In the seventh and final paper in The Lancet Series on HIV in people who use drugs, a call to action is made by experts who say that while scale-up of various interventions outlined in earlier papers are vital, these are not enough. Drug users should be decriminalised, along with other changes in policy on drug control and law enforcement. The paper is by Professor Chris Beyrer, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, and colleagues.
The authors highlight that it is possible to control HIV epidemics in people who use drugs with currently available strategies, such as opioid substitution (OST), needle and syringe programmes (NSP), and antiretroviral treatment (ART). The evidence backs a massive scale-up of all three in combination. Now is the time, say the authors, for countries to realise that national harm-reduction policies, programmes and services are desperately needed; failure to act or continuing with inadequate pilot programmes will not prevent the HIV epidemic in drug users advancing.
The authors say: "The dangers of inaction in meeting the needs of people who use drugs include continuing spread of HIV infection in new populations and regions, increased complexity of HIV-1 epidemics at molecular levels, decreased access to opioids for pain management and palliative care, and the human, family, health, and social costs of mass incarceration and detention."
They add: "Expanded action and advocacy by health professionals on behalf of people who use drugs are urgently needed in both health-care and criminal justice sectors. Health professionals should not be complicit in programmes and policies that have no evidence base or that violate human rights. The voice of people who use drugs themselves needs to be heard at all levels, from service delivery to policy decision making."
Highlighting that reform of justice systems is a large part of harm reduction, the authors call for decriminalisation of drug users, along with legal services and access to health services for people who use drugs in all forms of prison and detention. They say: "If drug control sectors and law enforcement are not a part of new approaches, then harm-reduction programmes will be closed, substitution clinics will stay sparsely attended, and ART and preventive interventions will have a low uptake by drug users."
They conclude: "Only around 10% of people who use drugs worldwide are being reached [by current treatment programmes], and far too many are imprisoned for minor offences or detained without trial. To change this situation will take commitment, advocacy, and political courage to advance the action agenda. Failure to do so will exacerbate the spread of HIV infection, undermine treatment programmes, and continue to expand prison populations with patients in need of care."
Professor Chris Beyrer, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. T) + 1 443 807 0412 E) cbeyrer@jhsph.edu
For full Series paper 7 see: http://press.thelancet.com/drugshiv7.pdf
Journal
The Lancet