AIDS Alert International
International Groups Charge INCB with Needlessly Impeding HIV Prevention
More transparency, more prevention encouragement needed
A new report says the International Narcotics Control Board (INCB) has used secrecy, old-world habits, and anti-science beliefs to discourage nations from preventing HIV infection through the use of needle exchange programs and other risk reduction efforts.
While the United Nations has stated policies in support of having nations improve their HIV prevention work through harm reduction measures, including needle exchange programs, the INCB treats these initiatives with criticism, according to "Closed to Reason: The International Narcotics Control Board and HIV/AIDS," a report released in late February 2007, by the Open Society Institute (OSI) of New York, NY.1
"Harm reduction is a part of HIV prevention that every member of the United Nations has signed, so the INCB is out of step with the rest of the world," says Daniel Wolfe, deputy director of OSI's International Harm Reduction Development Program. Wolfe is a co-author of the new report.
The problem is that the INCB, whose role is to serve as the watchdog of international drug conventions, is a 13-member board that is independent, closed to the public, and which operates with very little accountability, Wolfe says.
"The INCB can't tell countries what to do, but it does issue an annual report that is essentially a report card on how countries are doing with drug control," Wolfe says. "The INCB opens the United Nations commission that deals with drug issues every year, and it speaks at the World Health Assembly, so the INCB clearly is a leader in drug control."
The OSI report calls for the INCB to use its leadership to encourage countries to improve HIV prevention efforts, including harm reduction programs, Wolfe adds.
Wolfe points to this example of how the INCB is out of step with the HIV/AIDS epidemic: "They will go to Bulgaria, which has extremely harsh drug laws that result in people increasing injection use and decreasing use of health services because drug users are scared, and the drug board won't mention this problem and will say that drug control in Bulgaria is well developed," he explains.
The problem is that in many countries around the world, the HIV epidemic still is young, but it's growing rapidly among injection drug users (IDUs), Wolfe says.
These areas include Vietnam, Malaysia, China, Indonesia, and some former Soviet Union countries, he says.
"In many of these countries, harm reduction is being implemented, but the problem is the INCB offers negative comments or no comments at all," Wolfe says. "So the cost of that silence could very well be many more HIV infections and a repeat of tragedies we don't need to experience."
Russia and other countries use the INCB's comments as an excuse for not doing more to prevent the spread of HIV among IDUs, Wolfe adds.
"Countries appreciate positive mention of new or potentially controversial developments, so if, instead, they get silence or concern from the board, that leads to negligence in HIV prevention," he says.
The report specifically notes these problems:
• INCB members when speaking in public sometimes contradict scientifically based recommendations for harm reduction.1
For instance, INCB members have spoken out against sterile syringe programs and opiate substitution treatment.1
"In 2003, the board acknowledged that countries might need to take action with needle sharing, but even as they offered grudging recognition of those approaches, they often cautioned that harm reduction might do more harm than good," Wolfe says.
• The INCB has tried to silence UN representatives who support a wider range of HIV prevention efforts, including making an angry phone call to Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, when he made positive remarks about a Canadian safer injection facility that reduced HIV risk.1
"The board called Lewis and asked that he be censured and that he detract his support of 'opium dens,'" Wolfe says. "The board offered no evidence or support for its designation of these sites as opium dens, and there is increasing amounts of research showing these sites may have beneficial health effects."
• The INCB emphasizes drug control at the expense of public health with actions suggesting disapproval of countries that use opiate substitution treatment, although these have been added to the World Health Organization's Model List of Essential Medicines in 2005.1
"The irony is that in some cases, as in the case of Russia, board members have used their names and affiliations to put forward some very strong anti-harm reduction policies in their countries," Wolfe says. "They urge countries not to implement methadone treatment even though Russia has the fastest-growing HIV epidemic in the world, and as many as two million drug users need treatment."
• INCB meetings are closed to observers; their reports are inconsistently documented; members speak on matters of which they have no expertise —often making mistakes—without being held accountable; the board's Web site has no information about the board or its staff, and the INCB Secretariat, whose salary is paid by the UN, is unresponsive to requests for information.1
The INCB's response to the OSI report highlights its unaccountability: "We consulted the board before releasing the report, and we asked a number of questions about how they chose which countries to visit, and we asked for details of their proceedings for board meetings," Wolfe recalls.
"Months later, they sent us back a three-sentence letter that suggested we consult their Web site, which had none of the information we asked them about," he says. "So you're talking about a body that is using its independence as an excuse for its lack of accountability."
The report calls for the INCB to speak with international experts and to start providing references and scientific evidence for its pronouncements, Wolfe says.
Here are some of the other suggestions from the report:
• The INCB should regularly assess the adequacy and supply of substance use treatment, and it should provide technical support to countries to help them estimate the need for opiate substitution treatment.1
• When making public statements or releasing reports regarding drug use and health, the INCB should cite scientific evidence and provide sources of information for its annual reports.1
• The WHO, UN member states, and the UN Economic and Social Council should make certain INCB members include people who have expertise in HIV/AIDS policy and in international law.1
• An independent evaluation of the INCB should be commissioned by the UN Secretary-General, and this should include a scientific evaluation of the board's statements on health and an examination of its independence and expertise.1
Reference:
- Csete J, Wolfe D. Closed to reason: the International Narcotics Control Board and HIV/AIDS. Report sponsored by the Canadian HIV/AIDS Legal Network and the Open Society Institute. Feb. 2007:1-37.
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