at Risk); Dr. R. Doug Bruce (Yale School of International: Catherine Cook, Pippa Gray, Medicine); Adam Fletcher (University of Cardiff); Annie Kuch, Rick Lines and Maria Phelan. Élise Roy and Pascale Leclerc (Département des sciences de la santé communautaire, Université de Sherbrooke); Tanya Deshko and Andrij Klepikov (International HIV/AIDS Alliance Ukraine); Susie McLean, Kate Iorpenda and Anja We received an enormous amount of information in producing this report, amounting to thousands of documents, and were not able to include all of it. Pending funding, Harm Reduction International is planning to compile the various documents, case studies and responses we received into a follow-up report focusing on policy guidance, and into a microsite as a resource for researchers. Methodology A note on definitions For the full methodology for the literature review For this report the term ‘children’ applies to conducted for this report, see Annex 1. all children below the age of 18 years, including adolescents, as defined in the Convention on Limitations the Rights of the Child. The United Nations defines adolescents as persons aged 10–19 This report is not a systematic review. As such, years, and young people as persons aged there are gaps, and we have not included every 15–24 years. country. Due to space constraints, each country referred to is dealt with very briefly. Clearly, in Various terms are used in the regional sections, each case the picture will be far more complex. however, including ‘child(ren)’, ‘adolescent(s)’, We also acknowledge that we may have missed ‘children and young people’ and, to a lesser some important studies, and we encourage extent, ‘youth’. We fully acknowledge that they readers to send these to us for inclusion in later are not all the same, and we do not necessarily research on this topic. While we have worked use them interchangeably. The reason to include with colleagues and partners in various countries them in this report is that the studies and reports to identify resources, language barriers will have that form its basis are inconsistent in their age come into play in our main search, which was categorisations and definitions. As such, for conducted in English. a study on young people under the age of 25, we cannot use the word ‘adolescent’, although these young people may be captured in the data. Conversely, to rely throughout on broader definitions of ‘youth’ or ‘young people’ would mask our focus. The challenges posed by age disaggregation are explored within the report. Contents Foreword: Greg Ramm, Save the Children USA 01 Executive Summary 02 Introduction: a sharper lens on injecting among under-18s 04 1. A snapshot of available data 07 1.1 A global estimate is absent; national estimates are rare 07 1.2 The need for action: insights from countries with a high 10 prevalence of injecting Asia 12 Eurasia 21 Western Europe 28 Middle East and North Africa 34 Sub-Saharan Africa 37 Americas 40 Oceania 46 2. Discussion 49 2.1 Data limitations 49 General limitations in data collection on drug use among young people Additional limitations relating to available studies on injecting drug use among under-18s 2.2 Recurring issues 54 3. Conclusion and recommendations 58 Annex 1: Methodology 60 References 64 Foreword 01 Foreword People who inject drugs are frequently However, the report also shows that we described as ‘hard to reach’. Information about know enough to act. For our part, Save the who they are, what risks they face and harms Children, through our collaboration with civil they suffer, and, importantly, what services society and government partners in a number they need to address these challenges, can be of countries, especially in Asia, is working to incomplete at best. People who inject drugs ensure that the needs of children and young are often difficult to reach because they are people are addressed when designing and criminalised, face arrest and imprisonment, delivering HIV programmes to people who and frequently experience police abuse. They inject drugs. In Bangladesh, Nepal, Viet Nam often remain hidden from view because of the and Myanmar, we are working to fill the gaps intense stigma from their local communities. in our strategic information to better and more comprehensively address the needs of younger Within these populations of people who inject injecting drug users, as well as advocate for drugs, children and young people are almost appropriate and equitable funding. invisible. Our information about them is often non- existent. Age disaggregation is poor in government There are many more organisations carrying out data collection. Surveys rarely include them or extremely difficult and inspiring work. But some cannot because they are too young. services that do exist are poorly equipped to meet the specific needs of children and young As this report observes, this represents a people who inject drugs. Others are hindered ‘blind spot’ in responses to drug-related by legal, political and funding barriers. harms and in work with most-at-risk children and young people. It is time to make every effort to make children and young people who inject drugs more visible No child should be hidden.