War on Drugs Poses a Challenge for HIV Treatment, Prevention Among Users

The “War on Drugs” has a negative impact on the treatment and prevention of HIV, a new study suggests.

This aggressive approach to enforcement has unsuccessfully reduced drug use, incarcerating thousands of drug users who may have benefitted more from drug treatment.

In a study published in The Lancet HIV, investigators systematically reviewed 106 peer-review studies on criminalization and HIV treatment or prevention among injecting drug users (IDU) between January 2006 and December 2014.

The results of the analysis showed that of the studies, 91 suggested that drug criminalization had a negative effect on HIV prevention and treatment, 15 suggested no association, and 6 suggested a beneficial effect. However, the benefit was small and were generally methodologically weak.

“More than 80% of the studies evaluating the criminalization of drug use demonstrated worse health outcomes among those targeted by these laws and their communities at large,” said study leader Stefan Baral, MD, MPH. “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.”

Despite more than 1.5 million drug-related arrests made in the United States each year, drug use still runs rampant. Prior research estimates that 56% to 90% of IDUs will be incarcerated at some point in their life.

Findings from the new study suggests alternative strategies and policies that are necessary to help limit the detrimental effects of drug use, such as overdose, infectious disease, and unemployment due to arrests and incarceration.

In 2015, more than 50,000 Americans died from a drug overdose. In recent years, overdoses have become the leading cause of accidental deaths.

The Obama administration had made some attempts to decriminalize the possession of small amounts of marijuana, but a memo issued last week by Attorney General Jeff Sessions ordered federal officials to begin seeking out the toughest penalties possible, even for less serious drug offenses.

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

Baral stressed policies that allow for programs such as needle exchanges need to be put in place to minimize related infections and fatal overdoses. There are an estimated 13% of IDUs believed to be living with HIV infection worldwide.

“People have addition and they have nowhere to turn,” Baral said. “They are getting HIV and hepatitis C because they are sharing dirty needles. They end up in jail or the emergency room or worse. We are at a turning point with a massive increase in the number of people using opioids and there seems to be no end in sight.”