The "War on Drugs" has failed, particularly with regard to the spread of HIV in middle-income nations and some developing nations in Asia. The disease is now starting to bleed into Africa as well.

The spread of HIV among injection drug users is a most crucial issue in middle-income countries: poor nations simply cannot afford so expensive a vice on a large scale, and affluent nations often have instituted harm-reduction policies, such as needle exchange and opioid substitution programs, to mitigate the health risks

An estimated five million people have become infected with HIV through injection drug use (IDU) worldwide; nearly half of them are in China, Vietnam, Russia, Ukraine and Malaysia—almost all of which could be considered developing nations (Russia has propped up its faltering economy with the foreign exchange of oil sales). IDU is the principle vector for the epidemic in most of the nations of the former Soviet Union.

Injection drug use has become a growing problem in Africa along recently established transit routes for cocaine from South America, and to a lesser extent along routes for heroin from Asia. Those transit points are seeing emerging injection drug use, spurred on by the fact that locals running the drug routes are often as likely to be paid with a portion of the stash as with cash.
 
Despite massive investments in drug law enforcement in the past three decades, with much of the international interdiction effort paid for by the U.S. government through assistance to national military and police forces, there is "a general pattern of falling drug prices and increasing drug purity" throughout the world, according to the Vienna Declaration.

The petition drive, launched this summer at the International AIDS Conference in Vienna, Austria, aims to reorient government policies on injection drug use from focusing on prohibition, law enforcement and incarceration to focusing on treating addiction as a medical problem with medical solutions.

The extensive criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences, says the declaration.

"These policies fuel the AIDS epidemic and result in violence, increased crime rates and destabilization of entire states," said Julio Montaner in a prepared statement. He is one of the leaders behind the declaration, past-president of the International AIDS Society and director of the British Columbia Centre for Excellence in HIV/AIDS in Canada.

HIV is a blood-borne disease, and when street drugs such as opioids, amphetamines and cocaine are injected into a vein, a small amount of blood—and the virus, if present—often is drawn back into the syringe or remains on the outside of the needle.

HIV can be transmitted to another person who uses that needle. In fact, the odds of transmission are much higher from injection drug use than from sex because the needle bypasses the skin or mucosal tissue, which have passive barrier and active immune functions that can offer some protection against infection.   

Some people share needles for communal or ritualistic reasons, much like passing around a marijuana joint. But given the widely known risks of transmitting HIV, hepatitis and other infections, the most common reason why people continue to share needles is the unavailability of other syringes. The shortage can be due to cost or prohibitionist policies, such as requiring a prescription to obtain a needle or the presence of a needle as evidence of illegal activity. 

Needle exchange programs that make clean syringes more readily available have demonstrated success in decreasing the rate of new HIV infections among injection drug users. But these approaches often are met by community resistance because of the stigma associated with drug users and fears of crime associated with drug dealing.

Regardless of whether one uses injection drugs, there are practical reasons why everyone should be concerned with HIV within the injection drug community. Most obvious is that injection drug users have sex with non-users, and the virus can spread to their partners and children.
 
Biologically, HIV is a constantly mutating virus. The greatest changes in viral diversity occur when two separate strains of the virus infect the same cell and a new combination strain emerges from that cell. Simultaneous exposure to two or more strains of HIV most efficiently occurs when syringes are shared between injection drug users.

"What is needed is a massive scale-up of combination prevention, treatment, and care. In opioid-driven epidemics, this approach includes an essential minimal package of safe injection programs, opioid substitution therapy [such as methadone], and antiretroviral treatment" for their HIV infection, according to a panel of experts in a recent series of papers appearing in the journal The Lancet.

They noted that "there are synergies between biomedical science, public health, and human rights" in implementing this approach to substance abuse and HIV.

Examples from Europe, Brazil, Hong Kong and several U.S. cities show that a package of harm-reduction interventions recommended by the World Health Organization (WHO) can keep the rate of new HIV infections low and stable among injection drug users for many years and not result in increased drug use.

Portugal is an example of what a comprehensive drug reform policy can accomplish. Beginning in 1999, the country decriminalized personal possession and consumption of drugs and began to treat drug addiction as a medical rather than a legal or police problem.

Overall, drug use there among persons aged 15–19 declined from 10.8 percent in 2001 to 8.6 percent in 2007, whereas the portion of new HIV infections attributed to IDU fell from 54 percent to 30 percent over the same period.

Similar treatment strategies have also helped to decrease HIV infections by 80 percent among injection drug users in the U.S. They now constitute just 12.9 percent of all new infections each year.

5 Comments

1. 1. Semiahmoo 02:35 PM 8/25/10

   "The disease is now starting to bleed into Africa as well." How old is this article? Twenty-five years seems about right.

