THE international system of drug prohibition is under increasing challenge these days.
As illustrated by the Vienna Declaration launched at the recent International AIDS Conference, powerful voices are arguing that prohibition is undermining efforts to slow the spread of HIV among and from injecting drug users.
The declaration articulates the argument that the criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed.
Recent papers and editorials in leading medical journals have picked up these themes, specifically the failure of the war on drugs and the need to consider how states, rather than criminals and corrupt police, could regulate these drugs.
An important new guidance document issued by the US President's Emergency Plan for AIDS Relief finally endorses harm reduction, though still not by name.
The Vienna Declaration (www.viennadeclaration.com) was drafted by very senior international figures including Nobel laureate Francoise Barre-Sinoussi, co-discoverer of HIV, Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria, and Julio Montaner, president of the International AIDS Society.
Thousands of people from many counties around the world signed the declaration.
Vienna was chosen as the site for this international AIDS conference largely because of its proximity to Russia and other countries in eastern Europe and Central Asia that responded poorly to the epidemic of HIV spreading among injecting drug users.
Many of these countries recently intensified their massive investment in drug law enforcement at the very time that it's become clear that law enforcement has failed to cut global drug supplies, merely shifting problems from one place to another.
In recent decades, the price of street drugs has slumped and their purity has increased. But drug law enforcement is supposed to increase the price of street drugs and decrease their purity.
Illicit drug use is also spreading to more countries.
The international trade in illicit drugs is estimated to have an annual turnover of $US322 billion ($364bn).
The lucrative profits are fuelling crime, violence, instability and corruption in countries including Colombia, Mexico, Pakistan and Afghanistan.
The sharing of needles and syringes among injecting drug users accounts for one in three new HIV infections outside sub-Saharan Africa.
This means injecting drug use now accounts for one in 10 new HIV infections in the world.
The declaration notes that in some countries 70 per cent of injecting drug users are infected with HIV and 80 per cent of new HIV infections are attributed to injecting drug users.
Recognition that zealous drug prohibition and HIV control among injecting drug users are mutually exclusive options is not confined to AIDS activists.
UN Secretary-General Ban Ki-Moon said in May 2009 that in addition to criminalising HIV transmission, many countries impose criminal sanctions for same-sex sex, commercial sex and drug injection. Such laws constitute barriers to reaching key populations with HIV services.
Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction.
Last month the UN Development Program, together with UNAIDS, announced the formation of a new global commission to examine how legal environments affect HIV efforts. Their joint press release notes that laws can compromise the ability of high-risk populations to access HIV prevention and treatment.
Global drug prohibition also makes it more difficult to raise the funding needed for effective HIV prevention services. Each year the world spends only $US180 million on harm reduction while it's estimated that $US2.13bn is required.
Consequently, the world provides an average of only two sterile needles and syringes per drug user each month. Only 8 per cent of international heroin injectors are in methadone treatment.
After a long struggle, some countries are now beginning harm reduction programs while others are rapidly expanding old programs with low coverage.
In recent weeks, methadone treatment has begun in Tajikistan, Morocco, Cambodia and Bangladesh; it began in Afghanistan in February.
But while there've been recent moves towards more enlightened and effective approaches to illicit drugs, there've also been a few painful backwards steps.
This month, for instance, the UN's Ban appointed Yuri Fedotov, a Russian diplomat, as executive director of the UN Office on Drugs and Crime.
Yet in Russia, 37 per cent of people who inject drugs have HIV and injecting drug users account for about 80 per cent of new HIV infections.
Further, Russia refuses to provide opioid substitution therapy such as methadone, opposes the most effective means of controlling HIV among injecting drug users and has an appalling record of breaching the human rights of injecting drug users.
Clearly, Fedotov's appointment will severely damage the credibility of UNODC as the UN's leading agency on HIV related to injecting drug use and prisons.
Still, the Vienna Declaration is another sign that the system of global drug prohibition, which began 101 years ago, is slowly dying.
Although it's not yet known what will replace the old system, it's clear a new system will one day abandon the one-size-fits-all approach for nations and be based solidly on science and human rights.
Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital in Sydney
Dr. Alex Wodak,
Director, Alcohol and Drug Service,
St. Vincent's Hospital,
Darlinghurst, NSW, 2010,
AUSTRALIA
Telephone: (61+02) 9361 8012
If no prompt answer, try 9361 8014
Facsimile: (61+02) 8382 4738
awodak@stvincents.com.au
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