The war against drugs is hurting the fight against HIV, according to a new report by the Global Commission on Drug policy, an international panel that advocates science-based strategies to reduce the harm caused by drugs.
"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," the authors said. "The war on drugs has also led to a policy distortion, whereby evidence-based addiction treatment and public health measures have been downplayed or ignored."
Among measures that hamper drug users' access to HIV services, the report cited fear of arrest, restrictions on the provision of sterile syringes to drug users, prohibition of opioid substitution therapy and other evidence-based treatment, as well as the lack of HIV prevention measures in prisons, disruptions in HIV antiretroviral therapy, and in adequate investment in proven HIV prevention strategies.
"High rates of incarceration among drug users with, or at risk of, HIV infection are a matter of deep concern, given that incarceration has been associated with syringe-sharing, unprotected sex and HIV outbreaks in many places around the world," the authors noted.
Globally, an estimated 16 million people inject illegal drugs, of whom about three million - nearly one in five - are living with HIV.
"In addition to promoting the sharing of syringes and other HIV-risk behaviour, punitive drug law enforcement measures create barriers to HIV testing and treatment [among injecting drug users (IDUs)]," the authors said.
The Kenyan government reported that according to a 2011 survey, people who inject drugs have an HIV prevalence of 18.3 percent - one of the highest rates in any population.
Jackson*, 25, a heroin addict, voluntarily admitted himself in February for rehabilitation at a private facility in the Kenyan capital, Nairobi. Not long after he checked himself in, the police raided the centre, bundled him into a police vehicle and charging him with trafficking.
Photo: Sifu Renka/Flickr
|Incarceration is associated with syringe-sharing, unprotected sex and HIV outbreaks (file photo)|
"I knew drugs would kill me because I had even tested HIV-positive. I wanted help and went to the rehabilitation [facility], but the police spoilt all that," he told IRIN/PlusNews. "Yes I was an addict, but there was no evidence at the time and the court released me."
His incarceration in police cells during the seven months that the court process took meant he had no access to treatment for HIV or for his addiction. He says now he is too afraid to even walk into a health facility to get treatment, and instead lives on the streets where he is still using drugs.
"This is the only place where I feel I am safe. Even the hospital belongs to the government, and you don't know if there are informers there," he said. "I can't go - I will die using drugs."
Experts told IRIN/PlusNews that treating drug addiction and abuse as a criminal act rather than as a public health concern was endangering the lives of drug users and their sexual partners.
"The best way to reduce the market for illegal drugs is to sensitize people on its health dangers, rather than to criminalize it. When you criminalize, people simply hide but do not stop using drugs," criminology lecturer Vincent Ombasa told IRIN/PlusNews.
Cynthia Masiga, a health worker in a government health facility in Nairobi, said: "So long as drug abuse is criminal… if a drug addict comes in, I know I am dealing with a criminal. It is very easy for somebody to blame you for not reporting to the police. It is complicated."
Research shows that encouraging IDUs to test for HIV, treating the addiction and the infection, and keeping the individuals in care, is a more successful strategy for preventing the spread of HIV than incarcerating addicts.
The Global Commission on drug Policy report cited a Swiss programme for injecting drug users that distributed syringes, supervised injecting facilities, and made methadone therapy, heroin prescription, and ARVs easily accessible, and saw HIV prevalence among drug users drop from 68 percent in 1985 to about 5 percent in 2009.
The report called for public health bodies in the United Nations system to lead the response to drug use, to push governments to halt the practice of arresting and imprisoning drugs users, and to "replace ineffective measures focused on the criminalization and punishment of people who use drugs with evidence-based and rights-affirming interventions proven to meaningfully reduce the negative individual and community consequences of drug use".
"Act urgently," the authors recommended. "The war on drugs has failed, and millions of new HIV infections and AIDS deaths can be averted if action is taken no."