CDTCs PPT on Rights and Effectiveness - FINAL 9_Aug_2009
1. Compulsory drug treatment
centres in South and East Asia:
Rights and Effectiveness
Sonia Bezziccheri
UNODC Regional Centre for East Asia and the Pacific
Session on Specific populations: Who Is Doing What?
9th ICAAP Bali, Indonesia
10 August 2009
3. 3
UNODC Review: HIV/AIDS and
Custodial settings in SE Asia
An Exploratory Review
into the Issue of
HIV/AIDS and Custodial
Settings in Cambodia,
China, Lao PDR,
Myanmar, Thailand and
Viet Nam. (2006)
4. 4
Methodology
- Purpose: Inform on conditions of CDTCs in
Greater Mekong Sub-region
- 19-item questionnaire
- Literature review
- Limitations: data
- 2009 literature review update
UNODC Review Cont’d
5. What is the CDTCs approach?
A form of restriction of an individual’s personal
freedom in which those drug users or those
suspected of drug use who do not voluntarily
opt for rehabilitation and treatment are forced
to undergo these practices for a determined
period of time.
6. 6
General characteristics
CDTCs are present across the GMS countries and Malaysia
CDTCs are established through either criminal or administrative
law.
CDTCs are often under law enforcement authorities; or the
judiciary, the Ministry of Health and/or the Ministry of Social Affairs.
Considered essential to meet the goal of a Drug Free ASEAN by
2015
Often established under a Prime Ministerial Decree to treat drug users
as ‘patients’ rather than ‘criminals’
Often a result of the decriminalisation of drug use (under
administrative law)
Lacking sufficient funding
High relapse rates post discharge
Contribute to stigma and discrimination of drug users
Contribute to burden public health/ increase HIV risks
Concern for human rights bodies, UN Special Rapporteurs
7. Problem: CDTCs increasing despite lack of
evidence on (cost and treatment) effectiveness
0
10
20
30
40
50
60
70
80
90
100
110
120
2004
2005
2006
2007
2008
2009
Year
NumberofCDTCs
Cambodia
Thailand
Viet Nam
Planned for
2009
8. Problem
Lack of evidence based drug
dependence treatment
1. Treatment generally based on forced abstinence
only – not medically supervised
2. ATS and occasional/recreational users – treatment
inappropriate
4. Unqualified and untrained staff
5. No tailoring to individual needs – lack of assessment
per client basis
6. Lack of aftercare services
7. Not in line with UNODC/WHO Principles of Drug
Dependence Treatment
9. Problem cont’
Treatment outcomes/relapse rate:
China:
China National Surveillance (2005): 62% relapse after 3 days; 20%
relapse after 30 days
WHO (2002): 80% relapse after 2 weeks; 95% relapse after 6 months.
Liu et al. concluded that there is ‘no correlation between
confinement at a drug detoxification centre and drug use (that is
ongoing abstinence from drug use) … detoxification and Rehabilitation
through Labour Centres offer at best only a period of abstinence from
drug use.’
Viet Nam:
WHO (2009) found: 95% relapse
10. Problem cont’
HIV high risk behaviours in CDTCs
reported by every country:
Injecting drug use - sharing of needles and diluents
Unprotected sex
Tattooing
Penile modification
Blood splatters (via rape and other violence)
Use of others’ razor/toothbrush
11. Problem cont’
HIV Prevalence
Viet Nam: study in 6 of the 06 Centres show HIV
prevelence ranged from 30 to 65% (Martin G et al
2005)
China:
National HIV prevalence in the Rehabilitation through
Labour Centres 5% (Bureau of RE-education
Administration 2006)
HIV prevalence amongst IDUs in CDTC in Cai Yuan
City, China, was estimated at 42% (Dolan et al., 2004)
12. UNODC Review
Problem cont’
Lack of HIV Services for PWID
1. Only 1 (IEC) out of 9 intervention for HIV prevention for injecting
drug users advocated by UNODC/WHO/UNAIDS on offer in most
countries in CDTCs
2. No access to Oral substitution therapy and disruption of MMT
3. No access to condoms
4. No access to syringes
5. Poor general health care / access
6. Limited access to ARV / disruption of ARV treatment
However, controlling the transmission of HIV as well as hepatitis and
tuberculosis, were prioritised by the GMS countries in a UNODC
regional review, as the most important health risks which needed to
be addressed in CDTCs.
