Drug users, HIV, & the War on Drugs
The Need for Needle Exchange Programs
The Advisory Council on the Misuse of Drugs has concluded in their report on AIDS in 1988 that “HIV is a greater threat to public and individual health than drug misuse. The first goal of work with drug misusers must therefore be to prevent them from acquiring or transmitting this virus” (1). So why has our government continuously promoted punitive ideals from the War on Drugs in relation to AIDS prevention?
When AIDS first emerged it was known by the 4 H’s: Homosexuals, Haitians, Hemophiliacs and Heroin Addicts. There of course is stigma surrounding this virus and that corresponds with existing stigmas we have about some of these groups. The vulnerable population of AIDS either got it by their own fault whether that be “risky immoral” sexual behavior or they were shooting up drugs which of course is amplified by the stigma addicts already have. The injection drug user (IDU) population should not be ignored when discussing AIDS as then we would just be contributing to the idea that some people are worthy of care and some people aren’t. Also policies should be put in place to help this population, such as needle exchange programs, instead of restrictive policies that reflect the mentality on the War on Drugs. The War on Drugs was a political and social strategy that started traction in the 1970s with President Nixon to combat illegal drug usage by criminalizing and incarcerating drug offenders (2).
The statistics behind intravenous drug users and HIV are jarring and reflect the constant need, since the wake of the epidemic, for some sort of preventive measures to be taken. According to the 2016 Prevention Gap Report drug users are 24 times more likely to contract HIV than the general public (3). Additionally, of the 11.7 million people in the world who are injecting drugs it is estimated that 14% of those people are living with HIV (4). Specifically, in the United States a 2015 CDC report indicates that “6% (2,392) of the 39,513 diagnoses of HIV in the United States were attributed to IDU and another 3% (1,202) to male-to-male sexual contact
and IDU” (5).
Additionally, the report states that black men were the most vulnerable and that if these current rates of contraction continue an estimated 1 in 23 women who inject drugs and 1 in 36 men who inject drugs will be diagnosed with HIV in their lifetime. So these statistics indicate that IDU are still at a high risk of contracting AIDS. Research indicates this is due to multiple factors including poverty, sharing needs, criminalization, and the overlap of injection drugs and sex work (6). At the wake of this disease in the 1980s and 90s the statistics surrounding IDUs were even worse indicating that 16% of those with HIV were IDUs in 1985 and in 1995 those rates increased to 30% (7). How HIV and AIDS has affected the IDU population not only has direct detrimental effect to drug users but also poses the most risk in spreading HIV to people who aren’t IDUs and who are heterosexual as many IDUs often have sexual encounters with non-drug users (8). This only stresses the importance of effective preventative measures further in order to help the current at risk population as well as ensure it doesn’t continue to spread to other populations as well.
Similar to the barriers that gay people faced when trying to receive adequate preventative care from the federal government, IDUs have also fallen victim to the ramifications of the conservative administrations specifically the mentality of the War on Drugs. The criminalization and stigmatization has produced policies that have further added to the spread of HIV rather than the containment- and this is seen in the controversy around one of the most effective preventative programs: needle exchange programs.
Needle exchange programs are programs set in place that provide free sterile needles and syringes and also allows an opportunity for people to dispose of used needles and syringes (9). Considering one of the main risk factors for contracting HIV was through sharing needles (cities with high levels of HIV have a 40% rate of people sharing syringes)(10), these needle exchanges are meant to reduce the rates in which people share needles and henceforth reducing not only HIV but other diseases that may be spread the same way. This is of course an extremely controversial topic.
Despite United States public health experts in the 1980s urging the United States stray away from punitive drug policies towards more harm reduction care in order to reduce the spread of HIV, it was still met with harsh opposition from the Regan Administration. In opposition to needle exchange programs it was argued that these programs would send a message that encouraged people to use drugs rather than prevent it. Rep. Charles Rangel of New York in 1988 remarked that “by providing needles on even a limited basis, the state- the government, society- would be saying ‘yes’. We would be saying, in an unmistakable sense, that these killer substances are okay. That shooting up is at least understandable, acceptable. Government would be cooperating in narcotics use, by providing the means” (11). Ragel’s comments are clear reflections of the narratives being proposed by the “War on Drugs” and “Just Say No”, but his comments reflect ignorance and a vast ignorance of science. By the late 80s there were needle exchange programs in several European countries and Australia that indicated positive results stating that these programs did not lead to an increase of drug use and often helped IDUs gain treatment (12). This attitude reflects the same attitudes that conservative politics of the 80s enforced against the gay community by ignoring AIDS in general and refusing to implement programs that encouraged safe sex. It just shows how these conservative politics value “morals” over scientific facts.
