Harm Intensification

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Norway Government Wants to Decriminalize Heroin Smoking

The Norwegian government said Friday it wants to decriminalize the smoking of heroin as a harm reduction measure, Agence-France Presse reported. Smoking heroin is less dangerous than injecting it, and the move could reduce the number of overdoses, officials said.

heroin smoking image from 1965 UNODC newsletter
"The number of fatal overdoses is too high and I would say it's shameful for Norway," said Health Minister Jonas Gahr Stoere. "The way addicts consume their drugs is central to the question of overdoses. My view is that we should allow people to smoke heroin since injecting it is more dangerous," he said.

According to the Norwegian Institute for Alcohol and Drug Research (SIRUS), heroin overdoses accounted for 30% of 262 fatal overdoses in 2011. By comparison, only 168 people died in traffic accidents that year.

The city of Oslo has opened a supervised injection site in a bid to reduce overdoses, but decriminalizing heroin smoking would also help, said Stoere. Users currently can't smoke at the supervised injection site.

"This isn't about some kind of legalization of heroin but about being realistic," he said. "Those who are in the unfortunate situation of injecting themselves in a drug room should be able to inhale. It is less dangerous, you consume less and the risk of contracting a disease is lower," he added.

"It's a paradox that you can't smoke heroin when you can inject it, since the first method is less dangerous than the second," SIRUS researcher Astrid Skretting told AFP. "But the culture of injecting which provides a more immediate effect than smoking seems deeply rooted in Norway and it's not certain that a decriminalization will lead to a radical change in behavior," she suggested.

The Norwegian government is set to unveil its latest plan for fighting drug addiction next week. Stoere said the heroin smoking decrim plan has the backing of the center-left government.

Oslo
Norway

In Memoriam: Dave Purchase, Needle Exchange Pioneer

Needle exchange pioneer Dave Purchase died last month in Tacoma, Washington, where he had long resided and where he began handing out sterile syringes to prevent the spread of AIDS among intravenous drug users back in the summer of 1998. Purchase died on January 21 of complications from pneumonia. He was 73.

http://stopthedrugwar.org/files/dave-purchase-250px.jpg
Dave Purchase
Purchase is widely cited as having started the first needle exchange in the country, although that is difficult to verify.

A Harley rider, the bearded and burly Purchase was working as a drug counselor when he was hit by a drunk driver in 1983. He returned to work after recovering and used $3,000 from a settlement from the crash to buy his first supplies and begin handing out needles, cotton swabs, bleach, and condoms. Within months, he had handed out 13,000 needles, most of them bought with his own money.

By 1993, Purchase had founded the Point Defiance AIDS Project, working with local authorities, and the North American Syringe Exchange Network (NASEN), which now distributes more than 15 million needles a year to syringe exchange programs.

Purchase started his exchanges without official sanction and said he was prepared to go to jail for possessing drug paraphernalia, but then-Tacoma Police Chief Ray Fjetland wisely suspended enforcement of the paraphernalia law at the exchanges. Over the years, Purchase's Tacoma exchange became a model, especially in winning the cooperation of local authorities.

At last count, there were around 200 needle exchange programs in the country, which distributed some 36 million syringes in 2011. Those needle exchange programs have been repeatedly shown to save lives by reducing the spread of AIDS and other blood-borne infections. Dave Purchase wasn't the only early needle exchange advocate, but he was a tireless one, and countless people owe their lives to his efforts.

And maybe more than lives. In a testimonial posted on the NASEN web site (linked below), Nick Crofts expressed thoughts felt by many in calling Dave "a presence in the world... a taken-for-granted, a defining pole, a constant point of reference when there was trouble or confusion, an ethical touchstone." Crofts wrote, "[a]ll the people Dave inspired share one characteristic with him... he accepted people for what they were, he valued them for their very existence, he made it known to them and everyone else that their lives were equally important as his and everyone else's. This is the hallmark and the revolution of the harm reduction movement... and Dave stamped this all over the north American scene, and through his acolytes all over the world."

Dave may be gone now, but his work lives on. More testimonials and links about him can be found on the NASEN web site and the Tacoma Syringe Program Facebook page.

Tacoma, WA
United States

Naloxone Anti-Overdose Bill Moving in New Jersey

A bill that would expand access to the overdose-blocking drug naloxone is moving in the New Jersey legislature. The bill, Senate Bill 2082, the Opioid Antidote and Overdose Prevention Act passed the Senate Health, Human Services and Senior Citizens Committee Monday on a unanimous vote and now heads for a Senate floor vote.

