EDGE San Francisco

The worldwide war on drugs is a key factor fueling the global HIV/AIDS epidemic among drug users and their sexual partners, and major policy changes are urgently needed, according to a new report released by the Global Commission on Drug Policy.

"Prohibitionist policies have been shifting the market to stronger drugs and led to a war on users with numerous human rights abuses, police harassment, violence, [and] extortion," said Michel Kazatchkine, former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. "The fear of police and stigma is driving users underground and away from access to information, care, and medical services."



The commission - which includes human rights activists, former United Nations officials, and several former presidents and prime ministers - said that repressive national drug policies and criminalization of drug users drives them away from prevention and treatment services.

The report, entitled "The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic," was released June 26 during an international media teleconference from London featuring commission members Kazatchkine, former president of Colombia Cesar Gaviria, and former president of Switzerland Ruth Dreifuss.

"The public health implications of HIV treatment disruptions resulting from drug law enforcement tactics have not been appropriately recognized as a major impediment to efforts to control the global HIV/AIDS pandemic," according to the report.

Inconsistent use of antiretroviral therapy both threatens the health of people with HIV and makes it more likely that they will transmit the virus to others, according to the report.

Locally, advocates called the report "unprecedented."

"This report is unprecedented: global leaders, including former heads of state, saying that the drug policies promoted and enforced by the United States are one of the reasons that the HIV epidemic is so large and that we need to completely overhaul our approach to drug use and drug users to end HIV/AIDS," said Laura Thomas, the San Francisco-based deputy state director for the Drug Policy Alliance.

The commission also emphasized that illegality of drugs leads to flourishing black markets accompanied by organized crime and violence. Drug enforcement takes resources away from more productive uses, and even strict policies have done little to reduce the availability of illicit drugs.

"The war on drugs is not stopping drug use, and it also contributes significantly to the AIDS epidemic by driving users into the shadows," said commission member Richard Branson, founder of Virgin Records and Virgin Airways, at a drug policy forum in March. "As an entrepreneur, if my business was failing for 40 years, I would close it down."

Worldwide, drug use accounts for an estimated one-third of new HIV infections outside of sub-Saharan Africa. Drug-related HIV transmission is particularly rampant in Russia, Eastern Europe, and parts of Asia. Some U.S. cities are also epicenters of drug-driven epidemics, especially those that do not have established harm reduction programs. Restricted access to drug injection equipment and prohibitions on its possession encourage users to share syringes, one of the most efficient routes for transmission of HIV, hepatitis B and C, and other blood-borne infections.

The commission noted that drug policies are too often based on morality or law enforcement priorities rather than scientific evidence. "While this is a common problem internationally, a number of specific countries, including the U.S., Russia, and Thailand, ignore scientific evidence and World Health Organization recommendations and resist the implementation of evidence-based HIV prevention programs - with devastating consequences," the report states.

"The AIDS epidemic is a harsh and brutal teacher that obliges us to take a scientific approach to deal with sex workers and drug addicts," said Dreifuss. "Public health has to be at least as important as criminalizing the drug traffic."

Studies have shown that drug treatment programs are more effective at reducing drug use than criminal justice solutions, and that harm reduction efforts such needle exchange programs, safe injection facilities, opiate substitution therapy, and legal provision of prescription heroin are effective in reducing disease transmission, overdose deaths, and drug-related crime. Countries that treat drug addiction as a public health issue - including Australia, Portugal, and Switzerland - have dramatically lowered HIV incidence among drug users.

"San Francisco has long understood the connection between HIV/AIDS and drug policy - it’s why we support sterile syringe access and methadone and medical cannabis access, and pushed for harm reduction approaches to methamphetamine use among gay/bisexual men," said Thomas. "We still need to do more if we’re serious about ending HIV here, including establishing supervised injection facilities."

The report makes several recommendations for reform, including "replacing the criminalization and punishment of people who use drugs with the offer of health and treatment services to those who need them."

Mass incarceration of non-violent drug offenders raises the risk of contracting HIV both for prisoners themselves and for the communities they return to. According to the report, 25 percent of HIV-positive Americans may pass through correctional facilities each year, and disproportionate incarceration rates are a major factor underlying markedly higher HIV rates among African Americans.

Other recommendations include breaking the taboo on debating drug policy reform, encouraging governments to experiment with various models of legal regulation of drugs, refocusing law enforcement efforts on violent organized crime and drug traffickers, and promoting alternative sentences for small-scale and first-time dealers.

"The war on drugs has failed," the commission concluded, but "millions of new HIV infections and AIDS deaths can be averted if action is taken now" to change global policies.