Pubdate: Wed, 28 Apr 2010
Source: Los Angeles Times (CA)
Page: A15
Copyright: 2010 Los Angeles Times
Contact: http://mapinc.org/url/bc7El3Yo
Website: http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: Evan Wood
Note: Evan Wood, a physician and associate professor of medicine at 
the University of British Columbia, directs the Urban Health Research 
Initiative at the BC Centre for Excellence in HIV/AIDS.
Cited: 18th International AIDS Conference http://www.aids2010.org/
Referenced: The Vienna Declaration http://www.viennadeclaration.com/

DRUG WAR'S COLLATERAL DAMAGE

Governments Need to Acknowledge the Link Between HIV Epidemic and 
Anti-Drug Policies.

Last week, thousands of scientists, physicians and activists fighting 
the HIV and AIDS pandemic around the world gathered in Vienna to 
discuss the latest breakthroughs - and frustrations.

There were reports on several landmark studies describing the crucial 
role that treatments can play in reducing the infectiousness of 
HIV-positive individuals. And there was encouraging news from Africa, 
where a study found that an intra-vaginal anti-viral gel could reduce 
the risk of HIV infection among women who used it by 40%.

But there was also sobering news at the 18th International AIDS 
Conference, including stark evidence of how the HIV epidemic is 
raging unchecked among some populations of illicit drug users.

Vienna was selected to host the biannual meeting of HIV experts 
because it is the gateway to one of the world's most rapidly growing 
HIV epidemics: that among heroin users in Eastern Europe. Outside 
sub-Saharan Africa, about 1 in 3 new HIV infections stems from 
injecting illegal drugs, and in some parts of Eastern Europe and 
Central Asia, 70% of those who inject illicit drugs are infected with 
the virus. Get the best in Southern California opinion journalism 
delivered to your inbox with our Opinion L.A. newsletter. Sign up A)

In response to these alarming statistics, this year's conference 
endorsed as its official statement the Vienna Declaration, a document 
I helped draft to draw widespread attention to how the U.S.-led war 
on drugs has played a central role in driving the HIV epidemic around 
the world.

Writing in the medical journal the Lancet, where the Vienna 
Declaration was also published, Michel Sidibe, the executive director 
of the Joint United Nations Program on HIV/AIDS (UNAIDS) and other 
prominent scientific leaders stated the situation succinctly: "The 
war on drugs has failed."

Criminalizing drug abuse drives addicts deeper underground and into 
the kinds of unsafe practices such as needle-sharing that spread 
infection. We have seen clearly that countries with the most 
draconian drug laws also have the highest rates of HIV infection 
among users. In Russia, for example, where 1 in 100 adults is now 
estimated to be HIV-infected, a fierce drug war has outlawed basic 
harm reduction tools, such as methadone maintenance treatment. 
Methadone is on the World Health Organization's list of essential 
medicines, but Russian physicians cannot even openly discuss the need 
to prescribe the treatment without fear of reprisals.

The mass incarceration of drug users is particularly alarming, given 
the spread of HIV in prisons. A Pew Trusts analysis of U.S. 
Department of Justice data noted that 1 in 9 African American males 
aged 20 to 34 is in prison, many of them as a result of drug law 
enforcement. Given the link between prisons and HIV, it is not 
surprising that in places such as Washington more than 80% of HIV 
cases identified between 2001 and 2006 were among African Americans.

Beyond HIV and AIDS, the declaration also notes that the war on drugs 
is ineffective. "National and international drug surveillance systems 
have demonstrated a general pattern of falling drug prices and 
increasing drug purity - despite massive investments in drug law enforcement."

In just a few short weeks since being made public, the Vienna 
Declaration has been endorsed by more than 13,600 individuals, 
including five Nobel laureates and various other global leaders in 
science, medicine and public health.

There also have been signs that the world may be heading toward more 
reasoned drug policies. Just before the Vienna conference, the Obama 
administration announced overdue and welcome steps to help fight the 
HIV epidemic among drug users. Most important, given the strong 
support for syringe exchange programs from the U.S. Institute of 
Medicine and WHO, the administration has reversed a longtime ban on 
funding clean syringe programs.

But there is still much that needs to be done. The Vienna Declaration 
calls for governments to "implement and evaluate a science-based 
public health approach to address the individual and community harms 
stemming from illicit drug use." Not surprisingly, considering that 
strident special-interest groups have long misled U.S. voters into 
believing that the drug war is an essential crime-reduction tool, 
most government delegations at AIDS 2010, including the U.S. 
government delegation, remained largely silent on the Vienna Declaration.

Decades of worldwide drug-related violence have made clear that drug 
prohibition enriches organized crime and causes bloodshed. But the 
devastating public health consequences of the drug war have been less 
recognized, and government acknowledgement of the link between the 
war on drugs and the HIV epidemic is urgently needed. The next 
International AIDS Conference will be in Washington in 2012. Before 
that meeting, governments around the world will be asked to state a 
formal position regarding the declaration.

In the meantime, the declaration also asks for several 
noncontroversial steps, including that governments "undertake a 
transparent review of the effectiveness of current drug policies." 
Given the international public health emergency presented by HIV 
among drug users and the estimated $2.5 trillion in tax dollars 
wasted on the drug war over the last 40 years, the U.S. should move 
forward with this simple call.
- ---
MAP posted-by: Richard Lake