13. Problem cont’: Overlap with prison
Pre-trial detention conditions in Thailand
(pre-assessment period of 45 days in
prison prior to CDTCs)
1) Restricted health care access
2) Poor living conditions
3) Forced withdrawal – not medically
supervised
4) HIV infection risk high in prison (IDU, MSM,
violence, penile modification)
14. Problem cont’
A cost effective approach?
Recent Viet Nam study says ‘No’
USD
Unit costs per resident in centers
Rural $225
Urban $641
Unit cost of interventions
VCT*
$23.6
Needle & Syringe programs $15-21
per clean needle $0.10
Drug substitution treatment $292-$587
* VCT includes ELISA test, distribution of condoms, IEC materials and consultancy
Courtesy PPT by Martin G et al ‘Does Rehabilitation in closed settings
work in Viet Nam? IHRA 2009 UNODC/OSI Major Session on CDTCs
15. Human Rights Intl. Standards,
Norms
Current CDCTs approach of confinement of drug users is not aligned
with:
1. International Covenant on Economic, Social and Cultural Rights:
The Right to the Highest Standard of Physical and Mental Health
2. International Covenant on Civil and Political Rights
3. Convention on the Rights of the Child
4. Convention against Torture and other Cruel, Inhumane and
Degrading Treatment or Punishment
5. WHO/UNODC Principles of Drug Dependence Treatment
Discussion Paper
6. Alternatives to Imprisonment: UNODC guidelines for developing
non-custodial sentencing approaches for drug dependent people
who engage in petty drug related offences.
16. 16
Conclusions
The CDTCs approach:
1. Is an ineffective response: it fails in its primary objective of supporting drug
dependent people to achieve abstinence
2. Does not provide evidence based drug dependence treatment:
No clinical assessment/diagnosis to establish drug dependence
No individualized treatment for drug dependence
Only one form of ‘treatment’ available: abstinence
3. Addresses drug dependence as a criminal or administrative offence rather than
a chronic relapsing health condition with the result of involuntary
confinement and ‘treatment’
4. Is an inefficient investment in drug dependence treatment
cost ineffective
5. Raises issues of human rights of drug users
6. Is not recognised as an ‘alternative to imprisonment’
7. Increases HIV risks and stigma for everyone who is confined:
Higher prevalence of HIV and increased HIV risk
Does not provide the comprehensive package recommended by UNODC/WHO/UNAIDS
Disrupts HIV treatments and MMT
CDTC do not meet international guidance for the provision of HIV services for PWID and
programmes in closed settings, consistent with WHO principle of equivalence (1993).
17. 17
Recommendations
1. Drug dependence should be seen as chronic relapsing health
condition
2. Further evaluation/review of cost and treatment effectiveness of
CDTCs is required
3. HIV comprehensive package (9 interventions) offered voluntarily in the
community + in all closed establishments (i.e. CDTCs) based on WHO
Principle of Equivalence
4. Increase investment in effective/evidence based drug dependence
treatment
5. Cease long period of detention without trial/access to health care
6. Respect for human rights of drug dependent people/occasional users
7. Involve NGOs/civil society/families/affected community in the research;
design, and implementation of responses
20. 20
Example of success: Iran’s
experience
1980s CDTC approach under State Social Welfare
CDTC was experimental, not evidence based
1983: plan to scale up CDTC in all 30 provinces; but
reached only 13 centres
Relapse rate: > 90%
Courtesy Dr Parviz Afshar, Senior Advisor for Minister of Welfare and Social Insurance
21. 21
Iran’s experience cont’d
Comprehensive HIV package for
people who inject drugs in the
community and in prisons
1996: HIV outbreak in CDTCs
2002: A comprehensive HIV/AIDS package for injecting drug users
implemented with triangular clinic model in community and in prisons,
including comprehensive aftercare
2002-2006: rapid scale up; and decreased HIV infections, re-
incarceration, relapse rates
2007: CDTC approach declared ineffective and abandoned
Courtesy Dr Parviz Afshar, Senior Advisor for Minister of Welfare and Social Insurance
Editor's Notes
The presentation is organized into 5 sections:
1. UNODC Regional Review: summary of the UNODC RCEAP review of “HIV/AIDS and Custodial Settings in South East Asia
2. Problems : what we understand on health and custodial settings in South East Asia
3. Conclusions: what we can overall conclude from the findings and what remain unanswered
4. Recommendations: what we recommend as the ‘way forward’ as based on the gaps identified
5. UNODC strategy: what the UNODC plans to do to address the issues raised, and how these planned activities relate to the UNODC Regional Centre for East Asia and the Pacific UNRPF
The purpose of the review was to inform UNODC on health conditions on custodial settings in South East Asia, including compulsory drug treatment centres (CDTCs).
