Opinion

Harper's new Anti-Drug Strategy
is not anti-HIV

Injection drug use continues to be a driving factor in the global HIV/AIDS epidemic.¹ Harm reduction services, including needle exchange programs, have long been identified as essential components of an effective HIV prevention strategy. While scientific consensus has been reached regarding their efficacy in reducing HIV transmission,^2,4 such interventions remain controversial. In contrast, 'zero tolerance' approaches to drug use have been shown ineffective,⁵ however, they remain popular among conservative policymakers over evidence-based public health approaches. These should be matters of grave concern as they have a potentially devastating impact on HIV prevention efforts.^6-8

For instance, in the US, while close to one quarter of all new HIV infections have been attributed to injection drug use,⁹ there remains a federal ban on funding for needle exchange programs. In Russia, between 2002 and 2004 funding for needle exchange programs has reportedly fallen 29% while the prevalence of HIV among local injection drug users (IDU) populations is up to 60% in some areas.¹ Unfortunately, the "new" Conservative federal government of Canada is similarly allowing ideology to undermine the adoption of evidence-based HIV prevention policies. This was clearly illustrated by the recent statements of the Minister of Health, Tony Clement reported separately in this issue (see "'Doctors, get tough on drugs': Tony Clement" on page 22). Despite evidence of continuing HIV transmission among IDUs nationally,¹⁰ this government recently announced that no federal funds would be directed to support the operation of needle exchange programs in Canada or the supervised injection facility in Vancouver.^11-13

The government has also taken steps apparently aimed at eliminating harm reduction strategies. As part of this effort, the existing Canada's Drug Strategy (CDS) is being replaced with the new Anti-Drug Strategy which has been described as focusing on enforcement, prevention and treatment interventions.¹³ Harm reduction is no longer part of the strategy, a worrisome departure from the CDS's traditional approach: "Because substance abuse is primarily a health issue rather than an enforcement issue, harm reduction is considered to be a realistic, pragmatic, and humane approach." ¹⁶

The exclusion of harm reduction initiatives from the new Anti-Drug Strategy is a dangerous step backwards in the fight against HIV/AIDS. Its increased emphasis on law enforcement has potential to further increase HIV and other blood born infections among IDU. Through sexual transmission, the partners of infected IDU can then be expected to spread the virus among a wider population. The focus on law enforcement will also likely prompt a rise in the incarceration rates of IDUs, with marginalized populations, particularly Aboriginal peoples, being hardest hit.¹⁷ Imprisonment may further fuel the rate of disease transmission as incarceration has been independently associated with HIV infection among Canadian IDU.¹⁸

Canada's new 'Anti-Drug Strategy' appears ill conceived. Furthermore, the new Anti-Drug Strategy is not anti-HIV. As such, this should not be accepted as a legitimate policy shift. In deviating from internationally established HIV prevention standards, which are based on the best available evidence, this strategy may in fact be better described as "anti-health" and "anti-science." It has been over four years since former US president Bill Clinton publicly acknowledged that he was wrong to withhold federal funds for needle exchange programs in the United States.²⁰ How long will take before the Government of Canada expresses the same regret? More importantly, how much unnecessary suffering and new HIV infections will be needed before our political leadership finally embraces evidence -based public health principles in the fight against HIV/AIDS? -- Kora DeBeck (BC Centre for Excellence in HIV/AIDS), Evan Wood Thomas Kerr, Julio Montaner (BC Centre for Excellence in HIV/AIDS and Dept of Medicine, UBC), Vancouver, BC

1. UNAIDS. 2006 report on the global AIDS epidemic. Geneva: UNAIDS; 2006.
2. World Health Organization, UNAIDS, UN Drug Control Office. Policy brief: Provision of sterile injecting equipment to reduce HIV transmission. WHO; 2004.
3. UNAIDS. Progress report on the global response to the HIV/AIDS epidemic 2003: Follow-up to the 2001 United Nations General Assembly special session on HIV/AIDS. Geneva: UNAIDS; 2003.
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5. The Lancet. Losing tolerance with zero tolerance. The Lancet. 2005;365:629-630.
6. Wood E, Kerr T, Small W, Jones J, Schechter MT, Tyndall MW. The impact of a police presence on access to needle exchange programs. J Acquir Immune Defic Syndr. 2003;34:116-8.
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13. Department of Finance Canada. The Budget Plan 2007. Ottawa: Government of Canada; 03/19/2007.
14. Office of the Auditor General of Canada. Report of the Auditor General of Canada -2001, chapter 11--illicit drugs: The federal government's role. 2001.
15. DeBeck K, Wood E, Montaner J, Kerr T. Canada's 2003 renewed drug strategy -an evidence-based review. HIV/AIDS Policy and Law Review. 2006;11:1-5-12.
16. Government of Canada. Canada's Drug Strategy. Ottawa: Minister of Public Works and Government Services Canada; 1998.
17. Brzozowski J, Taylor-Butts A, Johnson S. Victimizing and offending among the aboriginal population in Canada. Jurisdat Statistics Canada; 2006. Available: http://dsp-psd.pwgsc.gc.ca.proxy.lib.sfu.ca/ Collection-R/Statcan/85-002-XIE/ 85-002-XIE2006003.pdf (accessed 2007 April 15)
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19. International Covenant on Economic, Social and Cultural Rights. United Nations General Assembly, 993 UNTS 3, Article12. 1996.
20. Altman L. Clinton urges global planning to halt H.I.V. New York Times. 07/12/2002. Available: http://query.nytimes.com/gst/fullpage.html? sec=health&res=9C04E7D61030F931A25754C0A9649C8B63&n=Top%2fReference %2fTimes%20Topics%2fPeople %2fC%2fClinton%2c%20Bill (accessed 2007 April 10)