This is a guest blog by Josh Torrance
International drug control, as defined in the 1961 UN Single Convention, is designed to improve “the health and welfare of mankind”. In the belief that drug use can be consigned to the dustbin of history, countries are bound by international law to enforce prohibition. Instead, these policies have created a contemporary public health disaster of epic proportions. On World AIDS day, it is important to reflect on how much suffering these policies continue to cause millions of individuals around the globe.
HIV and injecting drug use are inextricably interlinked. Outside of Sub-Saharan Africa, 30% of HIV infections are due to injecting drug use. There are nine countries where over 40% of People Who Inject Drugs (PWIDs) are HIV positive. Data is extremely patchy, but mid-range estimates suggest that of the 16 million PWIDs worldwide, 3 million are HIV positive. The highest-ranging estimates propose that there may be 20 million PWIDs globally, 6.5 million of whom are HIV positive.
The dangers of sharing needles may seem obvious, but the education and awareness of these risks are shockingly inadequate in much of the world, especially the Global South. Even among those who are aware of the dangers low levels of access to sterile equipment (as Keziah experienced) can lead to PWIDs knowingly putting themselves at risk. Added to this, there is considerable overlap between PWIDs and sex workers - who often come under pressure to engage in unprotected sex.
This picture appears bleak, but there is positive work being done. There are now 90 countries with syringe exchange programs, compared to only 2 three decades ago. 10 Countries now operate Supervised Injection Facilities where users can inject drugs in sterile, safe environments with medical staff on hand. No one has ever died or contracted HIV in any of these facilities, and it is predicted that one Canadian site alone will prevent up to 1,500 new cases over a ten year period. The potential savings for health services around the world are huge.
The overall message to take away is that the legal and policy environment has a profound impact on the risks associated with certain drug using behaviours. HIV transmission among PWIDs is the product of criminalisation and failed attempts to ban certain psychoactive drugs. Even within a framework of prohibition, harm reductionist measures can dramatically reduce the transmission risk. If these drugs were legal and properly regulated, transmission could effectively be reduced to zero. Either way, criminal-market dealers seem unlikely to suddenly start providing clean needles with every sale.
(Pictured) The H17 Supervised drug consumption venue in Copenhagen, Denmark
Prohibitive laws and social stigma makes accessing testing, education and treatment extremely difficult for millions of HIV-positive drug users around the world. The punitive prohibition model of drug control that began in the 1960s has worsened public health, not improved it. By ending the criminalisation of people who use drugs, and bringing drug use and supply into a regulated space we can remove many of the drivers for HIV infections and other health harms. For many, it is already too late – but we know how to prevent more avoidable tragedies and must hold Governments accountable if they fail to act.