Russians and Ukrainians are once again being made victims of a utopian dream. Since the end of communism in 1991, these countries (and others) have experienced a dramatic increase in the use of illicit drugs. They have responded with draconian policies that mirror the simplistic message of a drug-free society espoused by UN drug treaties and the institutions that seek to enforce them. Today, these policies are contributing to an explosion of HIV infections in much of the developing world.
The UN treaties that guide global drug policy reflect none of the recent findings on drug use and addiction. Indeed, most UN drug conventions were enacted long before the appearance of HIV/AIDS -- a disease fuelled by injection drug use in the former Soviet Union and many parts of Asia.
Dramatic increase
Consider Russia and Ukraine, which have the world's fastest-growing rate of HIV infection. The number of people infected with HIV in Russia and Ukraine has increased by more than 18 times over the past five years. As many as 1.5 million Russians and 400,000 Ukrainians are estimated to have HIV; at least 85 percent of known infections are attributed to intravenous drug use.
Governments in Russia and Ukraine allocate the bulk of their drug-related resources to law enforcement in a misguided attempt to comply with the UN drug treaties. Individual users suffer police abuse and are driven away from vital health and treatment services. Meanwhile, the flow of drugs continues undiminished.
Repressive policies have never succeeded in eliminating demand for drugs. They do not tackle any of the economic, social, or health factors associated with the use of illicit drugs. Locking up drug users is not a solution -- in Russia, it is easier to score drugs in prison than outside.
Moreover, in a repressive climate, drug users who avoid arrest are more likely to face increased discrimination, reducing their motivation to take measures to protect their own health and the health of those around them. In such circumstances -- without hope for a better future or the opportunity for compassion-based interaction with society -- drug use and HIV spread rapidly.
Russia and Ukraine are not alone in facing these twin epidemics. Pakistan, Iran, China, the Central Asian countries, and other places with rising rates of intravenous drug use are bound for the same public health catastrophe if they pursue similar discredited policies.
Public health intervention to reduce the damage caused by drugs has been proven -- by decades of research in dozens of countries -- to be vastly more effective at lowering HIV infection rates and health-care costs. Using a conservative model, the British medical journal Lancet estimated that the US would have recorded net savings of US$500 million if it had implemented a national syringe exchange program between 1987 and1995.
Similarly, an international survey found that HIV infection among intravenous drug users decreased by 5.8 percent per year in cities with syringe exchange programs, and increased by 5.9 percent per year in cities without such programs.
Syringe exchange
No major study has shown that syringe exchange programs increase rates of drug use. Indeed, studies in the US, Australia and elsewhere show that drug treatment rates tend to remain steady or rise, because syringe exchange participants gain greater access to rehabilitative care.
UN agencies such as the Commission on Narcotic Drugs or the Office on Drugs and Crime are not mandated to prescribe specific drug strategies. However, their narrowly focused anti-drug stance strongly influences the policies and practices of member nations. Many individual governments, obsessed with compliance, are unable or unwilling to consider the negative public health effects of harsh anti-drug policies.
International institutions chose to look the other way in the 1990's as HIV/AIDS killed millions in Africa, infecting more than 25 percent of the population in some countries. Because of similar ignorance, this terrible epidemic now looms over the former Soviet Union and other regions. Have we really learned nothing?
Matter of public health
It is not too late for international and national policy-makers to reconsider their strategies. In defiance of the UN conventions, some countries have adopted more pragmatic approaches to dealing with drug use and HIV. By treating drug use first and foremost as a problem of public health, nations can fight the spread of HIV far more effectively. To achieve this, they should take the following steps:
Adopt anti-discrimination and equal-protection laws to guarantee the civil liberties and human rights of drug users and people living with HIV;
Acknowledge drug use as a public health issue, not a law-and-order issue, with government policies reflecting this reality;
Explicitly legalize needle exchange and the use of methadone and other "substitute" medications for treatment;
Create national programs that encompass a full range of pragmatic, inclusive and accessible harm reduction services, from education and drug treatment to substitution therapy and needle exchange;
Include drug users and their advocates in developing policies on drug use at both international and national levels.
Continuing resistance to calls to restructure anti-drug strategies and goals will only worsen the HIV epidemic and contribute to the deaths of millions of vulnerable people.
Kasia Malinowska-Sempruch is director of the International Harm Reduction Development Program at the Open Society Institute, which pioneered technical and financial support for harm reduction projects in postcommunist countries. She previously worked with the UN's HIV and Development Program.
Copyright: Project Syndicate
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