Drug use accounts for one in three new cases of HIV and is a major driver of the epidemic in Eastern Europe. The presence of the International AIDS Conference in Vienna (given Vienna’s proximity to this region) has been an opportunity for activists and academics to highlight the importance of addressing the issues surrounding drug use with particular regard to HIV vulnerability.
The Vienna Declaration, compiled by a few key organizations and signed by many more, is a “scientific statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies.” One of the main criticisms made by the Vienna Declaration is of the ongoing “war on drugs.” The war on drugs is characterized by an over-reliance on prohibition, harsh drug enforcement policies, and the targeting of already marginalized groups. The declaration outlines the harms caused by the war on drugs on the HIV epidemic, including driving away drug users from prevention and care services and into unsafe environments where vulnerability to contracting HIV increases.
In an effort to provide the evidence that paints a true picture of the ramifications of the war on drugs, the Lancet held a session here in Vienna featuring the July 2010 issue on HIV in People who use drugs. A comment by Nabia El-Bassel, Assel Terlikbaeva, and Sophie Pinkham contained in the issue offers a glimpse into the complicated interaction between gender and drug use with regard to HIV vulnerability. El-Bassel and her co-authors speak to the “double risk” faced by drug-using women in negotiating safe sex and drugs leading to the multiple ways women become vulnerable to contracting HIV. In particular, the authors highlight the discrimination faced by pregnant women who are also drug users, often in combination with ongoing stigmatization of HIV positive women accessing pregnancy related services. Many countries including the United States contribute to this ongoing stigma and discrimination: the state of South Carolina actively arrests and imprisons drug-using pregnant women. National Advocates for Pregnant Women reports that between 1989 – 2006, 126 pregnant women have been arrested during their pregnancies in South Carolina, most of whom were charged with drug and alcohol abuse. In these circumstances, women who are HIV positive will likely face additional burdens of lack of continuity of care, barriers to accessing needed treatments, and ongoing stigma and discrimination.
The Vienna Declaration is a necessary step in its demand to force governments to justify unnecessary and harmful laws. The Lancet issue provides the evidence we need to make the case to end the war on drugs.
I am left wondering however: is it “rationality” that will work? Is it evidence that convinces lawmakers who think it’s a good idea to imprison pregnant women to think otherwise? Is it science that will make the lawmaker who believes that prison is an effective way to wean people off drugs, change his or her mind? Will targeting minority groups in drug enforcement change when there is suddenly evidence that validates that this is systematic? I am not entirely convinced.