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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Constance A. Nathanson, PhD, Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, 615 N. Wolfe St., 4th floor, Baltimore, MD 21205, 410-955-7805, cnathans@jhsph.edu
Injection drug use has been a significant mode of HIV transmission from the beginning of the epidemic. Its importance has increased over time. The two principal means advocated by public health authorities in industrialized countries for preventing HIV and other blood-borne infections among IDUs are methadone substitution and the use of sterile injection equipment. However, implementation of these recommendations varies markedly. I analyze these differences based on case studies of policies for the prevention of HIV/AIDS in injection drug users in four countries: the U.S., Canada, Britain, and France. Causal factors include cross-national differences in the history of drug control policies, in political systems, in the politics of public health and medical care, and in the construction of injection drug use as a criminal justice or a health care problem. U.S. construction of HIV/AIDS in IDUs as a drug problem seriously limits the authority of public health experts to prescribe and the federal government to fund effective responses. Prevention programs are fragile and highly dependent on mobilization at the local level. Britain, at the other extreme, made an early commitment to the proposition that HIV was a greater threat than drug use and centrally funded community-based syringe exchange programs beginning in the late1980s. France and Canada fall between these policy poles. More generally, U.S. opposition to harm reduction is a brake on policies outside as will as within its own borders. Change will require the stranglehold of U.S. drug control policies to be removed from public health.
Learning Objectives: Following this presentation, the participant will be able to
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.