UTOPIAN DREAM FUELING EXPLOSION OF HIV CASES

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.