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health and human development vulnerabilities

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					                  Addressing
health and human development vulnerabilities
       in the context of drugs and crime
UNEXPLORED TERRITORY

NO ONE’S LAND



Discrimination    Stigma     Ignorance

                 Prejudice
DRUG USERS AND DRUG DEPENDENT PERSONS
DRUG USERS
AND DRUG DEPENDENT PERSONS
PERSONS WHO HAVE COMMITTED AN OFFENSE
IN PRISON SETTING
PERSONS WHO HAVE COMMITTED AN OFFENSE IN
PERSONS VULNERABLE TO HUMAN TRAFFICKING
PERSONS VULNERABLE TO HUMAN TRAFFICKING
                 UNODC has
                 the unique position
                 to ameliorate
                 the condition of…

Victims of crime:
- Drug users                      Perpetuators of crime:
- Vulnerable to HIV               - Offenders
- Vulnerable to                   - Convicted offenders
human trafficking
and violence

       UNCONDITIONED RIGHT TO HEALTH
Vulnerabilities relating to drug use and dependence


 Political Declaration 2009
 Paragraphs 20, 21, 22, 23

 Prevention of drug use, treatment of drug dependence,
 rehabilitation and reintegration

 Prevention of health and social consequences of drug use

 HIV prevention, treatment care and support
Health at the center stage of the drug control system
                  (A.M. Costa, 2009)
Supply reduction                                            Demand reduction
                   To protect the health of people,
                   particularly the most vulnerable,
                   from the dangerous effects of drug use
                   and from drug use disorders



                          HEALTH CARE


                      To reduce drug-related diseases
                      and social consequences




                             Harm reduction
Vulnerabilities in prison setting
 United Nations Standard Minimum Rules
 for the Treatment of Prisoners (ECOSOC resolution 1984/47)

Art. 12 : The right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. Those who are imprisoned retain
this fundamental right

Resolution 2004/28: United Nations standards and norms
in crime prevention and criminal justice (E/RES/2004/28)

Art. 9: Prisoners shall have access to the health services
without discrimination on the grounds of their legal situation.

The United Nations General Assembly Special Session 1998
prisoners as an important group for activities to reduce demand
Vulnerabilities in prison setting
Commission on Crime Prevention and Criminal Justice
                      2009
                     Thematic debate:
     Penal reform and reduction of prison overcrowding

        Improving health conditions in prison
               Reducing overcrowding
  Stopping of reducing the use of alcohol and drugs
                Improving sanitation
                   Providing food
                 Promoting exercise
           Preventing TB – HIV infections
         Preventing mental health disorders
Vulnerabilities in the context of human trafficking

   United Nations Convention Against
   Transnational Organized Crime (Annex II, Article 6)

   Protection of victims of trafficking in persons

   Para 3
   (c) medical, psychological and material assistance
       mental health promotion
       substance abuse prevention
   (a) housing
   (d) education-training opportunities
       employment
Ministry of Health   Ministry of Interior   Ministry of Justice



                                     UNODC
                         health and human development


        WHO              UNDP               UNICEF

  UNAIDS
                                   ILO               IOM

            A MULTI-DISCIPLINARY APPROACH
 Do we have consolidated evidence
   concerning the effectiveness of
        prevention of drug use,
    treatment of drug dependence
and prevention and treatment of HIV?
WHAT IS NOT WORKING IN PREVENTION

scare tactics and moralistic appeals

curricula that rely solely on information about drugs and their dangers

curricula that only work to promote self-esteem and emotional well-being

single shot assemblies

testimonials by former addicts

counseling in peer-group context

recreation and community service activities
WHAT IS WORKING IN PREVENTION
training in resistance skills normative education

life skills: communication

life skills: decision making

life skills: emotional communication

life skills: impulse control

life skills: self esteem

trained teachers

interactive methods / reliable information
WHAT IS WORKING IN PREVENTION
Supervising and monitoring skills

Caring, trusting relationships between parents and children

Warm child rearing style

Communication of positive family values

Setting age appropriate limits, rules and consequences

Praising children appropriately for their behavior and
accomplishments

Structured family life including having meals together

Parents involvement in the lives of their children
      WHAT IS NOT WORKING IN TREATMENT

Prison Punishment Pure re-education Working alone Spirituality
alone Individual psychotherapy alone Detoxification without after-
Care Short-term therapy Symptoms therapy Treatment without
assessment
WHAT IS WORKING IN TREATMENT

Brief intervention
Motivational interviewing
Cognitive-behavioural therapy
Contingency therapy
Family therapy
Vocational training
Self help 12 step
Therapeutic community method

Long term opioid-agonists
Slow release opioid-antagonists
Medications for psychiatric comorbidity

Integrated pharmacological and psychosocial therapy
WHAT IS NOT WORKING IN HIV PREVENTION
AND HEALTH CARE

