Speech by Koenders at Harm Reduction conference
Ladies and gentlemen,
It was last year in Mexico, during the World Aids Conference, that I proposed to organise this conference. It is a great pleasure and honour that we could welcome you here in Amsterdam to discuss a very important topic. Harm reduction in my view requires much more political attention. It requires courage and a lot of effort to put it high on the international agenda. It is a crucial element of the fight against aids. It is about emancipation. It is about a better balance between public security and health policy.
Unfortunately my schedule did not allow me to join you any sooner. I do apologize. Yesterday and this morning I had to attend the Development Council in Prague. As you know development cooperation covers a range of topics and areas that all demand specific attention, time and energy. Among the matters I discussed with my colleagues in Prague were the impact of the financial crisis on developing countries and the millennium development goals.
I am very happy to get here just before you head home with the results of this expert meeting. I understand that it has been a productive conference. You have looked at harm reduction and the responsibilities borne by the various stakeholders: civil society, service providers, governments, and donor agencies. You concluded that you could achieve better results by working together constructively and discuss these issues more candidly. And you haven’t side-stepped practical, political or ethical dilemmas. My job is to support you in your efforts and to look where our combined resources can be directed most effectively.
I would like to see greater support for harm reduction. Hence this conference. Harm reduction is an effective method – the evidence has long been available. But not enough is being done to put it into practice. Harm reduction encompasses policy, strategies and programmes designed to reduce the health risks posed by drug use. After all a world entirely free of drugs is a utopia.
Prevention is a primary aim of Dutch policy on drugs. We make every effort to prevent youngsters from using drugs. But we’re also realistic. There will always be some who experiment and end up getting addicted. We offer those people professional treatment in our public healthcare system. But where treatment isn’t successful, we try to limit the damage caused to the users themselves and to society at large. Health, Security and social implications have to be balanced without naïveté.
We in the Netherlands began providing methadone as a substitution therapy back in the 1960s. From the 1970s onwards, a number of local authorities started setting up drop-in centres. Programmes for exchanging needles were established in the early eighties. Since 2000, courts have been able to order drug-addicted criminals to undergo treatment. And in exceptional cases, by way of a trial, our doctors can prescribe heroin to patients with an incurable addiction.
The Netherlands has a relatively large pool of knowledge and experience when it comes to harm reduction. Our approach is for sure not ideal - and open for discussion - but contrary to what is often claimed, our country has one of the lowest numbers of problem users of hard drugs in the European Union. And the number of HIV infections in this group has fallen from 180 new diagnoses in 2002 to only 30 in 2005. That’s a drop of no less than 600%. This proves that under good circumstances the pragmatic approach can be effective. I am well aware there is no one-size-fits-all. But in my view these figures answer the critics of harm reduction better than any other argument.
The pragmatic approach that we have developed in the Netherlands didn’t come about overnight. As in other parts of the world, harm reduction initiatives started here at grassroots level. They were set up by drug users, their families and friends, informal carers and activists. People who started issuing clean needles from broom cupboards. People who refused to accept the stigmatisation that drug users generally encounter. People who eventually persuaded a majority of Dutch members of parliament that the status quo could not be maintained.
This is how the pragmatic approach came about in this country. It is based on a simple basic idea: drug addiction is (probably) first and foremost an illness. Only once we had accepted this fact could we implement a series of measures that combined to create a more dignified existence for those who, for whatever reason, were addicted to drugs. Only then could our system address the total care requirements of drug users. Only then could we ensure that legislation did not impede, but facilitated access to health care. Only then could drug users be viewed not as the problem but as part of the solution.
