Effects of Punitive Drug Policy on Drug Supply and HIV Incidence and Prevalence
The Lancet Symposium on HIV and Drug Use was held on 10 and 11 December 2010, and I came out of this conference with several insights into what is currently happening in drug policy reform, and where the focus is. First of all, I was struck by the statement of a Malaysian governmental official who stated while he was on the panel that there is no need to change the law to reach and treat persons at high risk for HIV infection and persons living with HIV.
In my view, the law is central to destigmatisation of people who use drugs. There are several laws in Malaysia that are arbitrary towards persons at high risk for HIV and persons living with HIV such as laws that restrict their travel to and/or residence in Malaysia[1] and the homophobic laws criminalizing ‘unnatural sex’ contained in the Penal Code[2]. The most punitive laws, however, are the ones contained in the Dangerous Drugs Act 1952 and the Drug Dependence (Treatment and Rehabilitation) Act 1983. The former, et al, provides that persons found with a small amount of drugs (2-5 grams of heroin; 20-50 grams of cannabis, for example) shall be sentenced to a minimum of 2 years jail and whipping of 3-9 strokes. The latter states that a person who is drug dependent is liable to be ordered by a Magistrate to attend rehabilitation centres for a minimum period of two years.
The problem with these laws is that they:
- Remove access to clean needles
- Remove social networks of persons who use drugs
- Reduce access to antiretroviral therapy
- Reduce access to treatment for various comorbidities related to drug use
- Enhance criminal networks in prison
- Increase risk of HIV infection
- Do not reduce quantity or supply of drugs in society
- Are contrary to human rights
- Stigmatise persons who use drugs, affecting their ability to reintegrate into society
Anecdotes from persons working with persons incarcerated as a result of drug use are testimony to this: that the day before release, persons held in compulsory detention centres and prisons alike are already discussing where they can buy drugs. Punitive policies also create fear in injecting drug users, resulting in hurried and unsafe injecting practices. As a result, sharing of needles is more common, increasing the risk of spread of HIV.
Most importantly, stigmatisation increases HIV infection. At the symposium, much emphasis was placed on use of language by public officials. At the moment, the words ‘drug addict’ imply that the drug user is less than subhuman, different from you and I. As a result, persons who use drugs are seen as the scum of society and are forced underground, further away from harm reduction and access to treatment, and are henceforth more likely to engage in risky behaviour. Stigmatisation as a result of incarceration-based policies reduces the chances of the individual from gaining meaningful employment, resulting in the individual resorting to crime to survive. It’s a vicious cycle. What’s most important is for people out there to know that persons who use drugs are persons deserving of love and support and health, above all.
The recent speech by the Malaysian Minister of Health, although commendable in that it has a strong emphasis on antiretroviral therapy and the improvement of lives of persons living with HIV, still calls persons who use drugs ‘drug addicts’, which creates stigma. Nevertheless, it can be seen that in Malaysia there is a clear and irreversible shift towards harm reduction, and efforts in this direction must continue.
The UK former Home Office Drugs Minister, Bob Ainsworth MP has recently made an amazing statement on reform of drug policy: ‘[P]rohibition has failed to protect us. Leaving the drugs market in the hands of criminals causes huge and unnecessary harms to individuals, communities and entire countries, with the poor the hardest hit. We spend billions of pounds without preventing the wide availability of drugs. It is time to replace our failed war on drugs with a strict system of legal regulation, to make the world a safer, healthier place, especially for our children. We must take the trade away from organised criminals and hand it to the control of doctors and pharmacists.’
This is a statement from someone who knows firsthand about how the war on drugs has failed. Academics too comment that ‘drug control has created a criminal black market of macro-economic proportions’.[3] People continue to use drugs, and in a community where prohibition and punitive policies predominate, drug use and spread of HIV will continue to rise.
[1] Immigration Act 1959/63 (Laws of Malaysia Act 155), s8(3)(b)
[2] Criminal Procedure Code (Laws of Malaysia Act 593), First Schedule, s377B
[3] Damon Barrett, ‘Security, Development and Human Rights: Normative, Legal and Policy Challenges for the International Drug Control System’ (2010) 21 International Journal of Drug Policy 140 at 141
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