A companion measure, Assembly Bill 95, awaits a hearing before the Assembly Health and Senior Services Committee.

Naloxone is an opioid antagonist, meaning it blocks and reverses the effects of opioid drugs, such as heroin, morphine, and Oxycontin. A Centers for Disease Control and Prevention report from last February found that some 50 naloxone programs nationwide had reversed more than 10,000 overdoses.

Naloxone is available only by prescription in New Jersey. The bill would expand access to the drug by providing protection from civil and criminal liability to medical professionals who prescribe the drug and laypersons who administer it.

Advocates applauded the bill's clearing the first hurdle and urged the legislature to finish the job.

"We must have a comprehensive strategy to reduce the huge number of tragic and preventable overdose deaths in New Jersey," said Roseanne Scotti, New Jersey state director for the Drug Policy Alliance. "Expanded access to Naloxone is a key component in that strategy. This bill will save lives and should now be acted on by the legislature with all possible speed. Lives hang in the balance."

"Drug overdose continues to be the leading cause of accidental death in New Jersey," said Sen. Joseph Vitale (D-Woodbridge). "Each year it surpasses the number of deaths caused by automobile accidents and guns.  Expanding access to naloxone will allow this medication to reach its full public health potential and will be an important part of New Jersey's comprehensive efforts to address drug abuse."

Patty DiRenzo of Blackwood lost her son, Salvatore, to an overdose when he was 26 years old.

"Sal was a beautiful soul who unfortunately struggled with addiction. If the people he was using with on the night he died had access to naloxone, he might still be alive today. Instead, my son was left alone to die. It's extremely important to have policies like this one in place, so that other families are spared the grief that mine has endured."

Eight states and the District of Columbia have already passed legislation easing access to Naloxone in a bid to reduce drug overdose deaths.

Trenton, NJ
United States

Naloxone Cheap Way to Prevent Drug OD Deaths, Study Finds

Drug overdose deaths are now the leading cause of accidental death in the US, surpassing automobile accidents, but a new study suggests that distributing naloxone to opioid drug users could reduce the death toll in a cost-effective manner. The study was published this week in the Annals of Internal Medicine.

Naloxone package (wikimedia.org)
Opioids, including not just illicit heroin but also widely used prescription pain pills, are responsible for about 80% of drug overdose deaths. Naloxone, an opioid antagonist, works by blocking opioid receptors in the brain, making it possible to reverse the effects of overdoses.

At least 183 public health programs around the country have trained some 53,000 people in how to use naloxone. These programs had documented more than 10,000 cases of successful overdose reversals.

In the study published in the Annals, researchers developed a mathematical model to estimate the impact of more broadly distributing naloxone among opioid drug users and their acquaintances. Led by Dr. Phillip Coffin, director of Substance Use Research at the San Francisco Department of Public Health, and Dr. Sean Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, the researchers found that if naloxone were available to 20% of a million heroin users, some 9,000 overdose deaths would be prevented over the users' lifetimes.

In the basic research model, one life would be saved for every 164 naloxone kits handed out. But using more optimistic assumptions, naloxone could prevent as many as 43,000 overdose deaths, saving one life for every 36 kits distributed.

Providing widespread naloxone distribution would cost about $400 for every year of life saved, a figure significantly below the customary $50,000 cut-off for medical interventions. That's also cheaper than most accepted prevention programs in medicine, such as checking blood pressure or smoking cessation.

"Naloxone is a highly cost-effective way to prevent overdose deaths," said Dr. Coffin. "And, as a researcher at the Department of Public Health, my priority is maximizing our resources to help improve the health of the community."

Naloxone has proven very effective in San Francisco, with heroin overdose deaths declining from 155 in 1995 to 10 in 2010. The opioid antagonist has been distributed there since the mid-1990s, and with the support of the public health department since 2004. But overdose deaths for opioid pain medications (oxycodone, hydrocone, methadone) remain high, with 121 reported in the city in 2010. Efforts are underway in the city to expand access to naloxone for patients receiving prescription opioids as well. This study is the latest to suggest that doing so will save lives, and do so cost-effectively.

New Jersey Finds Syringe Exchange Works

In a report released Tuesday, the New Jersey Department of Health and Senior Services has found that the state's needle exchange program has provided clean needles to nearly 10,000 drug users and gotten more than 2,000 of them into drug treatment. In the report, Health Commissioner Mary O'Dowd concluded that the program is a success and should be continued.

