The end of AIDS is not just possible but predictably achievable. Science is showing the way.
But science is laborious, time consuming and costly. Its achievements must be complemented by effective government action to control the spread of HIV among vulnerable populations.
As world leaders gather this week in Washington D.C. for the 2012 International AIDS Conference, it is impossible to ignore an inconvenient truth: that drug war politics and policies in the United States and many other countries are severely jeopardizing the overall "fight against AIDS." Simply stated, criminalizing those people who use drugs increases the risk of HIV infection and undermines efforts to protect them, their families and communities.
Roughly 33 million people worldwide are currently living with HIV -- and injection drug use accounts for one-third of all new HIV infections outside sub-Saharan Africa. New infections have been falling since the late 1990s but HIV incidence has increased by more than 25 percent in seven countries over this time span, largely as a result of the transmission of HIV through the sharing of needles and syringes contaminated with HIV.
Research from around the world has consistently shown that repressive drug law enforcement compels people who use drugs to remain hidden and stay away from public health services, thereby increasing the risks of HIV infection. Mass incarceration of people for nonviolent drug offenses also plays a major role in spreading the virus, as inhumane conditions and lack of HIV prevention and treatment in prisons leads to untreated AIDS behind bars and the subsequent spread of HIV among families and communities once those who have been imprisoned are released. By contrast, "syringe exchange", i.e. the provision of clean needles in exchange for soiled ones, and other "harm reduction" programs are among the most effective and cost-efficient HIV prevention interventions. It has been shown that they also link people to general health care, connect people with sources of addiction treatment, reduce overall drug use and save taxpayers money.
The evidence from different countries is telling. The fight against AIDS can be won in countries where addiction is treated as a health issue. New HIV infections in countries such as Australia, Portugal and Switzerland have been nearly eliminated among people who use drugs. The same is true of mother-to-child transmission of HIV where preventive medications are accessible to pregnant women. In Brazil - often cited as a model among developing countries in addressing the AIDS crisis -- AIDS cases associated with injection drug use dropped from 28 percent in the early 1990s to just 10 percent by 2003 following the implementation of "harm reduction" programs such as sterile syringe exchanges.
By contrast, in countries like the United States, China and Thailand, effective HIV prevention programs for people who inject drugs are tolerated but crippled by hostility from drug control forces, both local and national. If the United States had embraced the sorts of harm reduction programs that Australia and many European countries, including Margaret Thatcher's United Kingdom, did embrace during the 1980s, more than a hundred thousand lives would have been saved -- not only among people who use drugs but their lovers and children as well. One wishes that those responsible for so many needless deaths in our country could be held accountable - yet the willful ignorance and prejudice that has killed so many of our fellow citizens in decades past still persists. Just a few months ago, Republican leaders in the U.S. Congress re-instated a longstanding ban on the use of federal funds for syringe exchange programs -- a move that will cost thousands of lives in years to come.
Few countries are as backward in this area as Russia (where the epidemic is largely driven by people who inject drugs) and where the number of infected individuals has more than quadrupled since 2000. In Russia, more than one in 100 adults are infected HIV. Medications that could effectively treat heroin addiction are illegal in that country and, so far, its government has reneged on promises to fund syringe exchange programs.
Too many countries in the world have let their repressive and punitive drug policies get in the way of the public's health. Ours is one of them. Facilities where people who inject drugs can do so under medical supervision now operate legally in 61 cities around the world. These facilities have been proven to reduce the health and societal problems associated with injection drug use, including HIV transmission. None, however, exist as yet in the United States.
The current situation has quite literally resulted from a life-or-death decision made by politicians. The spread of HIV will not be stopped as long as drug use remains criminalized and as long as people who inject drugs are given up for lost.
Mathilde Krim is founding chair of amfAR and a member of the board of the Drug Policy Alliance. Ethan Nadelmann is founder and executive director of the Drug Policy Alliance.
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