The Vienna Declaration
In response to the health and social harms of illegal drugs, a large international drug prohibition regime has been developed under the umbrella of the United Nations.1 Decades of research provide a comprehensive assessment of the impacts of the global “War on Drugs” and, as thousands of individuals gather in Vienna at the XVIII International AIDS Conference, the international scientific community calls for an acknowledgement of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care.
The evidence that law enforcement has failed to prevent the availability of illegal drugs, in communities where there is demand, is now unambiguous.2, 3Over the last several decades, national and international drug surveillance systems have demonstrated a general pattern of falling drug prices and increasing drug purity—despite massive investments in drug law enforcement.3,4
Furthermore, there is no evidence that increasing the ferocity of law enforcement meaningfully reduces the prevalence of drug use.5 The data also clearly demonstrate that the number of countries in which people inject illegal drugs is growing, with women and children becoming increasingly affected.6 Outside of sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV.7, 8 In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group.8
In the context of overwhelming evidence that drug law enforcement has failed to achieve its stated objectives, it is important that its harmful consequences be acknowledged and addressed. These consequences include but are not limited to:
- HIV epidemics fuelled by the criminalisation of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.9, 10
- HIV outbreaks among incarcerated and institutionalised drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.11-13
- The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.14-16
- A crisis in criminal justice systems as a result of record incarceration rates in a number of nations.17, 18 This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offences are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.19
- Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalising drug users and undermines HIV prevention and other health promotion efforts.20, 21
- Severe human rights violations, including torture, forced labour, inhuman and degrading treatment, and execution of drug offenders in a number of countries.22, 23
- A massive illicit market worth an estimated annual value of US$320 billion.4 These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilised entire countries, such as Colombia, Mexico and Afghanistan.4
- Billions of tax dollars wasted on a “War on Drugs” approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.24
Unfortunately, evidence of the failure of drug prohibition to achieve its stated goals, as well as the severe negative consequences of these policies, is often denied by those with vested interests in maintaining the status quo.25This has created confusion among the public and has cost countless lives. Governments and international organisations have ethical and legal obligations to respond to this crisis and must seek to enact alternative evidence-based strategies that can effectively reduce the harms of drugs without creating harms of their own. We, the undersigned, call on governments and international organisations, including the United Nations, to:
- Undertake a transparent review of the effectiveness of current drug policies.
- Implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use.
- Decriminalise drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centres that violate the Universal Declaration of Human Rights.26
- Unequivocally endorse and scale up funding for the implementation of the comprehensive package of HIV interventions spelled out in the WHO, UNODC and UNAIDS Target Setting Guide.27
- Meaningfully involve members of the affected community in developing, monitoring and implementing services and policies that affect their lives.
We further call upon the UN Secretary-General, Ban Ki-moon, to urgently implement measures to ensure that the United Nations system—including the International Narcotics Control Board—speaks with one voice to support the decriminalisation of drug users and the implementation of evidence-based approaches to drug control.28
Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting. However, reorienting drug policies towards evidence-based approaches that respect, protect and fulfil human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.
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Drug War Statement Upstaged at AIDS Gathering
VIENNA — Some of the world’s top AIDS experts issued a radical manifesto this week at the 18th International AIDS Conference: They declared the war on drugs a 50-year-old failure and called for it to be abandoned.
No one heard.
Officially, the theme of the AIDS meeting, the world’s largest public health gathering, is the need to attack the rapidly growing epidemic among addicts in Eastern Europe, Russia and Asia. It was held in Vienna because this city is the doorway to the East and, in this German-speaking country, all the conference signs are in English and Russian.
(In a lovely ironic touch, the conference hall is only a few steps from the Ferris wheel in the Orson Welles film noir classic set in postwar Vienna, “The Third Man.” On it, a cynical dealer of counterfeit drugs tells his pursuer to look down at the people below and says: “Victims? Don’t be melodramatic…. Would you really feel any pity if one of those dots stopped moving forever?”)
But the organizers’ efforts to get publicity for the Vienna Declaration, which calls for drug users to be spared arrest and offered clean needles, methadone and treatment if they have AIDS, have come to naught. Almost no one here talks about the war on drugs.
Instead, everyone is publicly worrying that the war on AIDS is falling apart. Donor money is evaporating in the recession, and it is looking likely that only about a third of the 33 million infected people in the world will have any hope of treatment.
Frustration is high. Speakers like Bill Gates were interrupted by demonstrators in Sherwood Forest green calling for a “Robin Hood tax” — a tiny fee on the $4 trillion in currency transactions made daily by banks and hedge funds that could raise billions for AIDS.
