HIV and drug policy reform: The cost of a slow learning curve

Issue: The global war on drugs is jeopardizing the fight against AIDS. Criminalizing drug use drives HIV not just among people who use drugs but also among their families and communities. The U.S. can learn from other countries, where different approaches have led to significantly lower HIV incidence among people who use drugs. Description: Throughout the world, research has consistently shown that repressive drug law enforcement practices force people who use drugs away from public health services and into hidden environments where HIV risks become markedly elevated. Health-centered programs such as sterile syringe access programs are effective and cost-efficient. They also link people to health care, connect people to addiction treatment, and can reduce overall drug use. Lessons learned: In 2001, Portugal decriminalized drug possession and scaled up their harm reduction programs. HIV cases among people who use drugs plummeted by 34 percent between 2000 and 2008. Switzerland has implemented public health approaches such as syringe access, supervised injection facilities, and replacement therapy programs,. As a result, new HIV cases fell by 82 percent between 1990 and 2002. In Australia, by 2001 syringe exchanges had prevented 25,000 HIV infections and 21,000 hepatitis C infections, and had prevented 4,500 AIDS deaths. Recommendations: In countries where addiction is treated as a health issue, the fight against HIV is being won. New HIV infections there have been nearly eliminated among people who use drugs, These global best practices should be adopted in the U.S. to achieve our goal of an AIDS-free generation.