HIV - Decriminalise Drugs Worldwide
posted: 20/04/2009
Michele Kazatchkine's surprise intervention calling for the decriminalisation of drug users was widely welcomed by HIV and drugs campaigners who have also been calling for this. Michele Kaztchkine is head of the influential Global Fund to Fight Aids, Tuberculosis and Malaria and was speaking at the 20th International Harm Reduction conference in Bangkok.
Decriminalising personal drug consumption is highly sensitive and, despite intensive lobbying of governments about the possible advantages for public health, many politicians regard the idea of withdrawing criminal sanctions for drug use as politically toxic.
Sharing drug injection equipment, like needles, almost always leads to the passing on HIV. Even though the Global Fund and others have put a lot of money into drug harm reduction, rates of HIV transmission by sharing drug kit have remained stubbornly high.
That Kazatchkine has chosen to speak out now is not a coincidence. It comes close on the heels of renewed and fiercely fought debate on the issue, when the Vatican in Rome attempted to block UN reform of international drugs policy.
Advocates for reform were outraged when in February the pope issued a statement condemning harm reduction strategies as "anti-life" and, in the kind of language guaranteed to stoke up opposition to wider reform, claimed that assisting addicts to access help without fear of criminal penalty would lead to the "liberalisation of the use of drugs".
If the Vatican's statement was inflammatory, its timing also riled. According to campaigners it torpedoed a crucial UN declaration by exacerbating disagreements between countries about whether to collectively endorse harm reduction strategies such as the provision of the drug substitute, methadone.
UN and individual government officials were meeting in February in Vienna as part of the Commission on Narcotic Drugs to work on a new drugs "Declaration of Intent" for the next decade – a significant stage in the evolution of international drugs policy – when the pope's comments were released. The Vatican's action led to Italy withdrawing from a broad EU coalition supporting global harm reduction strategies, weakening the EU in the face of strong opposition from the US, Russia and Japan.
The UK-based drugs charity, Release, an organisation at the forefront of campaigns for decriminalisation, said the outcome was a "weak and hugely disappointing" declaration. A spokeswoman said that despite "a wealth of evidence to support its effectiveness", harm reduction had been sacrificed in favour of ineffective criminal sanctions. "Pages and pages of text endorsed the continuation of tackling drug supply and drug use through zero-tolerance criminal sanctions and law enforcement, a policy that has failed the tens of thousands of injecting drug users now infected with HIV."
HIV - how many infected through drug use?
Obtaining exact figures for the number of injecting drug users globally or the proportion of users living with HIV is problematic. Robust data is difficult to come by due to a number of factors including the fact that illegality discourages people coming forward. Nevertheless there are some reliable estimates and they help explain the current sense of urgency around rates of HIV infection among IV drug users. There are about 33 million people living with HIV globally according to UNAIDS, which compiles statistics for the organisation. It estimates that in 2007 (the most recent year for which data is available), around 2-3 million of the world's 16 million or so intravenous (IV) drug users were likely to be infected with the HIV virus.
Drugs use causes over 80% of all HIV infections in Eastern Europe and central Asia
Illustrating the threat currently presented by HIV infection via IV drug use, a spokeswoman said: "Use of contaminated injection during drug use accounts for more than 80% of all HIV infections in Eastern Europe and central Asia." It is also a "major entry point" for infection in other parts of the world including the Middle East and Latin America. "HIV prevalence among some groups in these regions is estimated at over 40%," she added. In addition – and particularly importantly for those such as Kazatchkine advocating decriminalisation – incarceration for possession of drugs further increases their risk of contracting or transmitting HIV, according to UNAIDS.
Harm reduction works – look at Britain
In its latest report on the global HIV epidemic, UNAIDS echoes the concerns of Kazatchkine. "Until sufficient political will exists to address the sources of HIV risk and vulnerability, the epidemic will continue to expand," it concludes. It also highlights that where countries have adopted a "comprehensive approach" to HIV and drug use (it includes Britain on its list), the spread of HIV among those who inject drugs has slowed.
