The war on drugs is driving much of the global AIDS pandemic, increasing new infections among injection-drug users in the U.S. and elsewhere, according to a new report from the Global Commission on Drug Policy.
The commission — led by a distinguished panel including the former presidents of Mexico, Poland, Colombia, Brazil and Switzerland, along with Virgin Airlines entrepreneur Richard Branson, the former chair of the Federal Reserve, Paul Volcker, and former Secretary of State George Schulz, among others — finds in its report that about one-third of all new infections outside of sub-Sarahan Africa occur in injection-drug users.
Since the 1990s, effective public-health strategies to curb HIV transmission in drug users have led to drops in new infections in most countries. But over the same time period, seven countries have seen a 25% increase in new infections. Not coincidentally, five of these countries — mainly in Eastern Europe and Central Asia — employ aggressive drug war strategies, such as arresting and incarcerating users for drug or needle possession.
These tactics have been shown to be ineffective not only for controlling drug use, but also for reining in the spread of HIV. Why? Because the fear of recrimination prevents drug users from seeking clean needles — a major risk factor for HIV infection. In the U.S. as well, areas with the highest infection rates are those that have the most aggressive drug policies, the report shows. The solution is straightforward, if drastic; it requires a complete overhaul of current drug policy: drug users need treatment, not imprisonment, and drug possession needs to be decriminalized, the authors argue.
Look no further than New York City, the epicenter of the American HIV epidemic among drug users in the late 1980s and early ’90s, as testament to the effects of a policy about-face. Twenty-five years ago, city law enforcement was battling outdoor drug markets by arresting users en masse; at the same time, the city reported a 50% HIV infection rate among people who injected drugs.
In the early ’90s, the situation began to change. The city started expanding methadone prescribing to help treat users addicted to drugs. Needle-exchange programs, run illegally mostly by AIDS activists from ACT UP, began to be established. At the start, the activists deliberately provoked arrest — but soon the courts would rule that the public health benefits of the programs outweighed any merits of keeping them illegal. Over time, many of the underground needle-exchange programs grew into legal, government-funded operations.
The rate of HIV infection among IV drug users in New York City has fallen by two-thirds since its peak; while injection-drug use once accounted for half of all new infections in the city, today it is linked to fewer than 5%.
The strategy has worked in other cities as well: a 1997 study f0und that HIV infection rates in U.S. cities without needle-exchange programs increased 6% per year; in contrast, infection rates in cities that had clean-needle programs fell by the same amount. International data presented in the new report tell the same story: when access to needles and methadone treatment is expanded — and when drug users do not have to fear arrest for possession of needles — HIV infection rates fall.
Research also shows that the reverse is true. A study published in The Lancet in 2010 found that nearly one-fifth of all HIV infections in the Ukraine may be associated with police beatings of IV drug users during arrest. Because possession of needles can be grounds for arrest and attack, fear of police keeps drug users from obtaining clean needles.
