Allan Clear is executive director of the Harm Reduction Coalition. Mr. Clear was one of twelve speakers chosen to address the United Nations at the 2006 High Level Meeting on AIDS, was a non-governmental delegate at UNODC “Beyond 2008”, and is a member of the Community Program Committee for AIDS 2012.
Mr. Clear wrote the following for Science Speaks’ Blueprint series, in which clinicians, researchers and advocates address the key elements they would like to see in the Global AIDS response blueprint that Secretary of State Hillary Clinton called at the 2012 International AIDS Conference in Washington.
At the 2012 International AIDS Conference Secretary Clinton called for a global aids blueprint. A blueprint already exists to impact the course of HIV infection among injecting drug users. A recognized package of interventions, if fully implemented, would alter the course of the epidemic for people who use drugs, concurrently affecting their partners and children. The “WHO, UNODC, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users” (“the guide”) (http://www.unodc.org/documents/hiv-aids/idu_target_setting_guide.pdf) outlines nine interventions that, if implemented, could stop HIV in its tracks. The guide includes syringe access programs such as syringe exchange, drug treatment – particularly medications such as methadone and buprenorphine that treat dependence to opiates – HIV testing and counseling, antiretroviral therapy , preventing and treating sexually transmitted infections, condom distribution programs for drug users and their sexual partners, education campaigns aimed at drug users, addressing hepatitis through diagnosis, treatment and vaccination, and targeting tuberculosis through prevention, diagnostic and treatment programs. At minimum, I would add two other interventions to that list: outreach to drug users and overdose prevention and response programs. After all, why work with populations at risk of contracting HIV only to have them die from drug overdoses?
Some parts of the globe have done a fine job connecting drug users with ARV therapy. Other devastated parts of the world have an injection-related HIV problem, yet drug users are not the people receiving ARV therapy. Drug users should never be left out of the treatment-as-prevention equation. In any plan of action, drug users must unequivocally be on equal footing with everyone living with HIV regardless of what they put into their bodies, how they make money or who they love. Getting drug users, sex workers and men who have sex with men into treatment has to be a priority not only for them but for their partners. The blueprint must recognize, without compromise, that treatment as prevention is effective.
In addition it must recognize that drug injection is a mechanical act. Making sterile syringes easily accessible to drug injectors will halt blood borne HIV infection in its tracks. In terms of cost effectiveness and a sound use of tax payers’ dollars, as well as getting drug users into medical treatment, this is the wisest course of action. However, until the US ban on funding syringe exchange initiatives is finally revoked, this will not happen, and any blueprint by the Office of Global AIDS Coordinator will be aspirational but not achievable.
The impact of such programming is directly proportional to the level of oppression that drug users experience in their daily lives. Drug users face unconscionable repercussions, including long-term incarceration, forced labor camps, the loss of their children and right to education, housing, and medical treatment. HIV can pale into the background of concerns. The conflict between criminalizing drug users and taking a public health approach to drug use often results in the criminalization end of the equation winning. The critical piece of this blueprint is not only defining the primary interventions but how to create a world where those interventions can be implemented to have most impact. While the US continues to incarcerate more of its citizens than any other country on the planet, deny access to federal support for the best HIV prevention for drug injectors and nullify basic human rights to people who have a history of drug use, there will be a resounding dissonance in its global planning.
The Vienna Declaration (http://www.viennadeclaration.com/) was a product of the 2010 International AIDS Conference and drafted by prominent scientists and physicians. Among its recommendations, it called upon governments to, “Decriminalise drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centres that violate the Universal Declaration of Human Rights.” Any blueprint shaping the future of global aids policy must endorse the sentiments and directives of the Vienna Declaration.
We cannot achieve an AIDS-free world unless the blueprint to end the epidemic is a plan of action.