Criminalization of injecting drug users (IDU) fuels HIV epidemic

Bobby Ramakant *

The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. Injection drug use (IDU) is one of the main modes of HIV transmission in parts of Asia, Eastern Europe and Latin America.

"Apart from medical harms associated with drug use, all other harms associated with drug use are a result of a state where government wanted to protect people from drug use and thus had put in place a number of laws that criminalize drug use. These laws compound the harms associated with drug use and also adversely impact the HIV epidemic," said Dr Marcus Day, Director of the Caribbean Drug Abuse Research Institute.

Dr Day was speaking on high-risk behaviour among injecting drug users (IDUs), their human rights, and their inclusion in HIV prevention and treatment programmes, at a PANOS pre-conference session for journalists, in lead up to the XVIII International AIDS Conference (IAC) in Vienna, Austria.

"Inherently injecting drug use is not a risky behaviour. What is the difference between person with diabetes who injects insulin, and injecting drug user? The person with diabetes gets the syringes over the counter, don't have to share syringes with other people with diabetes, they don't buy their insulin in the black market from somebody that is not sure what the chemical is.

Basically a person with diabetes buys their insulin from the pharmacies, they know it is pure, they know it is clean, it has been regulated in its production, they buy clean needles and syringes, they use a new syringe every time they inject, they have alcohol swab when they are injecting, they inject insulin in their house which is safe and clean and they are not worried about getting arrested" said Dr Marcus Day.

"The act of injecting yourself once, twice, thrice or five times a day is not inherently dangerous, what is dangerous is criminalizing people who inject, criminalizing drugs, criminalizing syringes" said Dr Day. Criminalizing policies on drugs, forces people to share syringes, inject in dangerous places, with no alcohol swab to clean, and indulge in high risk behaviours. "All of these behaviours are associated with the prohibition of law and not with the drug itself" said Dr Day.

When we criminalize the injecting drug use, needle or syringe exchange programmes, or where we don't even provide the opioid substitution therapy (OST), we are surely compounding the problem. OST is where methadone or buprenorphine is provided as a substitute to people who use heroin – some states provide heroin upon prescription like Switzerland for example, so that heroin users can buy heroin, syringes, they can safely inject and basically can live a relatively stable life and work and function in society. Same with methadone, many people use methadone for 20-30 years and are able to function with it in the society said Dr Day.

"The laws that are actually designed to protect us from harms associated with drug use are actually encouraging more harm, more disease. For example, if the drugs are so expensive that it is difficult to afford, IDU are forced to indulge in risky behaviours to raise enough money to be able to afford their drugs. These drugs are not inherently expensive, they are expensive because of prohibitions and laws that criminalize the drug trade, many IDU sell sex and sell sex cheaply and indulge in unsafe sex to raise money for drugs" said Dr Day.

Most rich IDUs can get away with the legal implications of drug use. Rich IDUs can afford to buy clean needles, syringes, drugs and inject in safe environment of their houses with alcohol swabs and observe other public health cautions. However, it is mostly the poor IDUs that face the most severe brunt of "war against drugs." It is the poor IDUs mostly who have to deal with most serious medical and social harms associated with drug use.

"Harm reduction is helping people where they are at, helping them deal with what their life is now, and then if they are willing to move on this continuum of life and progress, then we help them move but if they are not willing to move then help them chose the least amount of harm they could do to themselves" said Dr Marcus Day.

On 13 July, former presidents Fernando Henrique Cardoso of Brazil, Ernesto Zedillo of México and César Gaviria of Colombia - countries with major drug-trafficking problems - formally endorsed the Vienna Declaration. The Vienna declaration includes a call to forgo the "drug war" in favour of policies based on scientific evidence of the benefits of needle and syringe programmes and drug substitution therapy.