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This article discusses the central importance in Western Europe of active drug users/injectors working with their peers to combat the spread of HIV and reduce other health problems. The structure and workings of several different peer organizations are described, and an important distinction is made between “self-help” versus drug-user “unions” or “interest” groups. The roots of the first drug-user unions are traced to the junkiebonden that surfaced in the Netherlands in the early 1970s. Now, the European Peer Support Project, which is described, coordinates projects in six different western European countries, supporting several different initiatives, and producing training programs and manuals for users to assist them in their organizing efforts. The underlying premise of drug-user self-organizations is that repressive drug policy, as defined by criminal laws, is not only a fundamentally inappropriate approach to the “drug problem;” repressive drug policy is partly responsible for the creation of the “drug problem” in the first place.

BackgroundCorrectional centre populations are one of the populations most at risk of contracting HIV infection for many reasons, such as unprotected sex, violence, rape and tattooing with contaminated equipment. Specific data on drug users in correctional centres is not available for the majority of countries, including South Africa. The study aimed to identify the attitudes and knowledge of key informant (KI) offender and correctional centre staff regarding drug use, health and systemic-related problems so as to facilitate the long-term planning of activities in the field of drug-use prevention and systems strengthening in correctional centres, including suggestions for the development of appropriate intervention and rehabilitation programmes.MethodA Rapid Assessment Response (RAR) methodology was adopted which included observation, mapping of service providers (SP), KI interviews (staff and offenders) and focus groups (FGs). The study was implemented in Emthonjeni Youth Correctional Centre, Pretoria, South Africa. Fifteen KI staff participants were interviewed and 45 KI offenders.ResultsDrug use is fairly prevalent in the centre, with tobacco most commonly smoked, followed by cannabis and heroin. The banning of tobacco has also led to black-market features such as transactional sex, violence, gangsterism and smuggling in order to obtain mainly prohibited tobacco products, as well as illicit substances.ConclusionHIV, health and systemic-related risk reduction within the Correctional Service sector needs to focus on measures such as improvement of staff capacity and security measures, deregulation of tobacco products and the development and implementation of comprehensive health promotion programmes.

Demand-based estimates of total cannabis consumption rarely consider differences among different user types and variation across countries. To describe cannabis consumption patterns and estimate annual consumption for different user types across EU Member States, a web survey in Bulgaria, Czech Republic, Italy, the Netherlands, Portugal, Sweden and United Kingdom (England & Wales) collected data on cannabis use patterns from 3,922 persons who had consumed cannabis at least once in the past year. They were classified into four groups based on their number of use days in the past 12 months: infrequent users or chippers (<11 days), occasional users (11-50 days), regular users (51-250 days) and intensive users (>250 days). User type specific data on typical amounts consumed were matched with data on numbers of users per user type estimated from existing population surveys, taking differences in mode of consumption, age and gender into account. Estimates were supplemented with data from populations of problem users to compensate for under coverage. Results showed remarkably consistent differences among user groups across countries. Both the average number of units consumed per typical use day and the average amount of cannabis consumed per unit increased across user types of increasing frequency of use. In all countries except Portugal, intensive users formed the smallest group of cannabis users but were responsible for the largest part of total annual cannabis consumption. Annual cannabis consumption varied across countries but confidence intervals were wide. Results are compared with previous estimates and discussed in the context of improving estimation methods.