HARPER'S NEW ANTI-DRUG STRATEGY IS NOT ANTI-HIV

Injection drug use continues to be a driving factor in the global
HIV/AIDS epidemic.1 Harm reduction services, including needle
exchange programs, have long been identified as essential components
of an effective HIV prevention strategy. While scientific consensus
has been reached regarding their efficacy in reducing HIV
transmission,2,4 such interventions remain controversial. In
contrast, 'zero tolerance' approaches to drug use have been shown
ineffective,5 however, they remain popular among conservative
policymakers over evidence-based public health approaches. These
should be matters of grave concern as they have a potentially
devastating impact on HIV prevention efforts.6-8

For instance, in the US, while close to one quarter of all new HIV
infections have been attributed to injection drug use,9 there remains
a federal ban on funding for needle exchange programs. In Russia,
between 2002 and 2004 funding for needle exchange programs has
reportedly fallen 29% while the prevalence of HIV among local
injection drug users (IDU) populations is up to 60% in some areas.1
Unfortunately, the "new" Conservative federal government of Canada is
similarly allowing ideology to undermine the adoption of
evidence-based HIV prevention policies. This was clearly illustrated
by the recent statements of the Minister of Health, Tony Clement
reported separately in this issue (see "'Doctors, get tough on
drugs': Tony Clement" on page 22). Despite evidence of continuing HIV
transmission among IDUs nationally,10 this government recently
announced that no federal funds would be directed to support the
operation of needle exchange programs in Canada or the supervised
injection facility in Vancouver.11-13

The government has also taken steps apparently aimed at eliminating
harm reduction strategies. As part of this effort, the existing
Canada's Drug Strategy (CDS) is being replaced with the new Anti-Drug
Strategy which has been described as focusing on enforcement,
prevention and treatment interventions.13 Harm reduction is no longer
part of the strategy, a worrisome departure from the CDS's
traditional approach: "Because substance abuse is primarily a health
issue rather than an enforcement issue, harm reduction is considered
to be a realistic, pragmatic, and humane approach." 16

The exclusion of harm reduction initiatives from the new Anti-Drug
Strategy is a dangerous step backwards in the fight against HIV/AIDS.
Its increased emphasis on law enforcement has potential to further
increase HIV and other blood born infections among IDU. Through
sexual transmission, the partners of infected IDU can then be
expected to spread the virus among a wider population. The focus on
law enforcement will also likely prompt a rise in the incarceration
rates of IDUs, with marginalized populations, particularly Aboriginal
peoples, being hardest hit.17 Imprisonment may further fuel the rate
of disease transmission as incarceration has been independently
associated with HIV infection among Canadian IDU.18

Canada's new 'Anti-Drug Strategy' appears ill conceived. Furthermore,
the new Anti-Drug Strategy is not anti-HIV. As such, this should not
be accepted as a legitimate policy shift. In deviating from
internationally established HIV prevention standards, which are based
on the best available evidence, this strategy may in fact be better
described as "anti-health" and "anti-science." It has been over four
years since former US president Bill Clinton publicly acknowledged
that he was wrong to withhold federal funds for needle exchange
programs in the United States.20 How long will take before the
Government of Canada expresses the same regret? More importantly, how
much unnecessary suffering and new HIV infections will be needed
before our political leadership finally embraces evidence -based
public health principles in the fight against HIV/AIDS?

[References]

1. UNAIDS. 2006 report on the global AIDS epidemic. Geneva: UNAIDS; 2006.

2. World Health Organization, UNAIDS, UN Drug Control Office. Policy
brief: Provision of sterile injecting equipment to reduce HIV
transmission. WHO; 2004.

3. UNAIDS. Progress report on the global response to the HIV/AIDS
epidemic 2003: Follow-up to the 2001 United Nations General Assembly
special session on HIV/AIDS. Geneva: UNAIDS; 2003.

4. Wodak A, Cooney A. Do needle syringe programs reduce HIV infection
among injecting drug users: A comprehensive review of the
international evidence. Subst Use Misuse. 2006;41:777-813.

5. The Lancet. Losing tolerance with zero tolerance. The Lancet.
2005;365:629-630.

6. Wood E, Kerr T, Small W, Jones J, Schechter MT, Tyndall MW. The
impact of a police presence on access to needle exchange programs. J
Acquir Immune Defic Syndr. 2003;34:116-8.

7. Dixon D, Coffin P. Zero tolerance policing of illegal drug
markets. Drug and Alcohol Review. 1999;18:477-486.

8. Kerr T, Small W, Wood E. The public health and social impacts of
drug market enforcement: A review of the evidence. International
Journal of Drug Policy. 2005;16:210-220.

9. Centers for Disease Control and Prevention. Drug-Associated HIV
Transmission Continues in the United States. Available:
http://www.cdc.gov/hiv/resources/factsheets/idu.htm (accessed 2007 April 10).

10. Health Canada. HIV and AIDS in Canada: Surveillance report to
June 30, 2006. Ottawa: Division of HIV/AIDS Epidemiology and
Surveillance, Centre for Infectious Disease Prevention and Control
(CIDPC), Health Canada; 2006.

11. O'Neil P. B.C. blasts budget for favouring Quebec: Trade minister
denies province is being 'punished'. The Vancouver Sun. 03/20/2007:A1.

12. Wood E, Tyndall M, Montaner J, Kerr T. Summary of findings from
the evaluation of a pilot medically supervised safer injecting
facility. CMAJ. 2006;175:1399.

13. Department of Finance Canada. The Budget Plan 2007. Ottawa:
Government of Canada; 03/19/2007.

14. Office of the Auditor General of Canada. Report of the Auditor
General of Canada -2001, chapter 11--illicit drugs: The federal
government's role. 2001.

15. DeBeck K, Wood E, Montaner J, Kerr T. Canada's 2003 renewed drug
strategy -an evidence-based review. HIV/AIDS Policy and Law Review.
2006;11:1-5-12.

16.Government of Canada. Canada's Drug Strategy. Ottawa: Minister of
Public Works and Government Services Canada; 1998.

17. Brzozowski J, Taylor-Butts A, Johnson S. Victimizing and
offending among the aboriginal population in Canada. Jurisdat
Statistics Canada; 2006.

18. Hagan H. The relevance of attributable risk measures to HIV
prevention planning. AIDS. 2003;17:911-3.

19. International Covenant on Economic, Social and Cultural Rights.
United Nations General Assembly, 993 UNTS 3, Article12. 1996.

20. Altman L. Clinton urges global planning to halt H.I.V. New York
Times. 07/12/2002.