The goal of needle exchange programs is to reduce harm to injection drug users and the community at large by reducing the spread of blood-borne diseases, such as HIV/AIDS and Hepatitis C. According to the report, injection drug users accounted for nearly 40% of new HIV/AIDS cases in the state through 2010.

"Sterile syringe access programs (SAPs) which include drug treatment and behavioral interventions are one model proven to significantly prevent/reduce the transmission of these diseases," the report noted. "These programs have also been shown to facilitate enrollment of IDUs into drug rehabilitation programs."

New Jersey passed a pilot needle exchange law in 2006, and Atlantic City became the first in the state to implement a needle exchange the following year. Camden, Newark, and Paterson came on board in 2008, and Jersey City in 2009.

Those programs saw 9,912 people enrolled between November 2007 and November 2011. Nearly 300,000 clean needles were distributed, with more than 160,000 dirty ones collected. In 2010, the state began providing each program with a nurse, and since then 59 pregnant injection drug users have received prenatal care and drug treatment.

"We are totally thrilled and certainly very grateful to the commissioner for her support," said Roseanne Scotti, head of the Drug Policy Alliance New Jersey office, who faced off against lawmakers, law enforcement, and social conservatives to help push the bill through. "This is a culmination of a 20-year battle, when Senator Wynona Lipman introduced the bill back in 1992."

Trenton, NJ
United States

California Good Samaritan Drug Overdose Bill Signed Into Law

California Gov. Jerry Brown Monday signed into law Assembly Bill 472, the "911 Good Samaritan Bill," aimed at reducing fatal drug overdoses by removing the threat of criminal prosecution for people who seek assistance for people suffering from them. California becomes the 10th state to enact such a law since New Mexico led the way back in 2007.

fatal drug overdose (wikimedia.org)
Sponsored by Rep. Tom Ammiano (D-San Francisco), the bill received bipartisan support in the legislature and was cosponsored by the Drug Policy Alliance, the ACLU of California, and the Health Officers Association of California.

"This is a great victory for parents. None of us want our kids overdosing on drugs, but as I told the legislature, I'd rather have my kid around to yell at than attend a funeral," said Ammiano. "The young friends of those who overdose shouldn’t hesitate to seek help because they fear arrest. With the Governor's signature, they won't have to."

"This is an incredibly special day for the thousands of California family members who worked so hard and for so long to pass this life-saving bill," said Meghan Ralston, harm reduction manager of the Drug Policy Alliance. "This is just a small first step in reducing the number of fatal overdoses in California, but it's a deeply important one."

Drug overdose deaths are the number one cause of accidental death in California, as in many other states. The new law encourages people to seek emergency health services when they witness an overdose by providing limited protections from charge and prosecution for low-level drug law violations, including possession of small amounts of drugs. Those who sell drugs are not protected under the new law.

"I never go a day without thinking of my son Jeff and I never will," said Denise Cullen, cofounder of GRASP (Grief Recovery After a Substance Passing). "Losing a child to a drug overdose is a tragedy in ways I can't explain, but fighting so hard for him and for all the parents just like me, to get this law passed is really the best possible way I can honor him."

"After forty years of the war on drugs, California is finally righting its priorities by putting saving lives ahead of making petty arrests. The message is loud and clear: call for help in case of an overdose. This is an important step toward better drug and public health policies and it will save lives," said Margaret Dooley-Sammuli, senior policy advocate for the ACLU of California.

"The physician Health Officers who provide leadership for public health programs in every county are grateful to Governor Brown for partnering with us on this common sense, no-cost approach to saving lives," said Bruce Pomer, executive director of Health Officers Association of California. "It's urgently needed."

Now the task is to get the word out to those populations where it will do the most good. Advocates from dozens of state and local organizations will be working to do just that, both before the new law goes into effect on January 1, and throughout the following year.

Sacramento, CA
United States

Danes Want Heroin Pills for Addicts

In remarks reported by the Copenhagen Post Sunday, Danish Health Minister Astrid Krag announced that she is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection.

Heroin safer in pill form? Danes thinks so. (wikimedia.org)
It is time to offer users a safer choice, Krag said, adding that the pills should be available next year. She said the Danish Board of Health had evidence to believe making heroin available in pill form would reduce the risks of disease and overdose.

"With tablets, we get a tool that lessens the risk of incorrect dosages, injuries and incidences of cancer," she explained. "This will be an improvement of the current system. It clearly needs to be in place by 2013."

