When the AIDS epidemic first roared to life in the 1980s, the slow initial response of world governments to address the outbreak can, in part, be attributed to the stigma of its association with homosexuality. But now what was once derisively termed the “gay plague” is looking more and more like the “drug user plague”.
Outside of sub-Saharan Africa, where the AIDS virus is largely spread through heterosexual intercourse, one in every three new cases of HIV is contracted through the use of injectable drugs. In Central Asia and Eastern Europe, where the virus is spreading fastest, it’s estimated that drug users account for 80% of all HIV cases. And now, just as then, the stigma associated with its victims’ habits is costing lives.
To that end, the organizers of this year’s International AIDS Conference have made the reformation of global drug policy a major theme of discussion. The Vienna Declaration calls for governments and international organizations to decriminalize drug users, conduct aggressive reviews of the effectiveness of their drug policies, and offer more treatment options for this marginalized population.
“Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting,” the declaration admits. “However, reorienting drug policies… has the potential to reduce harm… and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.”
One of the most effective ways of curbing the spread of HIV (as well as hepatitis B and C) is needle exchange programs, which, until recently, could not receive federal funds in the US. Critics of the programs say they encourage drug use, but there hasn’t been any credible data to support this argument. Scientific evidence, in fact, suggests the effect on frequency of drug use is largely neutral. A study of 600 drug users in the US state of Alaska found that users who had access to needle exchange programs did not inject any more often than users that bought syringes at pharmacies. (The study itself met with controversy from advocates who said the trial put half the subjects in unnecessary risk, since the effectiveness of needle exchange programs was already proven.)
The US Congress lifted the ban on using federal funds for needle exchanges in December of last year, but riders added on to appease skittish conservatives may dilute the effectiveness of any programs that attempt to get off the ground. The bill contains the caveat that a needle exchange programs can’t be within 1,000 feet of a school, day care center, or any other place where children might congregate. AIDS activists say this makes it almost impossible to implement programs in urban areas where they are needed most.
Women who use injectable drugs find themselves doubly at risk for HIV from both unprotected sex and drug usage. In many countries, women face criminal penalties for using drugs while pregnant, meaning they’re less likely to seek treatment, and at a higher risk for transmitting the virus to their child.
Whether or not current government leaders will be willing to concede ground on the drug war remains to be seen. Three former presidents of Brazil, Mexico and Columbia — countries hit especially hard by both the drug war — announced their endorsement of the Vienna Declaration today.
“I hope that the Vienna Declaration will inspire many more political leaders to cast aside the drug war rhetoric and embrace evidence-based policies that can meaningfully improve community health and safety,” said Julio Montaner, President of the International AIDS Society, in a press release.
Image: CDC