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2. 2. malcolmkyle 05:30 PM 8/25/10

   Prohibition is a sickening horror and the ocean of incompetence, corruption and human wreckage it has left in its wake is almost endless.
   
   Prohibition has decimated generations and criminalized millions for a behavior which is entwined in human existence, and for what other purpose than to uphold the defunct and corrupt thinking of a minority of misguided, self-righteous Neo-Puritans and degenerate demagogues who wish nothing but unadulterated destruction on the rest of us.
   
   Based on the unalterable proviso that drug use is essentially an unstoppable and ongoing human behavior which has been with us since the dawn of time, any serious reading on the subject of past attempts at any form of drug prohibition would point most normal thinking people in the direction of sensible regulation.
   
   By its very nature, prohibition cannot fail but create a vast increase in criminal activity, and rather than preventing society from descending into anarchy, it actually fosters an anarchic business model - the international Drug Trade. Any decisions concerning quality, quantity, distribution and availability are then left in the hands of unregulated, anonymous and ruthless drug dealers, who are interested only in the huge profits involved. Thus, the allure of this reliably and lucrative industry, with it's enormous income potential that consistently outweighs the risks associated with the illegal operations that such a trade entails, will remain with us until we are collectively forced to admit the obvious.
   
   A great many of us are slowly but surely wising up to the fact that the best avenue towards realistically dealing with drug use and addiction is through proper regulation which is what we already do with alcohol & tobacco, clearly two of our most dangerous mood altering substances. But for those of you whose ignorant and irrational minds traverse a fantasy plane of existence, you will no doubt remain sorely upset with any type of solution that does not seem to lead to your absurd and unattainable utopia of a drug free society.
   
   There is therefore an irrefutable connection between drug prohibition and the crime, corruption, disease and death it causes. Anybody 'halfway bright', and who's not psychologically challenged, should be capable of understanding that it is not simply the demand for drugs that creates the mayhem, it is our refusal to allow legal businesses to meet that demand. If you are not capable of understanding this connection then maybe you're using something far stronger than the rest of us. So put away your pipe, lock yourself away in a small room with some tinned soup and water, and try to crawl back into reality A.S.A.P.
   
   Because Drug cartels will always have an endless supply of ready cash for wages, bribery and equipment, no amount of tax money, police powers, weaponry, wishful thinking or pseudo-science will make our streets safe again. Only an end to prohibition can do that! How much longer are you willing to foolishly risk your own survival by continuing to ignore the obvious, historically confirmed solution?
   
   If you support the Kool-Aid mass suicide cult of prohibition, and erroneously believe that you can win a war without logic and practical solutions, then prepare yourself for even more death, tortured corpses, corruption, terrorism, sickness, imprisonment, economic tribulation, unemployment and the complete loss of the rule of law.
   
   "A prohibition law strikes a blow at the very principles upon which our government was founded."
   Abraham Lincoln
   
   The only thing prohibition successfully does is prohibit regulation & taxation while turning even our schools and prisons into black markets for drugs. Regulation would mean the opposite!

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3. 3. McD 06:53 AM 8/31/10

   Not all drugs are harmful.
   
   Take cannabis, for example: without it the quality of life for hundreds and thousands and potentially millions of people with MS would be much worse and theres no harm in enjoying a better quality of life. Just think how much better everyones quality of life would be if people who could use cannabis and enjoy a better quality of life could actually use cannabis and enjoy a better quality of life. Everyone would then enjoy a better quality of life, even those whose quality of life didn't seem much better for being able to use cannabis, because they would be surrounded by people who enjoy a better quality of life. Wheres the harm in that?
   

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4. 4. McD 06:53 AM 8/31/10

   Not all drugs are harmful.
   Take cannabis, for example: without it the quality of life for hundreds and thousands and potentially millions of people with MS would be much worse and there’s no harm in enjoying a better quality of life. Just think how much better everyone’s quality of life would be if people who could use cannabis and enjoy a better quality of life could actually use cannabis and enjoy a better quality of life. Everyone would then enjoy a better quality of life, even those whose quality of life didn't seem much better for being able to use cannabis, because they would be surrounded by people who enjoy a better quality of life. Where’s the harm in that?
   

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5. 5. alicealice 05:26 PM 1/22/11

   http://www.thebody.com/content/whatis/art55845.html
   
   An article from the CDC in March 2010, stating that "the evidence that needle and syringe programs (NSPs) are effective in preventing HIV and hepatitis C virus (HCV) is weaker than acknowledged in the current scientific literature". This was written in August 2010 and they said "Needle exchange programs that make clean syringes more readily available have demonstrated success in decreasing the rate of new HIV infections among injection drug users." Sorry guys but you're wrong...

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