Karina Roman

Drug laws hamstring UN forum on AIDS

Canadian thinks serious problem of drug use won't be addressed

The United Nations special assembly on HIV/AIDS will look at many aspects of the global health crisis, but experts fear there won't be enough emphasis on the link between intravenous drug use (IDU) and the spread of HIV, especially because it would mean addressing the world's drug laws. "They've finally caught on to the severity of the pandemic," says Diane Riley, a Canadian and non-governmental organization delegate on the board of UNAIDS, the UN body overseeing the fight against HIV/AIDS. "But it's likely that the soaring incidence of HIV among drug users will not be a main topic on the agenda."

By the end of May 1999, 114 countries and territories had reported HIV associated with IDU, compared with 52 in 1992, says Ms. Riley. And HIV has grown more rapidly among IDUs than in any other group, especially in Asia, Eastern Europe and South America.

In Canada, the proportion of reported AIDS cases attributed to IDU increased from 8.3 per cent in 1995 to 21.7 per cent in 2000. "HIV probably wouldn't be a pandemic if it were not for the drugs connection," says Ms. Riley. "We have to wake up and realize what's happening."

Ms. Riley is with the International Harm Reduction Association, which promotes alternative policies and programs to current drug laws, which it sees as the real cause of harm, as opposed to the drugs themselves. Harm reduction includes syringe exchange, substitution therapy such as methadone for heroin addicts, explicit education programs in schools, safe injecting sites and de facto decriminalization of marijuana.

The problem, says Eugene Oscapella, an Ottawa-based lawyer and one of the founders of the Canadian Foundation for Drug Policy, is that harm reduction programs are illegal according to many drug laws around the world, especially those of the influential U.S., even though they would help stem the spread of HIV.

"Many of the problems we associate with drugs really flow from drug prohibition," he says. Prohibition fuels the black market for drugs, resulting in artificially inflated drug prices. Therefore, addicts looking for the biggest bang for their buck often turn to injecting. Needle exchanges are not available or legal in most states. And because a syringe is illegal in Canada if it has drug remnants in it, some drug users are afraid to bring in their dirty needles. And with so few "safe places" to shoot up, shooting galleries, often run by drug dealers, become the venue of choice, where needles and cleaning bowls are often shared. To fund their addictions, many IDUs turn to prostitution, which only serves to increase the risk of spreading HIV. Furthermore, many drug users end up in prison, where drug use is rampant and clean needles are scarce. "The futility of prohibition is seen clearly within prisons," says Mr. Oscapella. "Even when incarcerated for 24 hours a day, people will still have access to drugs and still do drugs." Even when users seek help, the abstinence model of treatment is what they face.

In contrast, substitution therapy can stabilize a user's life. But the real bonus in the fight against HIV is that it shifts the user away from injecting.

In Britain, the spread of HIV is deemed a greater danger to individual and public health than drug misuse. It has one of the most progressive substitution therapy programs in the world and has a national average of only one per cent HIV infection in injection drug users.

Ms. Riley believes that once people realize the HIV/AIDS pandemic is not that far from their own back yard, attitudes will change. "The level of denial is astounding," she says. "But acceptance will happen. Unfortunately, we're just at the beginning of the pandemic. It'll take 100 million deaths before people deal with it."