The Danish government approved heroin maintenance in 2008, with the first clinic opening in 2010. There are now five of them. A supervised injection site is set to open in the Copenhagen neighborhood of Vesterbro later this year. In the meantime, a mobile injection site is zooming around the neighborhood.

Opposition conservative party spokespersons said they were open to the proposal, but wondered how it would be paid for. But spokespersons for the government Socialistisk Folkeparti said that was just politics.

"It is remarkable that [the conservative opposition] says that financing must be in place before you make a proposal," said Jonas Dahl, health spokesman for the Socialists. "The working procedure has always been that we first get a professional recommendation from the Board of Health and then find the money."

Copenhagen
Denmark

California Drug Overdose Prevention Bill Passes

A bill aimed at saving the lives of drug overdose victims by protecting those who would come to their assistance from prosecution on drug charges passed the California legislature Monday on a bipartisan vote of 54-22 in the Assembly. It had already passed the Senate. The vote came days before International Overdose Awareness Day.

fatal drug overdose (wikimedia.org)
In recent years, Californians have been dying of drug or alcohol overdoses at a rate of ten a day, with the number of fatal overdoses increasing by 24% between 2000 and 2006, according to supporting documentation within the bill.

Introduced by Assemblyman Tom Ammiano (D-San Francisco), the bill, Assembly Bill 472, provides that neither the overdose victim nor a person who seeks emergency treatment for him shall be charged with the crime of drug possession or being under the influence of drugs, provided the drugs are for personal use.

Such bills are known as "Good Samaritan" bills and have already been passed nine other states.

In asking his colleagues to vote for the measure, Ammiano noted that more people die from drug overdoses than in car crashes. Fewer would die, he said, if witnesses sought prompt emergency help, but some hesitate for fear of being arrested for their drug use or possession. That argument got through to members of both parties.

"This is not going soft on crime," said Assemblyman Donald Wagner (R-Irvine). While he added that he does not condone drug use, he said it was necessary to "overlook some indiscretions for the greater good."

"It's critically important to save lives," said Assemblywoman Kristen Olsen (R-Modesto). "This bill doesn't condone drug behavior."

"It's not going to encourage underage use," noted Assemblyman Mike Feuer (D-Los Angeles). On the contrary, he said, the knowledge that overdose is so life-threatening should encourage users to reevaluate their behaviors.

"It's time we started saving lives in California," said Ammiano.

The bill was lobbied for by the Drug Policy Alliance, and supported by a range of organizations including California Society of Addiction Medicine, California Attorneys for Criminal Justice; California Professional Firefighters, California Association of Alcohol and Drug Program Executives County Alcohol and Drug Program Administrators Association of California, National Council of Alcohol and Drug Dependence of the San Fernando Valley, National Association of Social Workers, Asian Pacific AIDS Intervention Team, Bay Area Addiction Research and Treatment, Families ACT!, Grief Recovery After a Substance Passing and Parents for Addiction Treatment and Healing.

The only group to officially oppose it was the California Sheriff's Association.

The bill now goes to the desk of Gov. Jerry Brown (D).

Sacramento, CA
United States

New Jersey Good Samaritan Overdose Bill Passes

A bill designed to reduce drug overdose deaths by providing some legal protection to people who witness them and summon medical assistance has been approved by the state legislature and now awaits the signature of Gov. Chris Christie (R). The bill passed the Senate Monday on a 21-10 vote; it had cleared the Assembly back in May.

fatal drug overdose (wikimedia.org)
The bill, Assembly Bill 578, also known as the Good Samaritan Emergency Response Act, would provide limited legal protection against drug possession charges for people who witness an overdose and call 911. It is aimed at reducing drug overdose deaths by reducing the fear of arrest for those might call for assistance.

According to the Centers for Disease Control and Prevention, drug overdoses are now the leading cause of accidental death, replacing automobile accidents. More than 27,000 people died from drug overdoses in 2007, most of them from prescription opiates, either by themselves or in combination with other drugs, including alcohol.

Many drug overdose deaths occur in the presence of others and take hours to occur, meaning that there is time and opportunity to call for help. But strict enforcement of drug possession laws against would-be Samaritans discourages some from making that call.

Advocates are applauding the passage of the life-saving bill.

"Calling 911 should never be a crime. Our current policies focus on punishment and drive people into the shadows and away from help," said Roseanne Scotti, New Jersey State Director of the Drug Policy Alliance. "Saving lives should always take priority over punishing behavior.  A Good Samaritan law will encourage people to get help."