The review covers the Greater Mekong Sub-Region Countries (Cambodia, China, Lao PDR, Myanmar, Thailand and Viet Nam). Findings of the review were published in the publication: HIV/AIDS and Custodial Settings in South East Asia: An Exploratory Review into the Issue of HIV/AIDS and Custodial Settings in Cambodia, China, Lao PDR, Myanmar, Thailand and Viet Nam.
A note on methodology:
The review was initiated by formal letter sent to all UNODC field offices in the countries under review specifying the objectives of the project and requesting information on HIV/AIDS in custodial settings. The letter was also sent to UNAIDS, WHO and UNICEF offices, and to the wider regional UNODC RC networks and counterparts.
However, a very limited amount of information was received in response to the letter, hence reflecting the scarce attention given to such issues in the Greater Mekong Sub-Region. In response to this gap and with the assistance of experts, a 19-item questionnaire on HIV/AIDS and drug use in custodial settings was compiled and distributed to the six countries. Discrete results were gathered:
Cambodia and Myanmar filled the questionnaire as requested. Thailand, reflecting an enhanced data collection capacity, was the only country that completed separate questionnaires for prisons, juvenile detention centres and compulsory drug treatment centres. Lao PDR and China filled the questionnaire only with regard to compulsory drug treatment centres; no information was received on prisons. No response to the questionnaire was received from Viet Nam.
In addition to the questionnaire results, the project team reviewed the literature on existing assessments, projects and other information as provided by national and international organisations on conditions, health and management in custodial settings.
The limitations of this review are many, first and foremost, data gathered is only based on received questionnaires from governments, and literature review. None of the centres were formally evaluated, and no studies on high risk behaviours/vulnerabilities and quality of drug treatment were found at the time. Lack of data on HIV/AIDS in custodial settings will be a major finding of this work.
These centres contribute to stigma and discrimination:
The United Nations Special Rapporteur on Torture states that the acceptance of involuntary treatment and involuntary confinement runs counter to the provisions of the Convention on the Rights of Persons with Disabilities (CRPD), and that such practice may constitute torture or cruel, inhuman or degrading treatment or punishment.[1] Furthermore, Mr Nowak affirms:
"The Convention on the Rights of Persons with Disabilities (CRPD), states clearly that deprivation of liberty based on the existence of a disability is contrary to international human rights law, is intrinsically discriminatory, and is therefore unlawful. Such unlawfulness also extends to situations where additional grounds—such as the need for care, treatment and the safety of the person or the community—are used to justify deprivation of liberty."[2]
[1] http://www2.ohchr.org/english/issues/disability/torture.htm
[2] http://www.ohchr.org/EN/UDHR/Pages/DetaineesWeekInitiative.aspx
Problem:
Incarceration of drug dependent people in compulsory drug treatment centres (CDTC) is common trend; this was reported by 5 out of the 6 countries that were surveyed:
Cambodia is the only surveyed country that at the time of the questionnaire did not report on any such centres.
2. China reported on 140,000 clients and 516 CDTC in 2005 . ( However, according to the ‘Standing Committee of the National People’s Congress, there are 746 DTCs and 168 Rehabilitation Through Labour (RTL) centres. According to 1999 data, every year around 220,000 drug users are treated at compulsory rehab centres, and around 120,000 at RTL camps around the country. (HIV/AIDS and Custodial Settings in South East Asia p. 28)
3. Lao PDR reported 1,319 clients in 2004, and 844 clients in 2005; and a total of three CDTCs.
4. Myanmar reported 1,492 (2005); and 26 major and 40 minor CDTCs.
5. Thailand reported 9,781 (2004) and 2,358 (2005) people in compulsory drug treatment centres, with 35 centres in 2004, and 49 in 2005. Additionally, Thailand reported on 17 ‘youth training centres’ with 3,500 young inmates in 2004 and 2005.
6. Viet Nam did not report. It is reported elsewhere, however, that CDTCs may house around 100,000 in 80 so-called ‘05-06’ CDTCs around the country – hence outpacing population in prisons proper at 55,000 people.
