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The 'War on Drugs' has failed: policy should be based on science and human rights

By Elly Katabira

2 December 2010

The War on Drugs is a failure and is undermining the fight against HIV /AIDS. On World AIDS Day 2010, the International AIDS Society is asking its 19,000 plus membership of HIV professionals around the globe to sign up to the Vienna Declaration and speak with one clear and credible voice to call for a new, evidence-based approach to dealing with illicit drugs.

The evidence has long been in for IAS - over a third of the organisationsīs members work as health care and social services providers on the frontlines of the HIV epidemic. They know that the criminalization of drug users undermines public health efforts by driving drug users underground and away from prevention and care services,

They know that the War on Drugs places individuals already vulnerable to HIV infection in even higher risk settings; incarcerating them in over-crowded prisons where a high prevalence of HIV, a risk of violence, the use of non-sterile drug injection equipment, sexual contacts, tattooing and sharing of razors create an ideal breeding ground for the virus.

Our members also know that in a number of countries, record drug-related incarceration rates have negatively affected the social functioning of entire communities. Racial disparities in drug incarceration rates are also evident world-wide, and are particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.

But donīt just take our memberīs word for it. Look at the simply terrifying picture on injecting drug use an HIV infection emerging in some part of the world.

Outside of sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV. In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia (EECA), HIV prevalence can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group. Policy makers in the EECA region, however, have failed to respond to these startling statistics, and the region is unfortunately notorious in the HIV sector for its human rights abuses, police-brutality and disastrous drug policies. Methadone maintenance therapy, for instance, remains illegal in Russia, despite a high incidence of heroin use and despite the fact that methadone is on the World Health Organization's list of essential medicines and is recognized as one of the most effective treatments for heroin addiction.

IAS members working on the frontline also know what the solutions are.

They know that a human rights based approach to drug use is the only sane public health response . Such an approach has seen extraordinary policy changes in countries like Malaysia where substitution therapy such as methadone and buprephornine and syringe exchange programmes are now available for injecting drug users. Much of this turn around in Malaysian policy has been driven by the work of IAS member Dr Adeeba Kamarulzaman, Professor and Head of Infectious Diseases at the University of Malaya, Kuala Lumpur,

A human rights approach to drug use has seen changes, albeit on a more minor scale, emerging in countries like Ukraine where the prevalence of HIV in prisons is at least 10 times that of the overall population.

On 21 October 2010 several changes, each vital to the protection of the human rights of those living with, working with or affected by HIV in Ukraine, were incorporated into the country's legislation, including the right of HIV-positive injecting drug users (IDUs) and other IDUs to receive Opioid Substitution Therapy (OST). While the implementation of these policies needs to be carefully monitored by the local and international community --there is strong evidence that Ukrainian law enforcement officers systematically harass and intimidate medical and other health personnel involved in providing legal substitution therapy to injecting drug users-there can be doubt that these changes represent an important step forward.

We must also continue to look to the experiences of countries such as Portugal to remind us that revolutionary policy changes can be implemented and can achieve tangible successes. Ten years ago, Portugal had one of the worst injecting drug use problems in Europe , and the rate of HIV infections in drug users was described as a 'humanitarian crisis'. In 2001, Portugal became the first country in Europe to officially abolish criminal penalties for possession of drugs intended for personal use, implementing a decriminalisation programme that focused on prevention, education and treatment. Officials claim that the policy is working and records show a significant fall in levels of petty crime associated with addicts stealing to buy drugs, addiction rates themselves, and the number of HIV diagnoses among intravenous drug users.

The Vienna Declaration, the official statement of the XVIII International AIDS Conference (AIDS 2010)held earlier this year in Vienna, draws attention to and advocates for the removal of futile drug policies which not only fail to achieve the stated objectives of drug law enforcement, but actually result in overwhelmingly negative health and social consequences. Over 17 000 people including many of the worldīs leading scientists have signed on.. As a scientist, I am only too aware that most governments will only respect scientific evidence when public pressure is applied.

I urge all IAS members and the wider public to sign the Vienna Declaration and force governments to acknowledge that an evidence based approach to address the individual and community harms stemming from illicit drug use is the only way forward.


About the IAS

The International AIDS Society (IAS) is the world's leading independent association of HIV professionals, with over 14 000 members from more than 190 countries working at all levels of the global response to AIDS. Our members include researchers from all disciplines, clinicians, public health and community practitioners on the frontlines of the epidemic, as well as policy and programme planners. The IAS is the custodian of the biennial International AIDS Conference, which was held in Vienna, Austria from in July 2010.

Reproduced with permission - "International AIDS Society (IAS)"

International AIDS Society (IAS)

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