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”. Countries are bound by international law to enforce prohibition in the belief that illegal drugs can be eradicated - consigned to history. 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 (PIDs) are HIV positive. Data is extremely patchy, but mid-range estimates suggest that of the 16 million people who inject drugs (PWID) 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 the difficulty accessing sterile equipment (as Keziah experienced), leads to PWIDs sometimes knowingly putting themselves at risk. Added to this, there is considerable overlap between PIDs and sex workers - who often come under pressure to engage in unprotected sex.
The overall message to take away is that the legal and policy environment have a profound impact on the risks associated with certain drug using behaviours. HIV transmission among PWIDs is entirely driven by the product of criminalisation of users and failed attempts to ban certain psychoactive drugs despite rising demand. Scaled up harm reduction provision could dramatically reduce the transmission risk. If legal and properly regulated, these drugs could be distributed and consumed in safe spaces with sterile equipment - transmission could effectively be reduced to zero. No one has ever contracted HIV in a Swiss heroin clinic or supervised drug consumption facility. Safe Injection Facilities have already prevented countless HIV infections; it is predicted that one Canadian site alone will prevent up to 1,500 new cases over a ten year period. 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.