"When a life is on the line we can ill afford to waste time weighing the consequences of calling 911 or deciding whether or not to be truthful about what substance was used to overdose," said Senate bill sponsor Sen. Joseph Vitale (D-Middlesex). "By narrowly eliminating the criminal consequences one might face after calling 911 to report an overdose, I hope to diminish any hesitation one might have about doing the right thing."

"I and my family are so grateful to the senate for passing this life-saving legislation," said Patty DiRenzo, whose son Salvatore died of an overdose at age 27. "We, and the other families who have lost loved ones to overdose, will be advocating with Gov. Christie to urge him to sign this bill. It's extremely important that we prevent future overdose deaths and spare other families the grief that mine has endured."

If Gov. Christie signs the bill into law, New Jersey will become the ninth state to enact a Good Samaritan law. The others are Colorado, Connecticut, Florida, Illinois, New Mexico, New York, Rhode Island, and Washington. Similar legislation is pending in several other states.

Trenton, NJ
United States

"You Can't Stop AIDS Without Ending the Drug War" [FEATURE]

The XIX International AIDS Conference took place in Washington, DC, last week, bringing more than 20,000 scientists, activists, government officials, and journalists to assess the science and determine best practices for reducing the spread of the HIV virus. The US was able to host the conference for the first time in 22 years after it finally repealed a law denying people with HIV admission to the country.

http://stopthedrugwar.org/files/aids2012-protest-1.jpg
activists interrupt the conference opening session to protest the exclusion of drug users and sex workers (video at droginreporter.hu/en)
But other critical groups remained excluded -- drug users and sex workers. Although they make up a majority of people living with HIV in many countries, people who admit to ever using drugs or engaging in prostitution within the past 10 years are inadmissible under US immigration laws. The State Department could have issued a blanker waiver of inadmissibility for people attending the conference, but declined to do so.

Drug users and sex workers who wanted to attend the conference were thus faced with a dilemma: Tell the truth and be barred or lie on the visa application, which in itself is a violation of US immigration law. As a result, representatives of some of the groups most affected -- and most likely to be affected in the future -- were unable to attend.

"People do not want to run the risk of attending the conference in a country where they are told they are not wanted or desired," said Allan Clear, the executive director of the Harm Reduction Coalition. "It sends the message that people who have a history of drug use or sex work are not actually included in the dialog at all, and is a serious setback in the fight against AIDS. I don't think the US government has any particular interest in actually involving sex workers or drug users in policy or programming."

The exclusion of drug users and sex workers hasn't gone down well with activists. As far back as two years ago at the Vienna AIDS conference, Indian activist Meena Seshu called for a boycott of AIDS 2012, pointing out that it was unethical three decades into the AIDS epidemic to discuss AIDS policy without including those most affected. Some have boycotted the conference, opting instead to attend a Kiev conference that began July 9 for drug users and people living with HIV from Eastern Europe. Sex workers and their allies followed with a side meeting in Kolkata this week. While those two events are officially considered "hubs" of the International AIDS Conference, many attended them as a means of protesting the exclusion of drug users and sex workers in Washington.

Unhappiness broke into the open in Washington Monday when dozens of drug user and sex workers activists disrupted the conference's opening press event. They leapt from their seats unexpectedly and marched through the room, waving banners and shouting slogans such as "No drug users? No sex workers? No International AIDS conference!"

Discontent with AIDS policies that marginalize drug users and sex workers escaped from the conference rooms and onto the streets again on Tuesday, as hundreds marched to the White House chanting "No More Drug War" in a rally timed to coincide with the conference. The march broadened the scope of protest, linking the battle against AIDS with the war on drugs and corporate domination of US political life.

On the way to the White House, protestors stopped at UPS and Wells Fargo facilities to chide those corporations for unhelpful practices. UPS took heat for donating to politicians who voted to restore the federal ban on needle exchange funding, and Wells Fargo for investing in private prisons.

"Wells Fargo is literally invested in locking more people up," said Laura Thomas of Drug Policy Alliance (DPA).

Activism around drug users and AIDS also took place in the conference's Global Village, including the installation of a model of Vancouver's Insite supervised injection site and tours of a local needle exchange outreach van courtesy of DC's Family and Medical Counseling Services. The Harm Reduction and Global Drug Policy Zone in the village also featured special events and presentations put on by groups including the Harm Reduction Coalition, Harm Reduction International, the Hungarian Civil Liberties Union, the Eurasian Harm Reduction Network, and the International Network of People Who Use Drugs.