CDTC Approach Increasing
As a response to increased drug use and overcrowding in prison the number of CDTCs in the region is growing.
The policy of viewing a drug user as ‘patient’ rather than criminal, has resolved in the increasing the number CDTCs - rather than more availability of voluntary, evidence based drug treatment in the community.
In fact:
In Thailand, CDTCs increased from 35 in 2004, to 49 in 2005, and to 84 in 2008, with 14 more planned for this year
(Canadian Legal Network. Compulsory Drug Treatment in Thailand: Observations on the Narcotic Addict Rehabilitation Act B.E. 2545 (2002). Toronto, Canada. 2009. Page 16-17)
2. In Cambodia, while the country did not report on any such centres at time of questionnaire, by 2008 there were 14
(Interview with WHO Cambodia and the National Authority for Combating Drugs (NACD), January 2009)
3. Lao PDR increased them from 3 to 4 in 2008 and to 9 (8 of which are operational) in 2009
(UNODC internal document from Interview with Manjul Khanna, Project Coordinator of RAS I09/I13)
4. In Vietnam the number has risen from 80 CDTCs in 2005 to the present number of 109
(OSI. ‘At what Cost? HIV and Human rights consequences of the global ‘war on drugs.’ New York, USA. March 2009. P. 157.)
1) CDTCs seldom offer effective treatment based on scientific evidence
2) Compulsory drug treatment are abstinence oriented and based on forced abstinance; hence pharmacological interventions such as oral substitution maintenance therapy for opioid dependence – are not available in any countries under the review (though some detoxification centres in China provide opioid substitutes like methadone and buprenorphine to some degree as part of the detoxification process).[1]
[1] Cohen, J.E. and Amon, J.J. (2008). Health and Human Rights Concerns of Drug users in Detention in Guangxi Province, China. PLoS Medicine, 5(12), p. 1686.
Therapy in China
China also implements counselling on limited scale – though it is provided by trained security staff rather than health professionals.
A pilot relapse prevention program is available to small number of inmates at Shanghai Rehabilitation Labour Camp;
Thailand provided a greater range of options including TC, relapse prevention, family therapy.
(UNODC Review: “HIV/AIDS in Custodial Settings”, 2006)
Lack of effectiveness evidence
The first Therapeutic Community (TC) was established at a labour camp in Hunan and was favourably evaluated against standard re-education through labour approach. A six month follow up TC inmates and standard inmates found that TC inmates has significantly lower score on the Addiction Severity Index (ASI). (M. Zhao et., 2002).
3) Many people confined within CDTCs would be assessed to be only occasional or recreational drug users requiring only a minimal level of treatment, if any
(Dolan, K. et al. An analysis of demand reduction strategies in prisons and compulsory drug treatment settings in China, Indonesia and Viet Nam. The National Drug and Alcohol Research Centre (NDARC). 2007. Sydney, Australia. (In publication).
In many countries in the region
the primary drugs of abuse are Amphetamine Type Stimulants (ATS) – accounting for over 91% of those treated in Thailand for example
(Canadian Legal Network. Compulsory Drug Treatment in Thailand: Observations on the Narcotic Addict Rehabilitation Act B.E. 2545 (2002). Toronto, Canada. P. 15.)
Even in countries where opiates, and particularly heroin, remain the primary drugs of choice, such as China, there is a growing trend towards the use of ATS.
(Lu, L. and Wang, X. (2008). Drug Addiction in China. Annuls of the New York Academy of Science, 1141, p. 307.)
However, there is no data that cognitive and behavioural therapies as well as contingency management are provided for ATS dependence in the CDTCs.
As for the quality of drug treatment provided, we understand that:
Evidence based drug dependence treatment and after care services are seldom offered:
China and Myanmar reported on the provision of peer drug education in custody.
5. Where some ‘treatment’ is provided, it is generally applied in the same fashion to all, regardless of particular needs – with clients having no autonomy or meaningful choices over what treatment they receive.[1] [1] Canadian Legal Network. Compulsory Drug Treatment in Thailand: Observations on the Narcotic Addict Rehabilitation Act B.E. 2545 (2002). Toronto, Canada. 2009. p.22.
