War on drugs hurts HIV prevention and treatment, research review suggests

Researchers: Stiff penalties for drug possession have failed to reduce drug use while putting thousands in jail who might be better served by treatment

The criminalization of drug use—the so-called war on drugs—has had negative impacts on the prevention and treatment of HIV, according to a systematic review of research on the topic.

A team from the Johns Hopkins Bloomberg School of Public Health and the University of British Columbia analyzed 106 studies published between 2006 and 2014, sharing their findings this week in journal Lancet HIV.

"We must understand that punitive laws have neither decreased the supply or the use of drugs and have caused adverse health outcomes. The current approach is not working."
Stefan Baral
Johns Hopkins epidemiologist

Of the studies the team reviewed, 80 percent suggest that drug criminalization has a negative effect on HIV prevention and treatment among people who inject drugs. Across the world, the injection of drugs continues to be a key driver in the HIV epidemic, with about 13 percent of these drug users estimated to be living with the virus.

The researchers found that stiff penalties for possession of illegal drugs have failed to reduce drug use, while putting thousands of people in jail who might be better served by treatment.

"The evidence that criminalization helps is weak at best, and the vast majority of studies show that criminalization hurts when it comes to health, economics, and society-at-large," says one of the study's leaders, Stefan Baral, an associate professor of epidemiology at the Bloomberg School.

Baral notes that the study's publication comes on the heels of U.S. Attorney General Jeff Sessions' directives for federal authorities to start seeking the toughest penalties possible for drug violations, even for less serious offenses. In the meantime, the United States also faces an unprecedented opioid crisis.

The researchers suggest the need for alternative policies for limiting the harms of drug use, including infectious disease, overdose, and unemployment due to drug arrests.

According to the nonprofit Drug Policy Alliance, more than 1.5 million drug-related arrests are made every year in the U.S., the overwhelming majority for possession only, yet levels of drug use remain high. Previous research estimates that 56 to 90 percent of people who inject drugs will be incarcerated at some point in their lives.

Baral notes that fear of arrest or incarceration prevents many from seeking help for addiction; ideally, he suggests, people charged with drug offenses should be connected with treatment.

He also suggests that U.S. policies should allow for programs like needle exchanges and possibly safe consumption facilities to minimize infections and fatal overdoses. The 2015 HIV epidemic in Indiana, for example, was caused in part by the sharing of dirty needles among heroin users.

"We must understand that punitive laws have neither decreased the supply or the use of drugs and have caused adverse health outcomes," Baral says. "The current approach is not working."

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