This mindset has not been unique just to the 80s but has had lingering effects on modern day politics. Mike Pence, who has been famous for his highly fundamental conservative politics, has a history of maintaining these attitudes through the 21st century. In a 2002 comment about condoms he stated
“And the truth is that Colin Powell had an opportunity here to reaffirm this president’s commitment to abstinence as the best choice for our young people, and he chose not to do that in the first instance, but — and so I think it’s very sad. The other part is that, frankly, condoms are a very, very poor protection against sexually transmitted diseases…”(13).
His politics surrounding this issue specifically with the needle exchange, which he has always opposed showed its true detrimental effects when in 2016 200 people in rural Scott County, Indiana became infected with HIV primarily due to injecting drugs with contaminated needles. This was the biggest outbreak of HIV in decades and considering Pence’s ban on needle exchange programs is too much of a coincidence. Public health officials urged Pence to lift the ban and finally after an extreme amount of public pressure he did (14). This is a prime example of how deadly these conservative politics, based in the War on Drugs mentality can be, as there should be no reason that such a large outbreak of HIV should happen in 2016. And now, due to Pence’s ignorance and conservative values at least 200 people have been infected with HIV.
These needle and syringe exchange programs are extremely effective and necessary in the fight against HIV and AIDS. In relation to the Scott County outbreak, one of the main reasons the it was able to get under control was due to Pence finally lifting the ban on needle exchange programs. Not only are these programs effective in prevention but there’s also scientific evidence stating that these programs also help addicts in getting connected with healthcare professionals and henceforth being able to receive help in working to overcome their addiction (15). With the multiple benefits of needle exchange programs it’s frustrating to see conservative politicians still maintain this idea of punitive drug policies when the only hurt addicts and perpetuate the spread of HIV to other populations as well.
When analyzing the various aspects of the AIDS epidemic whether it be the gross negligence of implementing safe sex policies or the punitive drug policies it’s evident that conservative politics have quite literally aided in the deaths of thousands. Needle exchange programs must be implemented as they are essential in the stop of HIV and AIDS; if they are not, then the consequences have a grave and deadly effect.
References:
1. Tasleem J. Padamsee, “The Politics of Prevention: Lessons from the Neglected History of US HIV/AIDS Policy,” Journal of Health Politics, Policy and Law 42, no. 1 (2017): 80.
2. War on Drugs, Encyclopedia Britannica (2016).
3. UNAIDS, “Prevention Gap Report,” Joint United Nations Programme on HIV/AIDS (2016) http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf: 7.
4. People Who Inject Drugs, HIV And AIDS https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs#footnote4_sw44la0.
5. HIV and Injection Drug Use, (2016) https://www.cdc.gov/hiv/pdf/risk/cdc-hiv-idu-fact-sheet.pdf.
6. People Who Inject Drugs, HIV And AIDS https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs#footnote4_sw44la0.
7. Jeffrey H. Burack et al. “Epidemiology and HIV Transmission in Injection Drug Users,” HIV InSite Knowledge Base Chapter (1998): http://hivinsite.ucsf.edu/InSite?page=kb-07-04-01.
8. Tasleem J. Padamsee, “The Politics of Prevention: Lessons from the Neglected History of US HIV/AIDS Policy,” Journal of Health Politics, Policy and Law 42, no. 1 (2017): 79.
9. Syringe Service Programs https://www.cdc.gov/hiv/risk/ssps.html.
10. HIV and Injection Drug Use, (2016) https://www.cdc.gov/hiv/pdf/risk/cdc-hiv-idu-fact-sheet.pdf.
11. Tasleem J. Padamsee, “The Politics of Prevention: Lessons from the Neglected History of US HIV/AIDS Policy,” Journal of Health Politics, Policy and Law 42, no. 1 (2017): 82.
12. Ricardo E. Barreras, “New York City’s Struggle over Syringe Exchange: A Case Study of the Intersection of Science, Activism and Political Change” Journal of Social Issues 69, no.4 (2013): 698.
13. Allison Turner, “HRC Releases Hard-Hitting Video Highlighting Mike Pence’s Dangerous Record on HIV and AIDS” Human Rights Campaign (2018).
14. Paul Demko, “How Pence’s slow walk on needle exchange helped propel Indiana’s health crisis.” Politico (2016).
15. Syringe Exchange Programs are Part of Effective HIV, National Institute on Drug Abuse (2016).
