Drug war has hand in HIV epi­demic

Austin American-Statesman - - OPINION -

Thou­sands of sci­en­tists, physi­cians and ac­tivists fight­ing the HIV and AIDS pan­demic around the world gath­ered in Vi­enna, Aus­tria, re­cently to dis­cuss the lat­est break­throughs — and frus­tra­tions.

There were re­ports on sev­eral land­mark stud­ies de­scrib­ing the cru­cial role that treat­ments can play in re­duc­ing the in­fec­tious­ness of HIV-pos­i­tive in­di­vid­u­als. And there was en­cour­ag­ing news from Africa, where a study found that an in­tra-vagi­nal anti-vi­ral gel could re­duce by 40 per­cent the risk of HIV in­fec­tion among women who used it.

But there was also sober­ing news at the 18th In­ter­na­tional AIDS Con­fer­ence, in­clud­ing stark ev­i­dence of how the HIV epi­demic is rag­ing unchecked among some pop­u­la­tions of il­licit drug users.

Vi­enna was se­lected to host the bian­nual meet­ing of HIV ex­perts be­cause it is the gate­way to one of the world’s most rapidly grow­ing HIV epi­demics: that among heroin users in East­ern Europe. Out­side sub-Sa­ha­ran Africa, about one in three new HIV in­fec­tions stems from in­ject­ing il­le­gal drugs, and in some parts of East­ern Europe and Cen­tral Asia, 70 per­cent of those who in­ject il­licit drugs are in­fected with the virus.

In re­sponse to these statis­tics, this year’s con­fer­ence en­dorsed as its of­fi­cial state­ment the Vi­enna Dec­la­ra­tion, a doc­u­ment I helped draft to draw wide­spread at­ten­tion to how the U.S.led war on drugs has played a cen­tral role in driv­ing the HIV epi­demic around the world.

Writ­ing in the med­i­cal jour­nal the Lancet, where the Vi­enna Dec­la­ra­tion was also pub­lished, Michel Sidibe, the ex­ec­u­tive di­rec­tor of the Joint United Na­tions Pro­gram on HIV/ AIDS (UNAIDS) and other prom­i­nent sci­en­tific lead­ers stated the sit­u­a­tion suc­cinctly: “The war on drugs has failed.”

Crim­i­nal­iz­ing drug abuse drives ad­dicts deeper un­der­ground and into the kinds of un­safe prac­tices such as nee­dle-shar­ing that spread in­fec­tion. We have seen that coun­tries with the most dra­co­nian drug laws also have the high­est rates of HIV in­fec­tion among users. In Rus­sia, for ex­am­ple, where one in 100 adults is now es­ti­mated to be HIV-in­fected, a drug war has out­lawed ba­sic harm re­duc­tion tools, such as methadone main­te­nance treat­ment. Methadone is on the World Health Or­ga­ni­za­tion’s list of es­sen­tial medicines, but Rus­sian physi­cians can­not openly dis­cuss the need to pre­scribe the treat­ment with­out fear of reprisals.

The mass in­car­cer­a­tion of drug users is par­tic­u­larly alarm­ing, given the spread of HIV in pris­ons. A Pew Trusts anal­y­sis of U.S. Depart­ment of Jus­tice data noted that one in nine black males ages 20 to 34 is in prison, many of them as a re­sult of drug law en­force­ment. Given the link be­tween pris­ons and HIV, it is not sur­pris­ing that in places such as Washington more than 80 per­cent of HIV cases iden­ti­fied be­tween 2001 and 2006 were among blacks.

Be­yond HIV and AIDS, the dec­la­ra­tion also notes that the war on drugs is in­ef­fec­tive. “Na­tional and in­ter­na­tional drug sur­veil­lance sys­tems have demon­strated a gen­eral pat­tern of fall­ing drug prices and in­creas­ing drug pu­rity — de­spite mas­sive in­vest­ments in drug law en­force­ment.” Pro­test­ers called for sup­port for AIDS vic­tims at in Vi­enna, Aus­tria, last week.

In just a few weeks since be­ing made pub­lic, the Vi­enna Dec­la­ra­tion has been en­dorsed by more than 13,600 in­di­vid­u­als, in­clud­ing five No­bel lau­re­ates and var­i­ous other global lead­ers in sci­ence, medicine and pub­lic health.

There also have been signs that the world may be head­ing to­ward more rea­soned drug poli­cies. Just be­fore the Vi­enna con­fer­ence, the Obama ad­min­is­tra­tion an­nounced over­due and wel­come steps to help fight the HIV epi­demic among drug users. Most im­por­tant, given the strong sup­port for sy­ringe ex­change pro­grams from the U.S. In­sti­tute of Medicine and WHO, the ad­min­is­tra­tion has re­versed a long­time ban on fund­ing clean sy­ringe pro­grams.

But there is still much that needs to be done. The Vi­enna Dec­la­ra­tion calls for gov­ern­ments to “im­ple­ment and eval­u­ate a sci­ence-based pub­lic health ap­proach to ad­dress the in­di­vid­ual and com­mu­nity harms stem­ming from il­licit drug use.” Not sur­pris­ingly, con­sid­er­ing that stri­dent spe­cial-in­ter­est groups have long misled U.S. vot­ers into be­liev­ing that the drug war is an es­sen­tial crime-re­duc­tion tool, most govern­ment del­e­ga­tions at AIDS 2010, in­clud­ing the U.S. govern­ment del­e­ga­tion, re­mained largely silent on the Vi­enna Dec­la­ra­tion.

Decades of world­wide drug-re­lated vi­o­lence have made clear that drug pro­hi­bi­tion en­riches or­ga­nized crime and causes blood­shed. But the dev­as­tat­ing pub­lic health con­se­quences of the drug war have been less rec­og­nized, and govern­ment ac­knowl­edge­ment of the link be­tween the war on drugs and the HIV epi­demic is ur­gently needed. The next In­ter­na­tional AIDS Con­fer­ence will be in Washington in 2012. Be­fore that meet­ing, gov­ern­ments around the world will be asked to state a for­mal po­si­tion re­gard­ing the dec­la­ra­tion.

In the mean­time, the dec­la­ra­tion also asks for sev­eral non­con­tro­ver­sial steps, in­clud­ing that gov­ern­ments “un­der­take a trans­par­ent re­view of the ef­fec­tive­ness of cur­rent drug poli­cies.” Given the in­ter­na­tional pub­lic health emer­gency pre­sented by HIV among drug users and the es­ti­mated $2.5 tril­lion in tax dol­lars wasted on the drug war over the last 40 years, the U.S. should move for­ward with this sim­ple call.

Ron­ald Zak

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