To end Aids, we must help the vulnerable, not arrest them
When Michel Sidibé, the executive director of UNAIDS, spoke at the opening of the International Aids Conference he said he had a vision. The end of Aids by 2030.
That means, he said, voluntary testing and treatment reaching everyone, everywhere; each person with HIV having the virus suppressed, no-one dying from Aids, no baby being born with Aids.
It is a recurring theme at this conference, which is called Stepping Up the Pace. And there is much optimism here. Nearly 14 million people living with HIV in low- and middle-income countries are now being treated, according to a recent UNAIDS report.
But there are also grave concerns. There is a growing number of countries criminalising homosexuality – Uganda and Kenya the two latest. There is evidence that this stops people from coming forward to be tested, that they do not go to clinics for treatment, and HIV rates climb.
And there was a warning issued here, too, that the global funding for HIV prevention for people who inject drugs is in crisis.
Harm Reduction International, the International Drug Policy Consortium and the International HIV/AIDS Alliance launched a report which claimed that achieving an “Aids-free generation” would be impossible without concerted action.
And one only needs to look to Russia to see the very real threat. Russia’s bans on methadone as a replacement for heroin and needle exchange is fuelling one of the fastest-growing HIV epidemics in the world.
Russia now accounts for over 55 per cent of the new HIV infections in Europe. Since Crimea was annexed, there has been a ban on opioid substitution therapy (OST) programmes.
Michel Kazatchkine, the UN secretary general’s special envoy for HIV/Aids in eastern Europe and central Asia, said in a recent BMJ article that OST programmes had helped manage the epidemic in Crimea.
The ban introduced by Russia was, he said, “a blatant example of health policy being hijacked for political ends rather than being led by evidence”.
Harm reduction is a phrase echoing through this conference. It is a simple enough concept. If people are helped to avoid risky behaviour like injecting drugs with dirty needles or having sex without condoms, then they will avoid HIV. That will, in turn, save money for national health services and prevent deaths.
How to reduce harm, though, is not so simple. There are increasingly arguments that the war on drugs is itself driving the HIV/Aids epidemic. The Global Commission on Drug Policy says “the war” has failed on a number of levels. Despite huge investment towards eliminating the global supply of drugs such as heroin and opium, the availability of these drugs has remained remarkably stable over the past 30 years.
And criminalising drug users drives them underground, away from HIV prevention and services.
Indeed, at the conference evidence was presented by the Open Society Foundation on the growing number of countries such as Kyrgyzstan, Burma, Ghana, India and Kenya, where police have been working with sex workers and drug users to help them access services rather than arresting them.
This, of course, requires an enormous amount of political will, and while some countries are nowhere near ready to begin the discussions, it is clear the debate on ending the criminalisation of drugs has already begun.
Follow @vsmacdonald on Twitter