U.S. Ideologues Put Millions at Risk

Global fanfare accompanies every International AIDS Conference, but an obscure United Nations meeting next week in Vienna may prove more critical to the course of the global HIV epidemic. Delegates are gathering for the 48th meeting of the Commission on Narcotic Drugs, a largely unpublicized UN entity that sets the international drug control agenda and that this year is focusing on questions of HIV prevention. If recent events are any gauge, the commission—cowed by American hard-liners—will challenge the efficacy of programs, like needle exchange, proven to reduce HIV transmission among active drug users. With the world’s fastest-growing epidemics now fueled by intravenous drug use, millions of people at risk for HIV, particularly in Asia and the former Soviet Union, will pay the price.

Shown in dozens of studies in America and elsewhere to reduce transmission without increasing drug use, needle exchange is perhaps the most effective of all strategies to prevent the spread of HIV. Yet in a pattern familiar from debates over sex education, Washington conservatives seem eager to hold up distortions of science as a model for the rest of the world. At last year’s meeting of the Commission on Narcotic Drugs, Europeans and Australians watched in amazement as American delegates declared the evidence for needle exchange “unconvincing.”

U.S. representatives also blasted as a “counsel of despair” the harm-reduction approach, which recognizes that even drug users unable or unwilling to stop using drugs can be helped to avoid the AIDS virus and other problems. Backed by a coalition of prohibitionists that included Russia, Sweden, and Japan, the United States ensured that the resolutions adopted by last year’s commission were stripped of every mention of harm reduction. Any discussion of human rights of drug users was similarly excised.

This year the United States has not waited for a global gathering to force the UN to pledge allegiance to “zero tolerance.” American officials have put significant back-channel pressure on the UN Office on Drugs and Crime the current chair of the UN’s joint program on HIV/AIDS to retreat from needle exchange and other harm-reduction measures.

After a November meeting with Robert Charles, an assistant secretary of state in charge of the U.S. Bureau of International Narcotics and Law Enforcement Affairs, the director of the Office on Drugs and Crime, Antonio Maria Costa, promised that he would review all of the office’s printed and electronic statements to remove references to harm reduction. Costa also pledged that the office would be “even more vigilant in the future.” As a start, a senior staffer directed subordinates to “ensure that references to harm reduction and needle/syringe exchange are avoided in UNODC documents, publications and statements.”

More than semantic sanitation is at stake. In Russia, where estimated HIV cases now surpass those in all of North America and where 75 percent of new infections are attributable to intravenous drug use, officials have long pointed to the proceedings of the Commission on Narcotic Drugs to justify misgivings about needle exchange and refusal to treat addicts with noninjectable opiate substitutes like methadone.

Last year, Ukrainian officials returned from the commission to announce that they were shelving plans for a methadone pilot program.

In Thailand, government officials claimed that Costa had given his blessing to drug control efforts that included mass arrests, forced internments and more than 2,500 killings of suspected drug dealers. Costa strenuously denied the claim. But his office recently suspended a Bangkok-based program dedicated to reducing intravenous drug users’ vulnerability to the AIDS virus in East Asia.

Completely dependent on donor contributions—the largest share from the United States—the Office on Drugs and Crime is caught between the rock of American intransigence on drug policy and the hard facts that show needle exchange and other harm-reduction strategies to be effective.

Having removed condom information from federal Web sites and insisting on abstinence-only sex education at home and abroad, the Bush administration is now poised to override the best available evidence in deciding how best to fight HIV related to drug use. What is needed at this year’s Commission on Narcotic Drugs is unanimous commitment to deploying the tools, including needle exchange, known to reduce HIV among drug users, not the American policy of scuttling prevention methods proven to save lives.