As a participant at last week’s 19th International HIV/AIDS Conference, I was reminded of President Fernando Henrique Cardoso’s and UNDP Administrator Helen Clark’s call to armsearlier in July that there is a new prescription for the AIDS response: ‘courage is needed’.
The event was a pivotal moment – it was the first time that an international AIDS conference has been held on US soil, and this was made possible because President Obama overturned the travel ban for people living with HIV to enter the US. However, the conference also starkly highlighted one of the fundamental barriers to a scaled up, sustainable and rights-based response to the epidemic – many sex workers and people who use drugs were unable to enter the US and attend the conference because they are deemed as criminals under US law. In an attempt to remedy this great failure of this year's conference, two hubs, one focusing on drug use and the other on sex work, were organised prior to and during the conference to ensure that the voices of these vulnerable groups be heard.
The criminalisation of sex work and drug use fuels the HIV epidemic, undermining the many hugely positive and exciting scientific breakthroughs that the HIV response can take credit for. These include increased access to antiretroviral treatment and the critical importance of HIV treatment as prevention. Both HIV prevention and treatment are of equal importance in a rights-based approach. However, in a resource-constrained environment it is arguably more cost-effective to prevent HIV transmission in the first place. For people who inject drugs, this means primary HIV prevention measures such as the provision of sterile injecting equipment and opioid substitution treatment.
Our efforts to reach zero new infections will always be fighting the tide if policy and legislative barriers continue to inhibit an effective HIV response. This issue has been pertinently highlighted recently both by the Global Commission on Drug Policy and the Global Commission on HIV and the Law. Both Commissions call for the decriminalisation of drug use and the removal of legal impediments to harm reduction interventions for people who inject drugs as part of a comprehensive HIV response.
Although many people from the global drugs movement could not be in Washington (and the conference was all the poorer because of their absence) there were several impressive sessions at the conference on HIV and drug use. The Harm Reduction and Drug Policy networking zone in the Global Village, organised by Harm Reduction Coalition was definitely a highlight and enabled the holding of many important sessions that did not get into the main programme. These included the launch of the Global State of Harm Reduction report by Harm Reduction International and an overview of the Community Action on Harm Reduction project, among others.
Within the main programme, one of the most compelling speeches was made by Debbie McMillan in the Thursday plenary entitled ‘Making Waves: The Changing Tide of HIV and Drug Use’. Debbie highlighted the multi-faceted and complex relationship between criminalisation and vulnerability to HIV – sex work, drug use, and discrimination on the basis of race, sexual identity, gender, incarceration and ultimately HIV status. Her speech encapsulates the point by President Cardoso, Helen Clark and other leaders last week, such as Michel Kazatchkine and Michel Sidibe – we must put human rights front and centre of the HIV response.
We know what to do, we know how to do it – now we just need the political courage to turn the tide.
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