Global war on drugs is a major factor driving HIV pandemic,

Peter Moszynski

Major reforms of the global drug prohibition regime are urgently
required to halt the spread of HIV infection, according to the Global
Commission on Drug Policy.

The commission, a high level think tank that includes six former
presidents, warns that the global war on drugs is driving the HIV
pandemic among people who use drugs and their sexual partners.

In a report released last week in London, the commission explains how
“repressive drug law enforcement practices force drug users away from
public health services and into hidden environments where HIV risk
becomes markedly elevated,” whilst “mass incarceration of non-violent
drug offenders also plays a major role in increasing HIV risk.”

Injecting drug use accounts for about one third of new HIV infections
occurring outside sub-Saharan Africa. Globally, an estimated 16
million people inject illegal drugs, of whom about three million, or
nearly one in five, are living with HIV.

The average HIV prevalence among drug injectors in China, the US, and
the Russian Federation—the three countries with the largest
populations of injection drug users—is estimated to be 12%, 16%, and
37% respectively.

The commission points out that existing drug law enforcement policies
have failed to reduce global drug supply, quoting figures from the
United Nations Office on Drugs and Crime that show that the worldwide
supply of illicit opiates, such as heroin, has increased by more than
380% in recent decades, from 1000 metric tons in 1980 to more than
4800 metric tons in 2010. This increase coincided with a 79% decrease
in the price of heroin in Europe between 1990 and 2009.

Similar evidence of the drug war’s failure to control supply is
apparent when US drug surveillance data are scrutinised. Despite a
greater than 600% increase in the US federal anti-drug budget since
the early 1980s, the price of heroin in the US has decreased by about
80% during this period, and heroin purity has increased by more than
900%.

And, as was the case with the US prohibition of alcohol in the 1920s,
the global prohibition of drugs “now fuels drug market violence around
the world.”

The report maintains that the war on drugs has led to “a policy
distortion whereby evidence based addiction treatment and public
health measures have been downplayed or ignored.”

It says that a number of countries, including the US, Russia, and
Thailand, ignore scientific evidence and World Health Organization
recommendations and resist the implementation of evidence based HIV
prevention programmes “with devastating consequences.” In Russia, for
example, about one in 100 adults is infected with HIV.

In contrast, countries that have adopted evidence based addiction
treatment and public health measures have seen their HIV epidemics
among people who use drugs—as well as rates of injecting drug
use—dramatically decline.

The report concludes that “any sober assessment of the impacts of the
war on drugs would conclude that many national and international
organisations tasked with reducing the drug problem have actually
contributed to a worsening of community health and safety.”

Cited as: BMJ 2012;344:e4521

Footnotes

The War On Drugs And HIV/AIDS—How The Criminalisation Of Drug Use
Fuels The Global Pandemic is available at
www.globalcommissionondrugs.org/hivaids-pandemic/