Many activists blame the Obama administration, which is shifting its priorities to mother-and-child health. The halls are decorated with posters comparing Mr. Obama unfavorably with George W. Bush. On Wednesday, Archbishop Desmond Tutu criticized Mr. Obama in an Op-Ed article in The New York Times.
In his speech here, former President Bill Clinton said Ambassador Eric Goosby, the administration’s global AIDS coordinator, “ought to get some kind of Purple Heart for showing up.”
However, a new report from the Kaiser Family Foundation shows that the United States still gives more for AIDS assistance than all other countries put together, accounting for 58 percent of contributions. Its donations are still going up slightly, while those from Europe, Canada, Japan and Australia are flat or falling.
Officials from the Global Fund to Fight AIDS, Tuberculosis and Malaria say they fear they will not come close to the $17 billion target they set for their next donors’ meeting in September.
The other, more welcome, distraction has been the exciting results of a South African clinical trial in which a vaginal gel with an antiretroviral drug protected 40 percent of the women using it. This is the first good news about microbicides in decades of work. A gel women can use secretly has long been sought, since many men disdain condoms and many women want to get pregnant.
The Vienna Declaration is only the second time that the International AIDS Society has issued such a document. The last was the 2000 Durban Declaration, which reaffirmed that H.I.V. was the cause of AIDS. It was a response to the government of South Africa, the conference’s host, which at the time denied that the virus caused disease and refused to buy medicine for its citizens.
Outside of Africa, almost a third of all H.I.V. infections stem from drug injections.
The declaration contends that arresting drug users forces them into hiding, spreading the epidemic. It backs “science-based public health approaches“ proved in clinical trials, which can include everything clean needle swaps, 12-step recovery programs and methadone.
Dr. Evan Wood, an AIDS policy expert at the University of British Columbia and the chief author, cited Portugal’s approach. According to a 2009 report by the libertarian Cato Institute, in the decade since Portugal legalized possession of up to 10 days’ worth of any drug, including cocaine and heroin, its AIDS rate dropped by half, overdose deaths fell, many citizens sought treatment, drug use among young people fell and drug tourism did not develop. The institute called the policy “a resounding success.”
The declaration is largely aimed at countries of the former Soviet Union. In Russia, for example, close to 1 percent of its adult population is infected.
Nonetheless, the country forbids all methadone-type treatments, and the national health plan offers only abrupt detoxification, which has a high failure rate. The most frequent victims — prisoners and people not living in their assigned residence areas — are the least likely to get AIDS drugs, and activists say markups vastly inflate the prices of medications bought cheaply by foreign donors.
“The government says everything is fine,” said Aleksandra Volgina, 31, the leader of Candle, a Russian AIDS organization based in St. Petersburg. “We’re even donors to the Global Fund, but we don’t have treatment; we don’t even have prevention.”
She has stayed off heroin thanks to a 12-step program her family paid for, she said, but every month she worries about whether the government pharmacy will have all three drugs she needs, and some of her friends have died for lack of them.
“What’s going on in Russia is being silenced,” she said. “You can’t even knock on the Health Ministry’s door.”
Despite the quasi-Russian cast to the conference, no one from the Russian government attended, sponsors said.
Only two governments reacted to the declaration: Canada, which rejected it, and Georgia, whose first lady signed it in a public ceremony. The tiny former Soviet republic has a history of brutal treatment of drug addicts, Dr. Wood said. But it also has taken to defying Russia, with which it fought a brief war in 2008.
In the large American delegation here, almost every top official refused to discuss the declaration. Finally, one government official, speaking on the condition of anonymity, said he had just called the White House for guidance and was told no one had read it yet and there was no time to respond.
He did note that Dr. Goosby recently announced that countries getting American help to fight AIDS can use it to buy clean needles for addicts, a change from Bush administration policy.
The one exception to the official American silence was Dr. Nora D. Volkow, the normally low-profile director of the National Institute on Drug Abuse, who said she personally agreed with the declaration’s premise.
“Addiction is a brain disease,” she said. “I’m a scientist. The evidence unequivocally shows that criminalizing the drug abuser does not solve the problem. I’m very much against legalization of drugs or drug dealing. But I would not arrest a person addicted to drugs. I’d send them to treatment, not prison.”
Asked if she feared being attacked by Congressional conservatives, she said: “I took this job because I want drug users to be recognized as people with a disease. If I don’t speak about it, why even bother to gather the data?”