A/79/177 25. In the context of harm reduction, the stigma and marginalization associated with certain behaviours and/or substances may be linked with the legal framework surrounding them. For instance, a legal framework that is overreliant on criminal law has fuelled stigmatization and marginalization against individuals engaged in sex work and in the context of abortion, and same-sex relations, as well as in cases of HIV transmission, exposure and non-disclosure. At the same time, a legal framework that is overly lax with corporate actors can contribute to the disproportionate impact of their activities on certain individuals targeted by and/or exposed to marketing practices. 26. For example, in digital advertising, algorithms that are designed to optimize messaging according to previous individual behaviour, can lead persons with substance use disorders or eating disorders to be more exposed to the marketing strategies of the very products that are triggering for them. In this case, while disproportionate exposure occurs, in principle, on the basis of health status, 53 it can compound with other factors, which may also be prohibited grounds of discrimination, including race, gender or socioeconomic situation, 54 thereby increasing health disparities. A. Criminalization of individual behaviours 27. Law and policy can themselves become a conduit to harm, by either enhancing or generating it. In particular, criminalization often disproportionately affects individuals who have historically been more vulnerable, as explored in the present report: in cases of drug use, HIV exposure, transmission and disclosure, abortion, same-sex relations and sex work. 1. Drug use 28. Criminalization is one extreme option and represents a barrier to people who use drugs from seeking health care, 55 both in accessing medicines and services and in establishing therapeutic relationships and continuing treatment regimens when needed, therefore leading to poorer health outcomes as, in addition to stigmatization, people who use drugs may fear legal consequences or judgment and harassment. 56 29. The use of criminal sanctions, including the death penalty, results in more harm to people who use drugs and fails to reduce drug use and trafficking. 57 As of 2023, 34 countries retained the death penalty for drug-related offences. 58 In some countries, punitive and repressive drug policies have also led to extrajudicial killings. 59 30. Despite the fact that opioid-based medicines are included on the Model List of Essential Medicines maintained by the World Health Organization (WHO), many countries do not ensure access for medical use to opioid agonist therapy medicines __________________ 53 54 55 56 57 58 59 8/28 Discrimination on the basis of health status is prohibited as falling under article 2.2 of the International Covenant on Economic, Social and Cultural Rights’ prohibition of discrimination based on “other status”; and Committee on Economic, Social and Cu ltural Rights, general comment No. 20 (2009), para. 33. Committee on Economic, Social and Cultural Rights, general comment No. 20 (2009), paras. 18 –24. Submission from Switzerland. A/HRC/56/52, para. 31; and A/HRC/14/20, para. 47. A/65/255, paras. 14 and 16; and submission from Eleos Justice. Harm Reduction International, The Death Penalty for Drug Offences: Global Overview 2023 (London, 2024), p. 14; and submission from Eleos Justice. Submission from Eleos Justice. 24-13226