Olga Golichenko is the Harm Reduction Advocacy Senior Advisor and Enrique Restoy is the Human Rights Advocacy and Campaigns Coordinator at the International HIV/AIDS Alliance. 

Follow Olga and Enrique on Twitter.

On 26th June 2013, activists in 26 cities around the world demonstrated against the ‘war on drugs’. They were taking part in a global day of action organised by the Support. Don’t Punish campaign. They called on governments to change punitive laws and policies against drug use which undermine the dignity of people who use drugs and fuel the HIV - and hepatitis C - epidemics. 

Is this a revolutionary idea? Not so in the UK - which has been a champion of harm reduction programmes to prevent HIV amongst people who use drugs since their introduction by Margaret Thatcher’s government back in the 1980s. For the Thatcher cabinet this was part of an evidence-based, pragmatic approach that helped to fend off a HIV epidemic in the UK. 

The Conservative government policy on drug use, led by then Secretary of State for Health Lord Norman Fowler, was bold and effective. It was based on the belief that ‘the spread of HIV is a greater danger to individual and public health than drug misuse’ and ‘services should aim to minimise HIV risk behaviour by all available means’. This principle led to the introduction of clean needle and syringe programmes, drug substitution therapy (in particular methadone programmes) and other harm reduction interventions for people who use drugs in the UK. And it worked. Rates of HIV amongst injecting drug users in the UK are low (around 2% of people living with HIV in the UK are current or former injecting drugs users) and the UK’s rapid response is well regarded internationally. 

Now, with a growing international movement around the Support, Don’t Punish campaign, there is a unique opportunity for the UK to provide global leadership on this issue.

HIV and drug use

Today, 20 million people inject drugs and injecting drug use causes one in ten new HIV infections globally. Up to 90% of these infections are in regions such as the European Neighbourhood, Eastern Europe and Central Asia.

Whilst new HIV infections have been falling in many parts of the world since the late 1990s, new HIV infections linked to injecting drug use continue to rise, fuelled by national and global policies that criminalise drug use instead of taking the public health approach pioneered by the UK.

The International HIV/AIDS Alliance, whose secretariat has been based in the UK since its formation 20 years ago, has been delivering harm reduction programmes to injecting drug users in over eight countries for nearly 15 years. These interventions are based on strong scientific evidence that they prevent HIV amongst injecting drug users. Importantly, this approach preserves the dignity of people who use drugs and encourages them to protect their own health and that of their partners, family members and friends. We are grateful to the Global Fund to Fight AIDS, TB and Malaria, the Government of the Netherlands and to the European Union for their support of our work.

Earlier this year, the BBC reported from Ukraine (where the Alliance implements the national needle and syringe programme) that for the first time, the number of newly registered HIV cases among people who use drugs in 2012 dropped by 9% in comparison with 2011. 

Why the ‘war on drugs’ just doesn’t work

Despite success in the UK and now in Ukraine, most countries are engaged in a ‘war on drugs’ approach to injecting drug use, treating people who use drugs as a threat to national and international security and imposing draconian penalties that ruin lives. Over 30 countries apply the death penalty for drug offences. This approach has led to the spiralling of HIV and hepatitis C transmission. 

In China, Thailand, Vietnam and Cambodia people who use drugs are incarcerated in boot-camp style compulsory detention centres, or ‘treatment centres’, where forced labour and torture are common practices, and where HIV positive people have no access to HIV drug treatment. Study after study demonstrates that incarceration is strongly associated with increased risk of HIV and hepatitis C transmission. 

In Russia none of the estimated 2.5 million people who use drugs have access to substitution therapy (methadone), very few have access to clean syringes, and organisations face persecution for ‘propaganda’ when advocating for these kinds of evidence-based programmes. Unsurprisingly, HIV rates are rising at an alarming rate in Russia.

The response in China is more nuanced. The Chinese Government support a national methadone programme. Despite this progress, a harsh law and order approach undercuts the potential of this programme. The results are well documented by our colleague Garcia Shi, Policy Manager of Asia Action on Harm Reduction, AIDS Care China:

"People who use drugs in China lack access to clean needles and syringes; they don’t have enough money to pay for methadone substitution therapy fees; and they face the risk of being imprisoned in compulsory detoxification centres. Both the public and the Chinese government regard drug use as a criminal act."

The tide is turning – how the UK can lead the way

Drugs and drug policy is not a policy issue that often attracts a lot of attention. That’s why we were so thrilled that our global day of action on 26 June captured so much attention.

To date, over 85 international development, human rights, drug policy, HIV and wider health organisations have endorsed the campaign. Richard Branson, Michel Sidibé (UNAIDS Executive director) and former Polish President Aleksander Kwaśniewski have backed the campaign. 

This support is welcome. We feel the door is open and there is growing support for an alternative to the ‘war on drugs’. The Alliance looks forward to further dialogue with those across the political spectrum who want to look at how the UK can share its experience and success in order to help to bring about a world without AIDS. And we urge William Hague, Justine Greening and Jeremy Hunt to continue the bold leadership of Margaret Thatcher and Lord Fowler and be clear, the ‘war on drugs’ does more harm than good. 

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