Intended for healthcare professionals


Global war on drugs is a major factor driving HIV pandemic, report warns

BMJ 2012; 345 doi: (Published 02 July 2012) Cite this as: BMJ 2012;345:e4521
  1. Peter Moszynski
  1. 1London

Major reforms of the global drug prohibition regime are urgently required to halt the spread of HIV infection, according to the Global Commission on Drug Policy.

The commission, a high level think tank that includes six former presidents, warns that the global war on drugs is driving the HIV pandemic among people who use drugs and their sexual partners.

In a report released last week in London, the commission explains how “repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated,” whilst “mass incarceration of non-violent drug offenders also plays a major role in increasing HIV risk.”

Injecting drug use accounts for about one third of new HIV infections occurring outside sub-Saharan Africa. Globally, an estimated 16 million people inject illegal drugs, of whom about three million, or nearly one in five, are living with HIV.

The average HIV prevalence among drug injectors in China, the US, and the Russian Federation—the three countries with the largest populations of injection drug users—is estimated to be 12%, 16%, and 37% respectively.

The commission points out that existing drug law enforcement policies have failed to reduce global drug supply, quoting figures from the United Nations Office on Drugs and Crime that show that the worldwide supply of illicit opiates, such as heroin, has increased by more than 380% in recent decades, from 1000 metric tons in 1980 to more than 4800 metric tons in 2010. This increase coincided with a 79% decrease in the price of heroin in Europe between 1990 and 2009.

Similar evidence of the drug war’s failure to control supply is apparent when US drug surveillance data are scrutinised. Despite a greater than 600% increase in the US federal anti-drug budget since the early 1980s, the price of heroin in the US has decreased by about 80% during this period, and heroin purity has increased by more than 900%.

And, as was the case with the US prohibition of alcohol in the 1920s, the global prohibition of drugs “now fuels drug market violence around the world.”

The report maintains that the war on drugs has led to “a policy distortion whereby evidence based addiction treatment and public health measures have been downplayed or ignored.”

It says that a number of countries, including the US, Russia, and Thailand, ignore scientific evidence and World Health Organization recommendations and resist the implementation of evidence based HIV prevention programmes “with devastating consequences.” In Russia, for example, about one in 100 adults is infected with HIV.

In contrast, countries that have adopted evidence based addiction treatment and public health measures have seen their HIV epidemics among people who use drugs—as well as rates of injecting drug use—dramatically decline.

The report concludes that “any sober assessment of the impacts of the war on drugs would conclude that many national and international organisations tasked with reducing the drug problem have actually contributed to a worsening of community health and safety.”


Cite this as: BMJ 2012;344:e4521


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