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Aids campaigners will welcome call to decriminalise drug use | Society | guardian.co.uk

Aids campaigners will welcome call to decriminalise drug use | Society | guardian.co.uk.

Michele Kazatchkine’s surprise intervention calling for the decriminalisation of drug users will be widely welcomed by Aids and drugs campaigners who have been calling for the same thing. The issue is highly sensitive and, despite intensive lobbying of governments about the possible advantages for public health, many politicians regard the idea of withdrawing criminal sanctions for drug use as politically toxic.

Non-sterile injection of drugs is one of the most efficient ways of transmitting the HIV virus. Even with considerable investment by the Global Fund and others in the promotion of harm reduction, it remains stubbornly prevalent compared with other forms of transmission, particularly in countries outside Sub Saharan Africa.

That Kazatchkine has chosen to speak out now is not a coincidence. It comes close on the heels of renewed and fiercely fought debate on the issue, the latest chapter of which was a controversial attempt by the Vatican to sway UN drugs policy.

Advocates for reform were outraged when in February the pope issued a statement condemning harm reduction strategies as “anti-life” and, in the kind of language guaranteed to stoke up opposition to wider reform, claimed that assisting addicts to access help without fear of criminal penalty would lead to the “liberalisation of the use of drugs”.

If the Vatican’s statement was inflammatory, its timing also riled. According to campaigners it torpedoed a crucial UN declaration by exacerbating disagreements between countries about whether to collectively endorse harm reduction strategies such as the provision of the drug substitute, methadone. UN and individual government officials were meeting in February in Vienna as part of the Commission on Narcotic Drugs to work on a new drugs “Declaration of Intent” for the next decade – a significant stage in the evolution of international drugs policy – when the pope’s comments were released. The Vatican’s action led to Italy withdrawing from a broad EU coalition supporting global harm reduction strategies, weakening the EU in the face of strong opposition from the US, Russia and Japan.

The UK-based drugs charity, Release, an organisation at the forefront of campaigns for decriminalisation, said the outcome was a “weak and hugely disappointing” declaration. A spokeswoman said that despite “a wealth of evidence to support its effectiveness”, harm reduction had been sacrificed in favour of ineffective criminal sanctions. “Pages and pages of text endorsed the continuation of tackling drug supply and drug use through zero-tolerance criminal sanctions and law enforcement, a policy that has failed the tens of thousands of injecting drug users now infected with HIV.”

Obtaining exact figures for the number of injecting drug users globally or the proportion of users living with HIV is problematic. Robust data is difficult to come by due to a number of factors including the fact that illegality discourages people coming forward. Nevertheless there are some reliable estimates and they help explain the current sense of urgency around rates of HIV infection among IV drug users. There are about 33 million people living with HIV globally according to UNAIDS, which compiles statistics for the organisation. It estimates that in 2007 (the most recent year for which data is available), around 2-3 million of the world’s 16 million or so intravenous (IV) drug users were likely to be infected with the HIV virus.

Illustrating the threat currently presented by HIV infection via IV drug use, a spokeswoman said: “Use of contaminated injection during drug use accounts for more than 80% of all HIV infections in Eastern Europe and central Asia.” It is also a “major entry point” for infection in other parts of the world including the Middle East and Latin America. “HIV prevalence among some groups in these regions is estimated at over 40%,” she added. In addition – and particularly importantly for those such as Kazatchkine advocating decriminalisation – incarceration for possession of drugs further increases their risk of contracting or transmitting HIV, according to UNAIDS.

In its latest report on the global Aids epidemic, UNAIDS echoes the concerns of Kazatchkine. “Until sufficient political will exists to address the sources of HIV risk and vulnerability, the epidemic will continue to expand,” it concludes. It also highlights that where countries have adopted a “comprehensive approach” to HIV and drug use (it includes Britain on its list), the spread of HIV among those who inject drugs has slowed.

Kazatchkine argues that it is ultimately “public health oriented pragmatism” that produces results, not misguided criminalisation. However, if the Vienna conference is anything to go by, the widespread adoption of such an approach is still some way off.

As the Global Fund and other bodies working to fight the spread of HIV scramble for extra money in extremely challenging financial times, Kazatchkine says many are waiting with interest to see what sort of lead the US will take on the issue under Barack Obama. With around half of all people living with HIV in the US coming from the African-American community (despite accounting for just 12% of the population), the pressure will be on Obama to act.

“There are strong opponents to harm reduction both among the Republicans and the Democrats,” Kazatchkine says. But, he adds, “given the unequal risk for African Americans becoming infected by HIV compared to the white population in the US”, the issue is one he would expect the Obama administration to address.

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