Every human being deserves the fundamental right to a healthy life, but many around the world face stigma and harsh penalties, preventing them from getting help.
The Elton John AIDS Foundation is dedicated to empowering the most marginalised communities to pursue health on their terms, free from fear and stigma.
Four decades ago, the HIV movement grew out of a core belief in the dignity, equality, and human rights of all people. At the time, this stood in stark contrast to the prevalent public response to this new disease, characterised largely by fear, stigma, and discrimination.
Today, HIV need no longer be a death sentence. With effective medications, people living with HIV can have full and healthy lives, and if treated early and effectively, can eliminate the risk of transmitting HIV to others. These advances have saved millions of lives and demonstrate what can be achieved when we unite under a common principle of putting people first.
This progress, however, has not reached everyone. Many marginalised communities, particularly women and girls in sub-Saharan Africa, LGBTQ+ people, and ethnic minorities, continue to be left behind. For people who use drugs and particularly those who inject drugs, punitive policies that criminalise use and possession have been disastrous for their fundamental human right to health. It has fuelled the transmission of HIV, viral hepatitis, tuberculosis, and the incidence of overdose, and has driven record levels of incarceration.
Prohibitionist measures have failed to achieve their intended goal of a “drug-free world”. Instead, the number of people who use drugs, including those who inject drugs, continues to grow, with an estimated 296 million people having used drugs in 2021 alone: a population that, if it were a country, would be the fourth largest in the world.
At the 25th International AIDS Conference in Munich, Germany, we unite under the theme: “Putting people first!” We seek to lead with compassion, inclusion, human rights, public health, and scientific evidence. This approach is equally vital in drug policy. It mirrors the blueprint that has driven the successes of the HIV movement.
This approach isn’t revolutionary. “Harm reduction” measures are backed by decades of evidence, clearly demonstrating their effectiveness in saving lives. The introduction of programmes providing sterile needles and syringes in cities, including across Australia, New Zealand, Germany, the Netherlands, the UK, and Switzerland in the 1980s – at the height of the AIDS epidemic – were largely responsible for keeping HIV infections amongst people who use drugs at very low levels in these countries. In Vietnam, the rollout of needle and syringe programmes were estimated to have averted over 30,000 new HIV cases over a 10-year period, saving many lives in the process.
When effectively implemented and properly funded, such needle and syringe programmes, together with medications for opioid dependence such as methadone and buprenorphine, community provision of naloxone, drug checking services, and overdose prevention centres, can virtually eliminate HIV transmissions among people who use drugs and can reverse the global tide of fatal overdose deaths. We need more, not less of these essential services.
Just as laws which criminalise same-sex sexual acts contribute to higher rates of HIV, fear of punishment prevents many people who use drugs from seeking support. To overcome this, we must both decriminalise the possession of small amounts of drugs for personal use and invest significantly in treatment, counselling, and housing.
Countries like the Czech Republic, Portugal, and Switzerland offer decades of evidence demonstrating that a comprehensive public health approach to drugs can dramatically reduce HIV infection rates, connect people to health and social services, and ultimately save lives. Recent efforts to reverse the decriminalisation of drug use are based on the misconception that decriminalisation alone was intended to resolve a host of complex health and social issues. While this one step is crucial, it must be accompanied by robust health and social support systems.
Nevertheless, there are encouraging winds of change in many parts of the world: attitudes toward cannabis consumption, for example, are becoming less punitive in many countries. Support for overdose prevention centres, a vital tool for effectively responding to the opioid crisis, is gaining increased traction, and naloxone access is expanding.
The conversation is also shifting at the United Nations. This year, a coalition of 62 United Nations Member States led by Colombia – a country long adversely impacted by prohibitionist global drug policies – called for a review of the international drug control system. This was preceded by a report from the High Commissioner for Human Rights calling upon States to consider the legal regulation of drugs as a means of combatting illicit drug markets and reducing the harms of substance use – the first time a UN body has made this potentially transformative recommendation.
For over half a century the “war on drugs” has failed people across the globe. A public health approach must be front and centre of the response to drugs – as it was for the global HIV movement at the height of the crisis. This will require policy makers to be willing to change course, more active investment, more evidence-based decisions, more compassion, and more putting people first. Only then can we truly end Aids.
The Elton John AIDS Foundation is one of the leading independent AIDS organisations in the world
Helen Clark is the chair of the board of the Global Commission on Drug Policy
