Drug Policies and the Global HIV Epidemic (web article)

Countries with HIV infection rates driven by injection drug use should base their efforts on best public health practices rather than illicit drug policies, according to Kasia Malinowska-Sempruch of the International Harm Reduction Program of the Open Society Institute.

At an April 8 international seminar on Public Health and Human Rights in the Era of AIDS, Malinowska-Sempruch spoke about human rights violations against drug users, sex workers and the spread of HIV in Russia and the Commonwealth of Independent States (CIS).

The three-day seminar in Baltimore was sponsored by the Johns Hopkins Fogarty AIDS International Training and Research Program, directed by Chris Beyrer, MD, MPH ’90, associate research professor of Epidemiology, as well as the Johns Hopkins Bloomberg School of Public Health, the Open Society Institute and the Institute for Asian Democracy. Dr. Beyrer, who is also the director and principal investigator of the newly established Johns Hopkins Center for Public Health and Human Rights, chaired the conference.

“Epidemics among injection drug users are explosive,” said Malinowska-Sempruch. Fifty-two countries reported HIV infections among injection drug users (IDUs) in 1992. Ten years later, the number went up to 114 countries. Outside of Africa, one of every three new infections comes from contaminated needles. Five countries in the former Soviet Union and Asia—Russia, China, Malaysia, Ukraine, and Vietnam—report that the majority of their HIV cases are from injection-drug use.

“To put it crudely, if I’m an infected sex worker, it would be difficult for me to infect 30 men a day. But if I’m an IV drug user, it’s easy for me to infect 20-30 people a day,” said Malinowska-Sempruch.

Much of the problem with drug policies has to do inconsistent policy recommendations regarding drug use and HIV prevention from the United Nations system. For example, the UN Office on Drugs and Crime (UNODC) claims not to take a position on harm reduction programs such as methadone therapy and needle exchange programs. And the International Narcotics Control Board (INCB) condemns harm reduction programs as contributing to the problem of drug use. “[Many governments] want to be punitive, and what the UN conventions seem to do is to provide ammunition,” Malinowska-Sempruch said.

Strict law enforcement policies, such as zero tolerance, mandatory imprisonment (even for small amounts of a drug), and registration of drug users, contribute to the escalation of infections, says Malinowska-Sempruch. Restrictions on opium supply, for example, can cause people to switch to heroin, or from smoking to injecting. In prisons, needles are shared and HIV rates surge. In Russia, more than one-sixth of registered cases are in prison. In Lithuania, of the 321 HIV cases reported between May 2002 and August 2002, 284 were in one prison facility.

Malinowska-Sempruch says that UN conventions need to be amended to explicitly support strategies to reduce drug-related harm. Contradictory policies on substitution treatments such as methadone also need to be addressed. At the national level, she calls for ending mandatory imprisonment for small-time drug users, instituting more substitution treatment programs, implementing needle exchange programs in prisons and treatment facilities, and enabling purchase of sterile injection equipment.

Other speakers at the event included Zhura Halimova, Executive Director of the Open Society Institute, who spoke about human rights and HIV/AIDS in Tajikistan. Julie Stachowiak, a core faculty member of the Center for Public Health and Human Rights and a PhD student in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, presented on health and human rights among Russian IDUs and sex workers.--Kristi Birch