- Category: Injection Drug Users
- Published on Tuesday, 03 July 2012 00:00
- Written by Liz Highleyman
The worldwide war on drugs is a major factor sustaining the global HIV/AIDS epidemic among drug users and their sexual partners, according to a new report by the Global Commission on Drug Policy released in advance of the International AIDS Conference later this month in Washington, DC.
The report -- entitled The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic -- contends that repressive national drug policies and criminalization of drug users drives them away from prevention and treatment services, and calls for drug decriminalization and expansion of proven, cost-effective solutions to reduce HIV/AIDS.
"While some countries have virtually eliminated drug-related HIV transmissions, drug war policies in the U.S., Russia, Thailand, and China cause millions of needless infections and AIDS deaths," according to the Commission, which includes human rights activists, former United Nations officials, and several former presidents and prime ministers.
"This report is unprecedented," said Laura Thomas, Deputy State Director in San Francisco for the Drug Policy Alliance. "Global leaders, including former heads of state, saying that the drug policies promoted and enforced by the United States are one of the reasons that the HIV epidemic is so large and that we need to completely overhaul our approach to drug use and drug users to end HIV/AIDS."
According to the report, "[t]he public health implications of HIV treatment disruptions resulting from drug law enforcement tactics have not been appropriately recognized as a major impediment to efforts to control the global HIV/AIDS pandemic." Studies have shown that inconsistent use of antiretroviral therapy both threatens the health of people with HIV and makes it more likely that they will transmit the virus to others.
The commission also emphasized that illegality of drugs leads to black markets accompanied by organized crime and violence. Drug enforcement takes resources away from more productive uses, and even strict policies have done little to reduce the availability of illicit drugs.
"Prohibitionist policies have been shifting the market to stronger drugs and led to a war on users with numerous human rights abuses, police harassment, violence, [and] extortion," said Commission member Michel Kazatchkine, former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, at an international media teleconference from London on June 26, 2012. "The fear of police and stigma is driving users underground and away from access to information, care, and medical services."
Worldwide, drug use accounts for an estimated one-third of new HIV infections outside of sub-Saharan Africa. Drug-related HIV transmission is particularly rampant in Russia, Eastern Europe, and parts of Asia; some U.S. cities are also epicenters of drug-driven epidemics. Restricted access to drug injection equipment and prohibitions on its possession encourage users to share syringes, one of the most efficient routes for transmission of HIV, hepatitis B, and hepatitis C.
"The AIDS epidemic is a harsh and brutal teacher that obliges us to take a scientific approach to deal with sex workers and drug addicts," said Commission member and former president of Switzerland Ruth Dreifuss. "Public health has to be at least as important as criminalizing the drug traffic."
Studies have shown that drug treatment programs are more effective at reducing drug use than criminal justice solutions, and that harm reduction efforts such needle exchange programs, safe injection facilities, opiate substitution therapy, and legal provision of prescription heroin are effective in reducing disease transmission, overdose deaths, and drug-related crime. Countries that treat drug addiction as a public health issue -- including Australia, Portugal, and Switzerland -- have dramatically lowered HIV and hepatitis C incidence among drug users.
The report recommends replacing punishment of drug users with health and treatment services. Mass incarceration of non-violent drug offenders raises the risk of contracting HIV both for prisoners and for the communities they return to. An estimated 25% of HIV positive people in the U.S. may pass through correctional facilities each year, and disproportionate incarceration rates are a major factor underlying higher HIV rates among African Americans.
The report concludes with 11 recommendations:
1. Break the taboo. Pursue an open debate and promote policies that effectively reduce consumption, and that prevent and reduce harms related to drug use and drug control policies. Increase investment in research and analysis into the impact of different policies and programs.
2. Replace the criminalization and punishment of people who use drugs with the offer of health and treatment services to those who need them.
3. Encourage experimentation by governments with models of legal regulation of drugs (with cannabis, for example) that are designed to undermine the power of organized crime and safeguard the health and security of their citizens.
4. Establish better metrics, indicators, and goals to measure progress.
5. Challenge, rather than reinforce, common misconceptions about drug markets, drug use and drug dependence.
6. Countries that continue to invest mostly in a law enforcement approach (despite the evidence) should focus their repressive actions on violent organized crime and drug traffickers, in order to reduce the harms associated with the illicit drug market.
7. Promote alternative sentences for small-scale and first-time drug dealers.
8. Invest more resources in evidence-based prevention, with a special focus on youth.
9. Offer a wide and easily accessible range of options for treatment and care for drug dependence, including substitution and heroin-assisted treatment, with special attention to those most at risk, including those in prisons and other custodial settings.
10. The United Nations system must provide leadership in the reform of global drug policy. This means promoting an effective approach based on evidence, supporting countries to develop drug policies that suit their context and meet their needs, and ensuring coherence among various UN agencies, policies and conventions.
11. Act urgently: The war on drugs has failed, and policies need to change now.
Global Commission on Drug Policy. The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic. June 26, 2012.
Global Commission on Drug Policy. Six Former Presidents, Richard Branson and Other World Leaders: Criminalization of Drug Use Fuels the Global HIV/AIDS Pandemic. Press release. June 26, 2012.