This approach is not in line with the UNODC/WHO Principles of Drug Dependence Treatment whereby competent staff must develop “individual care plans with the patient
Evidence based drug dependence treatment and after care services are seldom offered:
China and Myanmar reported on the provision of peer drug education in custody.
Particularly, China also implements counselling on limited scale as provided by trained security staff rather than health professionals.
A pilot relapse prevention program is available to small number of inmates at Shanghai Rehabilitation Labour Camp;
The first Therapeutic Community (TC) was established at a labour camp in Hunan and was favourably evaluated against standard re-education through labour approach. A six month follow up TC inmates and standard inmates found that TC inmates has significantly lower score on the Addiction Severity Index (ASI). (M. Zhao et., 2002).
Thailand provided a greater range of options including TC, relapse prevention, family therapy.
Compulsory drug treatment are abstinence oriented; hence pharmacological interventions such as oral substitution maintenance therapy for opioid dependence – are not available in any countries under the review, whether in prison proper or compulsory drug treatment centres.
The outcome of these multiple treatment shortcomings is high relapse rates that range from 80% to 100%
Zhou Y, Li X (1999) Demographic characteristics and illegal drug use patterns among attendees of drug cessation programs in China. Substance Use Misuse 34: 907–920.
For example in China, WHO reports the relapse rate among those who had experienced detoxification centres of all kinds to be 80% after 2 weeks and over 95% after 6 months
(WHO. The practices and context of pharmacotherapy of opioid dependence in South East Asia and Western Pacific regions. WHO doc. WHO/MSD/MSB/02.1,2002. P. 30)
Indeed, one study in China found no correlation between confinement at a drug detoxification centre and drug use (that is ongoing abstinence from drug use) with the authors concluding that detoxification and Rehabilitation through Labour centres offer at best only a period of abstinence from drug use.
(Liu H, Grusky O, Zhu Y, Li X (2006) Do drug users who frequently receive detoxification treatment change their risky drug use practices and sexual behavior. Drug Alcohol Depend 84: 114–121.)
In Viet Nam, 95% of ex-confined drug users return to using after leaving the centres
(WHO Regional Office for East Asia and the Pacific. Assessment of Compulsory Treatment of People Who Use Drugs in Cambodia, China, Malaysia and Viet Nam: An Application of Selected Human Rights Principles. Manila, Philippines. 2009)
High HIV risk behaviours are prevalent inside CDTCs (and the acknowledgement by some authorities that HIV is prevalent amongst CDTCs’ patients).
including:
Injecting drug use - the sharing of needles
MSM,
Tattooing
Blood splatters (via rape and other violence)
Use of others’ razor/toothbrush
Human Rights Watch. An Unbreakable Cycle- Drug Dependency, Mandatory Confinement, and HIV/AIDs in China’s Guangxi Province. New York, USA. December 2008, p. 30.
UNODC RC Review: “HIV and Custodial Settings”, 2006
Lack of HIV services for People Who Inject Drugs (PWID):
Except for education, information and communication material none of the nine interventions recommended by UNODC and WHO are available in the Greater Mekong Sub-region with the exception of Thailand (UNODC,WHO,UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Geneva. 2009. P. 7-8.)
2. As treatment is predominantly detoxification based, there is generally no provision of OST, with those having received MMT outside of the centres having their MMT disrupted
3. No distribution of condoms
UNODC Review: “HIV/AIDS in Custodial Settings”, 2006
Why?
The UNODC review of 2006 pointed to a severe lack of financial support, shortage of qualified staff and a general negative attitude towards AIDS patients as being are major barriers for the provision of adequate services.
Further, people who are confined face a higher risk of exposure to other infectious diseases; tuberculosis is several times higher in prison if compared to the community.
HIV and AIDS cases in prison settings reported by countries in the UNODC Review:
HIV cases among inmates were reported in Cambodia (28 cases, 0.37 per cent), Myanmar (610, including 351 women, 0.94 per cent) and Thailand (869, 0.49 per cent).
However, data from vulnerability assessment in China and Viet Nam:
National HIV prevalence in the Rehabilitation through Labour Camps in China is estimated at 5% (Bureau of RE-education Administration 2006)
HIV prevalence among IDUs in drug treatment centre in Cai Yuan City, China, was estimated at 42% (Dolan et al., 2004)
AIDS related deaths were reported also by Cambodia (ten, 0.13 per cent), Myanmar (184, including 19 women, 0.28 per cent) and Thailand (331, 0.18 per cent).
