In 1986, British Prime Minister Margaret Thatcher’s special cabinet committee on AIDS made a fundamentally important decision which changed the course of the emerging HIV epidemic in the UK. In spite of some vocal opposition, it decided there should be clean needle exchanges for injecting drug users (IDUs) to prevent the spread of HIV.
The opposition to that move has been echoed in the years that followed — not least in the United States. Government-financed needle exchanges would condone crime, the critics claimed. It would encourage drug use and give entirely the wrong message to the public.
The experience of the last quarter of century has disproved those fears. There is no question that needle exchanges and drug substitution have reduced HIV: only 2% of new infections in Britain now come through that route. The policy has neither encouraged drug taking nor crime. Similar reports come from other nations that have adopted this approach. Tragically, not all nations have followed such a lead. Nearly half of the countries with epidemics concentrated among IDUs have no needle and syringe programs at all according to UNAIDS. The result is the further spread of HIV and an increasing death toll — only four of every 100 people who inject and are eligible for treatment get antiretroviral (ARV) drugs.
The plight of IDUs was one of the most urgent issues for the XIX International AIDS Conference which took place in Washington, D.C., and where more than 20,000 scientists, researchers, clinicians and activists met. The conference had not taken place in the U.S. for 22 years because of an HIV travel ban happily overturned in 2010 due to the efforts of the Bush and Obama administrations.
Mistakenly, policy on injecting drugs comes very low on many nations’ list of priorities. Ukraine, for example, has a population of 48 million, a land mass the size of France and an HIV prevalence second only to Russia in Europe. There are about 300,000 people living with the virus and 25,000 newly infected each year. About half the cases are due to shared needles.
However, the Ukraine government does very little prevention work, content to leave the work to nongovernmental organizations, notably Alliance Ukraine, a member of the International HIV/AIDS Alliance, that has tried to fill the gap with its own needle exchange programs. Without this work, as I saw for myself a few weeks ago, the situation would be even more dire.
So why do countries like Ukraine not follow the evidence and run programs of their own? Officials cite financial problems. It is true that Ukraine is one of the poorest countries in Europe. But finance is not the only problem in Ukraine or other countries like Russia who have ignored the benefits of harm reduction programs.
The truth is that a stigma remains attached to HIV. There is discrimination at the workplace and in the community. If it is known that someone is living with HIV, he or she runs the risk of social ostracism.
So what is the way forward? One action is open to the U.S. Over the last 10 years the U.S. has had a proud record bringing help to the developing world. In 2003, President Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest response mounted by one country against a single disease in history and has directly supported ARV treatment for nearly 4 million people. The U.S. is the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
That makes it all the stranger that having rescinded the ban on funding of domestic and international needle exchange a few years ago, Congress should now reinstate it. If the U.S. was to reconsider this ban and recognize that without needle exchange programs it is impossible to provide full protection from the spread of HIV and the death and suffering that goes with it, it would send a message around the world.
Voices against such a policy would doubtless be raised. But the opponents might reflect that the policy in Britain was not introduced by some left wing socialist administration but by the cabinet of Margaret Thatcher, leader of the most radical right-of-center government that Britain has seen since the Second World War.
Lord Fowler was Health Secretary in the Thatcher cabinet between 1981 and 1987. He was chairman of the Conservative Party between 1992 and 94 and most recently has chaired the House of Lords Select Committee on HIV/AIDS, which reported at the end of last year.