Information alone
Counselling alone
Demonization
Panic dissemination
Stigma and marginalization
Denial
Violation of privacy
Lack of medical care
Punishment for drug dependent individuals
WHAT IS WORKING IN HIV PREVENTION
WHAT IS WORKING IN DRUG USERS HEALTH CARE
 reliable information and counseling

 low-threshold pharmacological interventions
 (example opioid-agonists and antagonist drugs) easily accessible

 adequate social assistance for marginalized drug dependents

 vaccination programs against Hepatitis to all drug abusers

 medication and emergency kits for management of overdoses
 in appropriate places

 availability of measures to prevent acute consequences
 of stimulants abuse (free water…)

 appropriate interventions in emergency rooms

 well-equipped street-workers and peer outreach workers units

 measures to prevent car and workplace accidents

 social assistance for children of drug dependent individuals
help low and middle income countries
              to build

a community-based continuum of care
     through the ‘normal’ health
      and social services system
    for the vulnerable populations
            at all the stages
    of their problematic conditions
                          strengthening
     social support           family         educational activities
       to families           program           alternative jobs

  life skills                                   sustainable livelihood
  programs
and vocational
   training
                    A continuum                       health and social
                                                        care in prison
                       of care
high-threshold    recovery-oriented                     health and social
  treatment                                            care for vulnerable
    centres                                           to human trafficking

                                        HIV/AIDS         health care and
 low-threshold                        Hepatitis TBC       mental health
   treatment            outreach       prevention          treatment
    centres           interventions   and treatment
1) Advocacy/ethical approach

2) Training, science-based practice dissemination

3) Low cost treatment/health care centers/prevention

4) Data collection / evaluation and research

5) Adaptation to regional country needs /ownership

6) Guidelines and therapeutic tools
Life Skills Training during Junior High School
Up to 56% reduction in drug use by 12th grade

  45
  40
  35
  30
  25
                                 Marijuana
  20
                                 Hallucinogens
  15
                                 Narcotics
  10
   5
   0
       Control    Life
                 Skills
Combination of Olanzapine With Opioid-Agonists in the Treatment
of Heroin-Addicted Patients Affected by Comorbid Schizophrenia
Spectrum Disorders
Results suggest that adding any psychosocial support
to maintenance treatments improve the number of participants
abstinent at follow up (20% increase at 48 weeks)



3,000   Abstinent subjects
                                    associated treatment

                                    single treatment



                                       48 weeks
Countries Worldwide with Treatment UNODC Activities




                    Treatnet II
                   CAM-H90
                    EU-UNODC, Focus on Treatment
                    EU-UNODC
             Countries Worldwide with IDU/HIV UNODC Activities




Russia, Romania, Estonia, Latvia, Lithuania, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Ukraine, Moldova, Egypt,
Palestine, Lebanon, Pakistan, Afghanistan, Nepal, Iran, India, Sri Lanka, Bangladesh, Bhutan, Thailand, Laos, Myanmar, China,
Cambodia, Vietnam, Indonesia, Kenya, Mauritius, Brazil, Argentina, Paraguay, Costa Rica, Maldives, UAE, Yemen, South Africa
         Countries Worldwide with HIV UNODC Activities in Prisons




Algeria, Benin, Morocco, Namibia, Mozambique, Sudan, Swaziland, Togo, Zambia, Kenya, Latvia, Lithuania, Estonia, Russia, Romania,
Egypt, Lebanon, Jordan, Palestine, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Pakistan, Afghanistan, Bangladesh,
Cambodia, Nepal, Iran, India, Malaysia, Maldives, Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras,
Nicaragua, Panama, Bolivia, Ecuador, Peru
 INTEGRATION IN REGIONAL PROGRAMS?

                  Anti-trafficking
                  action

Alternative development                 Anti-corruption
action                                  action
                   25% of police
                   positive for drugs
Building                             Anti-money laundering
criminal justice system              action

                    Anti-terrorism
                    action
POLICE ETHICS
Sustainable Livelihoods:
A broader vision

Social Support and Integration
enabling Prevention
of Illicit Drug Use, HIV Epidemic and Crime
                                                                                Funding
Area of work                    Activity                                        requirements
                                                                                (million US dollars)


                                Establishment and validation of family skills                     10.0
Prevention of drug use          training programmes

Prevention of drug use                                                                             3.0
                                Adapting and mainstreaming evidence-based
                                drug education curriculum in schools

Prevention of drug use                                                                             3.0
                                Developing and establishing workplace
                                prevention programmes in public and private
                                companies

Drug dependence                                                                                   31.0
treatment and                   UNODC-WHO Joint Action Programme on Drug
rehabilitation                  Dependence Treatment


Prevention of HIV and                                                                             70.0
AIDS among drug users, in
prison settings and as it       UNODC obligations towards UNAIDS UBW 2008-
relates to the trafficking in   2009 and 2010-2011, Universal access by 2010,
persons                         MDG 6 by 2015

				
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