Kazatchkine argues that it is ultimately "public health oriented pragmatism" that produces results, not misguided criminalisation. However, if the Vienna conference is anything to go by, the widespread adoption of such an approach is still some way off.
As the Global Fund and other bodies working to fight the spread of HIV scramble for extra money in extremely challenging financial times, Kazatchkine says many are waiting with interest to see what sort of lead the US will take on the issue under Barack Obama. With around half of all people living with HIV in the US coming from the African-American community (despite accounting for just 12% of the population), the pressure will be on Obama to act.
"There are strong opponents to harm reduction both among the Republicans and the Democrats," Kazatchkine says. But, he adds, "given the unequal risk for African Americans becoming infected by HIV compared to the white population in the US", the issue is one he would expect the Obama administration to address.
The use of illicit drugs must be decriminalised if efforts to halt the spread of HIV are to succeed, one of the world's leading independent authorities on the disease has warned.
In an unprecedented attack on global drugs policy, Michele Kazatchkine, head of the influential Global Fund to Fight Aids, Tuberculosis and Malaria, told the Observer that, without a radical overhaul of laws that lead to hundreds of thousands of drug users being imprisoned or denied access to safe treatment, the millions of pounds spent on fighting HIV will be wasted.
Kazatchkine used his keynote speech at the 20th International Harm Reduction Association conference today in Bangkok to expose the failures of policies which treat addiction as a crime. He accused governments of using what he calls "repressive" measures that deny addicts human rights rather than putting public health needs first.
Harm reduction works
He argued that governments should fully commit to the widespread provision of harm reduction strategies aimed at intravenous drug users, such as free needle exchanges and providing substitutes to illicit drugs, such as methadone.
Drugs law and policing cause health harm
"A repressive way of dealing with drug users is a way of facilitating the spread of the [HIV/Aids] epidemic," Kazatchkine said. "If you know you will be arrested, you will not go for treatment. I say drug use must not be criminalised. Criminalise trafficking, not users. From a scientific perspective, I cannot understand the repressive policy perspective."
He condemns policymakers who argue that, because drug users frequently turn to crime to fund their habit, it justifies making it a criminal justice issue. Harm reduction both helps the addict and wider society and reduces the need to commit crime, he said. All of the groups affected by HIV, (for example heterosexual and gay African people, gay men, children infected by mothers) have seen great reductions in death rates, apart from one – injecting drug users.
"The one population where [HIV] mortality has been untouched - and in fact has worsened - has been IV [intravenous] drug users. It's amazing, because what we call harm reduction, such as exchanging needles, has been scientifically proven as the most effective.
"This is why I started my speech in Bangkok by mentioning the contrast between major progress achieved in decreasing mortality from HIV in the poorest countries of the world versus the total lack of progress for what is the main route of transmission in most parts of the world outside Africa."
Fears of criticism
Kazatchkine suggested that politicians feared that the public would label them soft on drugs. A doctor and respected HIV expert with 20 years in the field, he has in his two years at the helm of the Global Fund overseen some of the most dramatic improvements in treatment and prevention of HIV globally.
Since it was established in 2001, the fund has received $21bn in contributions from the world's wealthiest nations and used it to play a significant part in reducing rates of new HIV infections. It has also contributed to the distribution of much needed life-preserving anti-retroviral drugs to millions of people already diagnosed.
Alex Stevens, a senior research fellow specialising in drugs and criminalisation at the University of Kent, said the speech highlights many of the troubling consequences of criminal justice approaches to drugs policy.
"In many countries, serious human rights infringements are committed in the name of fighting drugs," he said. "These include the use of the death penalty for drug offences, compulsory treatment regimes that include methods (such as physical beatings) that are akin to torture, and, for example in the USA, depriving convicted drug law offenders of the right to vote."
Stevens said that, while the UK was ahead of many other countries on harm reduction, its tendency to criminalise drug users undermine its efforts.
Total global rethink on drugs needed
What is needed, Kazatchkine argues, is a total rethink of world drugs policies. "What I'm saying is that government's function is to protect their citizens. This is why harm reduction should be supported by all governments everywhere."
Source
earlier report
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