We will not end AIDS without drug decriminalisation

By Susie Mclean

SusieAlmost a third of all new HIV cases outside sub-Saharan Africa, are a result of sharing injecting equipment between people who inject drugs. 

Many countries continue to respond to drugs and HIV with punitive law enforcement measures such as arrests, incarceration, criminal penalties and compulsory detention that criminalise and punish users.

Yet, these tough and repressive measures are failing to deter people from using drugs. More than 12 million people in 158 countries currently inject drugs, close to 1.7 million of whom are living with HIV. The United Nation’s Office on Drugs and Crime (UNODC) estimates that illicit drug use will continue to rise by up to 25% between 2012 and 2050.

The evidence for the effectiveness of harm reduction interventions is described by UNAIDS as irrefutable. Yet access to harm reduction services for people who inject drugs is very poor. Harm reduction services struggle with under-funding, political pressure and raids by police and security officials.

We will not end AIDS without drug decriminalisation and a commitment to evidence-based harm reduction.

HIV epidemics amongst people who inject drugs have been averted, or reduced, in settings as diverse as Australia, Viet Nam, Ukraine, Malaysia, China, Portugal, Mauritius and Switzerland. These countries all have certain things in common: harm reduction programmes such as needle and syringe programmes and opiate substitution therapy. They make health services accessible to people who use drugs.

<p>A peer educator in Viet Nam collects used needles.</p>

Yet $100 billion is spent every year, globally, on drug law enforcement. But the number of people using drugs continues to rise. New research published this week in the Lancet by Harm Reduction International shows we could practically end HIV among drug users if just 7.5% of the money spent on drug law enforcement was redirected to harm reduction programmes.

We could practically end HIV among drug users if just 7.5% of the money spent on drug law enforcement was redirected to harm reduction programmes.

The Alliance’s position is clear, we want:

  • Drug policies that will help us end AIDS, in particular, policies aimed at harm reduction among drug users;
  • Decriminalisation of drug possession for personal use;
  • Meaningful involvement of civil society in decision making on global drug policy and HIV; and
  • Monitoring procedures so that we can track the effectiveness of drug enforcement policies.

Despite all the evidence, we hold little hope that global drug policy is about to change. Next week the UN’s Commission on Narcotic Drugs holds its 59th Session in Vienna. UN member states instructed CND to work with civil society groups on developing a so-called ‘Outcome Document’ summarising an approach to global drug policy to be ratified by members states when they meet at the UN in New York in April.

The Alliance along with other civil society organisations and key UN agencies has been working to make the case for harm reduction.

But references to harm reduction in the existing outcome document have remained stubbornly absent and a draft of the document that included explicit reference to measure such as ‘needle and  syringe projects’ and ‘opioid substitution therapies’ have been hurriedly removed after ‘informal meetings’ hosted by CND away from public scrutiny.

Right now, the prospect of securing an approach to global drug policy that will help end AIDS, looks bleak.

Susie McLean is the Alliance's Senior Adviser:  Drug Use and HIV.