DRUG WAR'S COLLATERAL DAMAGE

Governments Need to Acknowledge the Link Between HIV Epidemic and
Anti-Drug Policies.

Last week, thousands of scientists, physicians and activists fighting
the HIV and AIDS pandemic around the world gathered in Vienna to
discuss the latest breakthroughs - and frustrations.

There were reports on several landmark studies describing the crucial
role that treatments can play in reducing the infectiousness of
HIV-positive individuals. And there was encouraging news from Africa,
where a study found that an intra-vaginal anti-viral gel could reduce
the risk of HIV infection among women who used it by 40%.

But there was also sobering news at the 18th International AIDS
Conference, including stark evidence of how the HIV epidemic is
raging unchecked among some populations of illicit drug users.

Vienna was selected to host the biannual meeting of HIV experts
because it is the gateway to one of the world's most rapidly growing
HIV epidemics: that among heroin users in Eastern Europe. Outside
sub-Saharan Africa, about 1 in 3 new HIV infections stems from
injecting illegal drugs, and in some parts of Eastern Europe and
Central Asia, 70% of those who inject illicit drugs are infected with
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In response to these alarming statistics, this year's conference
endorsed as its official statement the Vienna Declaration, a document
I helped draft to draw widespread attention to how the U.S.-led war
on drugs has played a central role in driving the HIV epidemic around
the world.

Writing in the medical journal the Lancet, where the Vienna
Declaration was also published, Michel Sidibe, the executive director
of the Joint United Nations Program on HIV/AIDS (UNAIDS) and other
prominent scientific leaders stated the situation succinctly: "The
war on drugs has failed."

Criminalizing drug abuse drives addicts deeper underground and into
the kinds of unsafe practices such as needle-sharing that spread
infection. We have seen clearly that countries with the most
draconian drug laws also have the highest rates of HIV infection
among users. In Russia, for example, where 1 in 100 adults is now
estimated to be HIV-infected, a fierce drug war has outlawed basic
harm reduction tools, such as methadone maintenance treatment.
Methadone is on the World Health Organization's list of essential
medicines, but Russian physicians cannot even openly discuss the need
to prescribe the treatment without fear of reprisals.

The mass incarceration of drug users is particularly alarming, given
the spread of HIV in prisons. A Pew Trusts analysis of U.S.
Department of Justice data noted that 1 in 9 African American males
aged 20 to 34 is in prison, many of them as a result of drug law
enforcement. Given the link between prisons and HIV, it is not
surprising that in places such as Washington more than 80% of HIV
cases identified between 2001 and 2006 were among African Americans.

Beyond HIV and AIDS, the declaration also notes that the war on drugs
is ineffective. "National and international drug surveillance systems
have demonstrated a general pattern of falling drug prices and
increasing drug purity - despite massive investments in drug law enforcement."

In just a few short weeks since being made public, the Vienna
Declaration has been endorsed by more than 13,600 individuals,
including five Nobel laureates and various other global leaders in
science, medicine and public health.

There also have been signs that the world may be heading toward more
reasoned drug policies. Just before the Vienna conference, the Obama
administration announced overdue and welcome steps to help fight the
HIV epidemic among drug users. Most important, given the strong
support for syringe exchange programs from the U.S. Institute of
Medicine and WHO, the administration has reversed a longtime ban on
funding clean syringe programs.

But there is still much that needs to be done. The Vienna Declaration
calls for governments to "implement and evaluate a science-based
public health approach to address the individual and community harms
stemming from illicit drug use." Not surprisingly, considering that
strident special-interest groups have long misled U.S. voters into
believing that the drug war is an essential crime-reduction tool,
most government delegations at AIDS 2010, including the U.S.
government delegation, remained largely silent on the Vienna Declaration.

Decades of worldwide drug-related violence have made clear that drug
prohibition enriches organized crime and causes bloodshed. But the
devastating public health consequences of the drug war have been less
recognized, and government acknowledgement of the link between the
war on drugs and the HIV epidemic is urgently needed. The next
International AIDS Conference will be in Washington in 2012. Before
that meeting, governments around the world will be asked to state a
formal position regarding the declaration.

In the meantime, the declaration also asks for several
noncontroversial steps, including that governments "undertake a
transparent review of the effectiveness of current drug policies."
Given the international public health emergency presented by HIV
among drug users and the estimated $2.5 trillion in tax dollars
wasted on the drug war over the last 40 years, the U.S. should move
forward with this simple call.