Advocates also took advantage of the AIDS conference to unleash a campaign on the theme of "You Can't End AIDS Unless You End the Drug War." Articles to that effect appeared on Alternet and the Huffington Post (and were picked up elsewhere), while Global Commission on Drug Policy member Richard Branson penned a USA Today op-ed piece on how drug prohibition contributes to the spread of HIV. As part of the same campaign, Politico ran a full-page ad signed by Global Commission members and other notables, repeating the message and directly challenging both President Obama and Gov. Romney to "do the right thing." Giants in AIDS advocacy like Michael Kazatchkine and Stephen Lewis joined the calls in speeches given during the conference.

In an unexpected cap to things, former President Bill Clinton called for drug use to be treated as a public health issue, not a criminal justice one, in remarks at the closing plenary. Clinton cited The Huffington Post and Alternet op-eds, coauthored by the Drug Policy Alliance's Ethan Nadelmann and American Foundation for AIDS Research founder Matthilde Krim.

Activists demanding a larger role for drug users and sex workers in setting the policies that are supposed to help them fight AIDS came armed with powerful ammunition. Two recent reports clearly lay out how criminalizing drug use helps spread the disease and how many countries are failing to adequately deal with the spread of HIV among injection drug users.

The first report, from the Global Commission on Drug Policy, makes its findings clear in its title: "The War on Drugs and HIV/AIDS: How Criminalization of Drug Use Fuels the Global Pandemic." In the report, the commission noted that injection drug use now accounts for one-third of new HIV infections outside of sub-Saharan Africa, including some 354,000 people in the US.

"Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated," the commission said. "Mass incarceration of nonviolent drug offenders also plays a major role in spreading the pandemic."

The commission also remarked on "the remarkable failure" of drug prohibition in reducing the global drug supply. The worldwide supply of illicit opiates, such as heroin, has increased almost four-fold in recent decades, the commissioners noted. They also noted the drug war's contribution to the growth of organized crime and violence.

The commission identified proven addiction treatment and evidence-based public health measures that countries should put in place to reduce the spread of HIV and protect community health and safety. They include needle exchange programs, safer injecting facilities, and prescription heroin programs.

"Failure to take these steps is criminal," the commission said.

In the second report, "The Global State of Harm Reduction 2012: Towards an Integrated Response," from the London-based Harm Reduction International (formerly the International Harm Reduction Association), researchers found that while injection drug use has been identified in 158 countries, only half of them have any programs aimed at preventing the spread of HIV among injectors, and the situation internationally is not improving. Even in countries that are addressing the problem, programs suffer from lack of funding and donor support is decreasing. That is undermining the global response to AIDS, the report concluded.

"In the last two years, we have seen a significant scale-down of services in countries with some of the highest HIV burdens among people who inject drugs," said Rick Lines, the group's executive director. "As tens of thousands gather in Washington this week to call for an end to AIDS, it is becoming increasingly clear that governments have neither the will nor the intention of ending the spread of HIV among people who use drugs."

"We have seen the number of needle exchange programs in Russia drop for 70 in 2010 to only six in 2012. This is made worse by a retreat of many bilateral and multilateral donors to funding effective harm reduction interventions in many countries," said Claudia Stoicescu, public health analyst at Harm Reduction International and author of the report. "Such developments significantly limit progress toward global commitments to halve HIV transmission related to unsafe injecting by 2015, let alone any hope of achieving universal access to HIV prevention, treatment, care and support for people who inject drugs."

"The reluctance of governments to fund an adequate response to HIV and injecting drug use stands in stark contrast to the seemingly limitless budgets for ineffective and punitive law enforcement responses," said Lines. "Governments care more about fighting a losing war on drugs than they do about winning the fight against HIV."

As the world enters its fourth decade of living -- and dying -- with HIV/AIDS, this week's conference and its barriers to participation by and concern for some of those most directly affected by the crisis -- drug users and sex workers -- demonstrate how far we still have to go. They also make achingly clear the destructive role that drug prohibition and the criminalization of marginalized populations play in perpetuating the epidemic.

Maybe next time the International AIDS Society will hold its conference someplace where drug users and other marginalized groups can attend and be heard. Or maybe the United States will alter its harsh visa requirements aimed at drug users and sex workers. Either one would be good. Ending drug prohibition, the stigma it generates, and the obstacles to fighting disease it engenders would be better.

Washington, DC
United States

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