I’d like to emphasise this last point. Drug users have to be involved in the decisions that concern them. I was reminded of this during my recent working visit to Vietnam. There I heard the heartbreaking stories of women who were rejected by their families and friends because they had contracted HIV. Because of their drug habit, they had to live precariously at the fringes of society, constantly in fear of abuse and harassment by the police. They had nobody to turn to for protection, support or guidance. Until, with the help of a Dutch NGO (the Medical Committee Netherlands Vietnam) they started to organise themselves and were empowered to stand up for their rights and needs. They adopted the name ‘Cactus Blossom’ for their groups. By working together and with very little support from the NGO, most have been able to take control of their lives. They have negotiated access to health care and many are now engaged in productive employment.
The Cactus Blossom groups illustrate that the active involvement of drug users in the design and implementation of programmes is a condition for success. You have heard other examples during the conference. ‘Nothing for us without us’ is one of the principles of engagement, and rightly so. This principle is also indispensable in our attempts to neutralise the forces of stigma and discrimination.
Ladies and gentlemen,
The pragmatic approach that we advocate is predicated on the dignity of each individual. It is entirely in keeping with the views expressed by the UN Secretary-General on 2008’s International Day against Drug Abuse. He said: ‘As we mark the 60th anniversary of the Universal Declaration of Human Rights, I (…) call on Member States to ensure that people who are struggling with drug addiction be given equal access to health and social services. No one should be stigmatised or discriminated against because of their dependence on drugs.’
We in the Netherlands don’t claim to have a monopoly on the truth. But we have learned the hard way what works and what doesn’t. Based on that experience, we think we’ve come up with methodologies that might prove useful to others. That is why we are keen to share our knowledge and experience in this field. By holding this conference for example. But also by running programmes in prisons in Russia and Central Asia. We do this at bilateral level, like the recent agreement we and Australia reached with the Vietnamese government on setting up their harm reduction programme. And we do it via NGOs.
But we’re very aware that further cooperation and action are urgently needed. To reach the Millennium Development Goals by 2015 certainly. But also to reach the goal the world set itself for 2010 to provide universal access to HIV prevention, treatment, care and support. Each of us has a responsibility to do our very best to achieve that goal. It isn’t enough just to recognise the problem. So I’m delighted to see that, during this conference, proposals have been made that will contribute to better cooperation, data collection and monitoring of our joint progress. The guidelines for action in a development context are laid down in the Accra Agenda for Action. That Agenda defines the roles and responsibilities of all the various parties.
I am pleased that the European Union has now included harm reduction as an HIV prevention instrument in its drugs strategy up to 2012. In July 2007, the EU Horizontal Working Party on Drugs made various recommendations. Harm reduction interventions are also supported by a number of the EU’s neighbours. In the spring of 2007, representatives of EU member states and neighbouring countries signed a declaration in Bremen committing them to joint action aimed at increasing access to HIV prevention. Last weekend the White House announced that the new President will lift the federal ban on needle exchange programmes. We look forward to working constructively with the US in the international arena.
Ladies and gentlemen,
I’d like to conclude by assuring you that the Netherlands sees it as its mission to keep harm reduction on the international policy agenda and to support its translation into concrete action. This conference has put forward some interesting proposals. The Netherlands is keen to be involved elaborating and implementing them.
We will also set out our position clearly at the upcoming negotiations in the Commission on Narcotic Drugs in March and at the special session of the UN General Assembly on drugs in June. We will be aiming for no less than securing the inclusion of harm reduction in the political declaration by which member states determine international drugs policy. We will do the same when, in 2010, the honour of chairing the UNAIDS governing board falls to the Netherlands. You can count on that.
Before I finish, I would like to call on you:
- to continue your advocacy work on behalf of those groups whose fundamental rights are systematically violated;
- to continue fighting against the stigmatisation and discrimination that stops drugs users from accessing crucial health services;
- to work together to revise legislation where necessary; together with members of parliament, service providers, civil society, governments and donors all around the world; and finally,
- to improve data collection so that we can deploy our resources more effectively where the need is greatest.
I would like to thank you again for coming to Amsterdam. I also extend my thanks to the UK, Australia, Germany, UNODC, the Open Society Institute and Aidsfonds for making this conference possible. And I would like to express my gratitude to my own staff for organising this event.