July 27 is National HIV Testing Day and it’s not just a good time to get tested; it’s a good time to remember a big factor in the global HIV epidemic: the war on drugs.
The global war on drugs and repressive law enforcement is “driving” the HIV/AIDS pandemic among drug users and their sexual partners in the United States and across the world, according to a report released this week by a commission of international leaders that includes former US Secretary of State George Shultz and the former presidents of Mexico and Columbia.
The report comes about a month before the annual International Aids Conference will meet in the US for the first time in 22 years. Last year, the same commission declared the global war on drugs a failure and called for widespread decriminalization and drug policy reform.
An estimated 33 million people worldwide are living with HIV and use of injection drugs such as heroin and methamphetamine accounts for one-third of new infections outside of sub-Saharan Africa, according to the Global Commission on Drugs report. The global war on drugs, led and financed by the US in many parts of the world, has failed to decrease the amount of injection drugs on the market and prevents access to health services and clean needles.
In the past 30 years, for example, the global opiate supply has increased by more than 380 percent, with much of production occurring in Afghanistan. Despite US military intervention in Afghanistan and global effort to stem drug production and distribution, the price of heroin decreased by 75 percent from 1990 and 2009.
“Specifically, if the kind of intensive drug law enforcement that has been practiced under the global war on drugs was achieving its stated objectives of meaningfully reducing drug supply, one would expect that increasing anti-drug expenditures would coincide with higher drug prices, decreased drug potency and fewer drugs available overall,” the report states. “However, evidence from around the world indicates that this has not been the case.”
Criminalizing a Health Crisis
Globally, nearly 20 percent of injection drug users are HIV positive, according to the report. Drug laws that treat such users as criminals prevent them from seeking treatment, cause users to take bigger risks and lead to high HIV rates in prisons and jails.
Police are supposed to stop drug use, but law enforcement often has the opposite effect. Aggressive law enforcement in the US and elsewhere drives drug addicts underground and away from public health services such as needle exchanges that supply clean syringes, according to the report. As a result, users share more needles.
Police confiscate clean syringes and harass and even torture suspects and drug users, which can causes users to take even more drugs to cope with abuse and avoid public treatment and prevention services. Arrest and incarceration also interrupt antiretroviral therapies that keep HIV viral loads down among HIV-positive people, making it easier for such individuals to spread the virus, according to research conducted in the US and elsewhere.
“Fear. Fear. This is the very main reason. And not only fear of being caught, but fear that you will be caught and you won’t be able to get a fix,” a young anonymous drug user in Moscow told researchers who contributed to the report. “So on top of being pressured and robbed [by police], there’s the risk you’ll also end up being sick. And that’s why you’ll use whatever syringe is available right then and there.”
High HIV Rates Behind Bars and Among Black Americans
The report takes a close look at the US, where the mass incarceration of nonviolent drug offenders is a “significant factor” in the HIV/AIDS epidemic. HIV prevalence and AIDS cases are common behind prison bars in the US and as many as 25 percent of all HIV-infected Americans are estimated to pass through a jail or prison each year.
Ethnic and racial minorities in the US are many times more likely to be incarcerated for nonviolent drug-related offenses and this racist justice system is thought to be one of the key reasons for elevated rates of HIV infection among black Americans.
The US joins 20 low- and middle-income countries that report HIV rates of 10 percent or higher among inmates, according to the report, which calls for the decriminalization of nonviolent drug related crimes.
The drug war and drug prohibition also leads to widespread violence, the global leaders reported. Leaders of countries traditionally funded by the US and hardest hit by drug war violence, such as Guatemala, Uruguay and Honduras, are currently challenging US foreign policy goals and considering drug legalization and decriminalization.
US Ignores Harm Reduction
Drug-related HIV infections have been markedly reduced in Western European countries and Australia, where drug addiction is often treated as a medical issue rather than a crime, and clean needles are readily available at public syringe exchanges. Portugal, for instance, decriminalized the possession of illegal drugs for personal use in 2001 and began focusing on addiction as a public health issue. Between 2000 and 2008, the number of the number of new cases of HIV infection decreased from 907 to 267, while the number of cases of AIDS dropped from 506 to 108 among injection drug users.
Countries such as the US and Russia, however, continue to wage an aggressive war on drug users, and are either ignoring or underutilizing such public health strategies, known as “harm reduction” strategies, and the consequences are deadly.
Public syringe exchanges, where injection drug users can dispose of dirty needles and receive clean ones, have been widely observed to reduce HIV infection rates among drug users and the rest of society. As Truthout has reported, conservatives in the US have routinely blocked federal funding for syringe exchange programs and some states have only legalized the practice in the last decade.
The Obama administration, which urged Americans to get tested on Wednesday, publicly supported syringe exchanges in its 2010 strategy for fighting HIV, but US policy makers are wary of the term “harm reduction.” The White House failed to go out on a limb and defend such programs when Republicans in Congress reinstated a ban on federal funding to exchange clinics last year.