by Dr Stefan Seebacher, head of the health department, International Federation of the Red Cross Red Crescent Societies, IFRC and Dr Rick Lines, executive director, Harm Reduction International, HRI
Do no harm and protect people from injustice. These are the basic principles of the Hippocratic Oath, which is taken by doctors all over the world. Within these principles are the fundamental concepts of impartiality, humanity, equity and fairness which should underpin public policy. They also reflect the humanitarian foundations upon which the Red Cross Red Crescent Movement is built, principles that also boost the most effective responses to HIV. However, most governments are not approaching drug use as a medical concern. Most national governments are enforcing drug laws that are harmful and unjust, and they must change.
Drug use is undeniably a social and public health concern affecting every community and every country. It is cause for concern because the causes and consequences of drug dependence and drug related health harms do not just affect individuals. They can have a devastating impact on families, children and the communities in which they live.
Undoubtedly there is a clear need to tackle both the societal and health consequences of drug use. The problem is that the methods that are being used which have been adopted from around the world are based on a punitive legal framework ranging in severity depending on where you happen to live. It is an approach based on the concept that the threat of criminal sanction and public disapproval will deter people from using drugs. Decades of evidence has proven that this approach is ineffective.
In fact, in many cases these drug laws have made matters worse. Three million of the estimated 16 million people who inject drugs are living with HIV. In some countries, the prevalence is up to 70 percent, and often injecting drug use is the main route of transmission of the virus. In almost every country, especially those most affected, punishment dominates while public health responses suffer.
This is not just about inaction or a lack of political will to halt and reverse the spread of HIV. It is about punitive approaches to drugs fuelling the transmission of HIV and other diseases, and more complex HIV epidemics, in addition to a higher rate of mortality and significant socio-economic destabilization. The stigma associated with HIV is a central concern of those working in the field. However, the stigmatization of people who use drugs is a necessary consequence of the adoption of criminal laws around this behaviour. The discrimination of people living with HIV results in disproportionately low rates of access to anti-retroviral drugs, and fuels violence, abuse and many forms of social exclusion.
Efforts to reduce harm related to HIV, including needle and syringe programmes, opioid substitution therapy, along with a range of other interventions have shown to decrease HIV transmission among people who inject drugs. However, criminal laws and the way they are policed impede these often services for being offered. Drug policies must reflect the clear distinction between drug traffickers and drug users to ensure that the adequate healthcare is provided for drug users.
The evidence is clear. Our drug laws have generated harm and they have created an unjust system that adversely affects the most vulnerable and marginalised. The moral imperative is undeniable. We must decriminalise drug use and possession and replace these harmful laws with those rooted in the principles of prudence, fairness and equity that have so long been lost in the drive to criminalisation. As such, the IFRC and the HRI are joining with the International Planned Parenthood Federation (IPPF) and the International Network of People who Use Drugs (INPUD) at this year’s International AIDS Conference to call on all those in the HIV movement to support the decriminalisation of drug use.