5. These factors are compounded by the general poor access to health care facilities in the centres
6. And in particular access to ARV treatment
Cohen, J.E. and Amon, J.J. Health and Human Rights Concerns of Drug users in Detention in Guangxi Province, China. PLoS Medicine. 2008. 5(12). P. 1685; Human Rights Watch An Unbreakable Cycle- Drug Dependency, Mandatory Confinement, and HIV/AIDs in China’s Guangxi Province. New York, USA. December 2008. P. 28-29.
Of serious concern are the conditions individuals’ experience when held in pre-trial (or “assessment”, in the case of Thailand) detention.
Those confined have restricted access to health care, poor living conditions such as overcrowded cells and the insufficient provision of food.[1]
Furthermore, individuals suffer de facto forced detoxification with no medical supervision or provision of opioid substitution therapy (OST) for those who are opioid dependent, or psychosocial interventions for those with mental health difficulties[2].
The WHO/UNODC Principles of Drug Dependence Treatment instead states: ‘the main goal of detoxification programmes is to achieve withdrawal in as safe and as comfortable a manner as possible.’[3]
As with conditions inside CDTCs, there is a high risk of HIV infection in the pre-assessment period spent in prison in Thailand; this is due to the prevalence of risky behaviour such as needle sharing – a consequence of the lack of sterile needle provision.[4]
[1] ICESCR. Article 11.
[2] Canadian Legal Network (2009) Compulsory Drug Treatment in Thailand: Observations on the Narcotic Addict Rehabilitation Act B.E. 2545 (2002). Toronto, Canada. P. 11-18.
[3] UNODC. Drug Abuse Treatment and Rehabilitation: A Practical Planning and Implementation Guide. 2003. p. IV.2, at www.unodc.org/pdf/report_2003-07-17_1.pdf.
[4] A. Buavirat et al. Risk of prevalent HIV infection associated with incarceration among injecting drug users in Bangkok, Thailand: case-control study. British Medical Journal. 326 (2003): 308–326;
K. Choopanya et al. Incarceration and risk for HIV infection among injection drug users in Bangkok. Journal of AIDS 29(1) (2002): 86–94.
The current CDTCs approach contravene a number of human rights enshrined in these covenants;
in fact in the name of drug treatment, there have been incidents of:
absence of fair trial rights and arbitrary arrest and interference with privacy;
Mandatory HIV testing;
Lack of evidence drug dependence treatment and HIV prevention, treatment and care for DU/IDUs, a contravention of the Right to Health;
Lack of informed consent especially for non-evidence based approach
Torture, cruel, inhuman and degrading treatment;
Etc.
In conclusion:
CDTC approach is ineffective in its primary objective: to make people who use drugs free from drugs and drug dependence
CDTCs approach is cost ineffective; not based on evidence, or human rights
Drug dependence/use is treated as criminal or administrative offence rather than chronic relapsing health condition
CDTCs is not recognised as an ‘alternative to imprisonment’
Many drug users in CDTCs are not diagnosed as drug dependent
High prevalence of HIV and of HIV risks = everyone at risk
Disruption of treatment upon confinement (ARV, MMT)
Given intl. standards for the provision of HIV services for PWID and programme in closed settings, these should be available in CDTCs in line with 1993 WHO principle of equivalence
Recommendations:
HIV comprehensive package (9 interventions) offered voluntarily in the community + in all closed establishments (i.e. CDTCs)
Evidence based drug dependence treatment be provided in CDTCs
Respect for human rights of drug dependent people/occasional users
Drug dependence should be seen as chronic relapsing health condition
Evaluation/review of cost/treatment effectiveness of CDTCs
Cease long period of detention without trial/access to health care
Involve NGOs/civil society/families/affected community in the research; design, and implementation of responses
UN guidance documents that can be adapted to CDTCs
WHO/UNODC/UNAIDS Technical Guide for countries to set targets for Universal Access to HIV prevention, Treatment and Care for Injecting Drug Users.
UNODC/WHO Principles of Drug Dependence Treatment, Discussion Paper.
WHO Inside Out HIV Harm Reduction Education for Closed Settings
UNODC/UNAIDS HIV/AIDS Prevention, Care, Treatment and Support in Prison Setting: A Framework for an Effective National Response.
UNODC HIV and AIDS in places of detention: A toolkit for policy makers, programme managers, prison officers and health care providers in prison settings
