 
Drug Policy and AIDS funding: the forgotten agenda
The 15th International AIDS Conference in Bangkok
By Dr Massimo Barra, Vice-President of the International Federation of the International Red Cross and Red Crescent Societies
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2 August 2003, El País, Spain
Injecting drug use is known to have a very high rate of transmission of the HIV/AIDS virus. The latest United Nations Office on Drugs and Crime report on India for example, shows that 5-10% of HIV/AIDS infections are in injecting drug users. Drug users can transmit the disease to the community at large through sexual relations, especially in certain developing countries where AIDS education is often sorely lacking.
So why, last week where AIDS was in the spotlight, during the 15th International AIDS Conference in Bangkok, did we hear so little about this aspect of the AIDS crisis and its consequences on the spread of the epidemic? During the conference drug use and its consequences on the global HIV/AIDS crisis was hardly mentioned.
This is certainly connected to the lack of a global consensus regarding illegal drug use and the inherent problems within the current international drug control system. Large amounts of public funding for drug control are being spent on law enforcement instead of on the health based policies which contribute to curbing the spread of this terrible disease.
Progress in the prevention of the spread of HIV/AIDS is being hindered by drug policies which have their roots in law enforcement and repression. The “War on Drugs” approach has dominated international drug policy for the past 40 years and has had little or no effect on decreasing drug use. Policies concerning injecting drug use which are based on a health-care approach and are also more cost-effective, actively contribute to the fight against the spread of HIV/AIDS.
So why are these policies not being implemented? Given the fact that we know how to prevent the spread of this virus, why are we not doing all we can to do so?
We have the scientific knowledge that the implementation of policies such as needle exchange programmes and substitutive therapies prevent the spread of the disease, yet more often than not, these policies are not adopted. Why, in 2004, over 20 years after the discovery of the virus and its transmission routes, do activists have to demonstrate to obtain clean needles for injecting drug users, as they did in Bangkok, when we have known for years that programmes providing clean needles are an effective and cost-effective way of curbing the spread of the HIV virus, and do not encourage drug use?
By their lack of action, governments and policy-makers world wide are fuelling the HIV/AIDS crisis, perpetuating the epidemic and creating the perfect circumstances for the spread of HIV and Hepatitis C. The health of whole communities suffers. Avoiding that drug users become infected by reusing contaminated syringes can in turn prevent several more infections. We must ensure a wide range of prevention programmes, including access to sterile injecting equipment, and harm reduction efforts related to drug use.
How can we say that more money is needed for treating HIV/AIDS victims when the money we use on current repressive policies is contributing to them to becoming infected in the first place? The three United Nations drug conventions still do not recognise “harm reduction” as an integral and necessary part of modern international drug policy, even in the light of the global AIDS crisis.
The British Institute of International and Comparative Law and The Senlis Council, an international drug policy think tank have drafted a Fourth International Convention, which promotes these very policies. This provides a solid base for what is a necessary and logical step for international drug policy, if we want to tackle the HIV/AIDS problem in an effective and compassionate way.
It is a Red Cross Red Crescent tradition to be guided by science - the evidence of what works, because our motivation is to save lives and reduce suffering. We do not have time to get embroiled in ideological crossfire, and we do not believe people in need of care should be either. We are fortunate that the evidence for what works for preventing HIV amongst drug users is extremely clear, and very easily obtained.
Millions of people are dying unnecessarily of HIV/AIDS and we must find a way of treating this tragedy in a realistic, compassionate and cost-effective way. Health-based polices work and are less expensive than law enforcement policies. For example, according to the UK Home Office, every £1 spent on drug treatment saves £3 in the criminal justice system. We must implement policies which maximise the use of the funds available for international drug policy.
A new direction for global drug policy would be an important step in curbing the spread of the virus. We have to find the right solution to this problem. We must adapt drug policy to the reality of the HIV/AIDS crisis and we must stop denying that the present economic model is not working. An effective global drug policy has an important role to play in the future of curbing the spread of HIV/AIDS. The discussions in Bangkok are proof that this is far from being recognised.
Dr Barra is currently the Vice President of the International Federation of Red Cross and Red Crescent Societies. A medical Doctor, he has been a Red Cross volunteer since the age of eight and was a board member of the Global Fund to Fight AIDS, Tuberculosis and Malaria from January 2003 to March 2004. He was one of the first medical doctors in Italy to take care of drug users.
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