AIDS Vienna

At the Ganslwirt needle exchange facility in Vienna's sixth district, users of heroin and other opiate drugs gather from across the city. One 20-year-old Austrian man, Stefan, who declined to give his last name, says that he comes here, as do most people, to drop off their used needles in exchange for clean ones.

"It's very important for me to be able to change needles here," Stefan said. "Otherwise I'd have to ask friends to use their needles which would be very dangerous."

Needle exchange and treatments like Opiate Substitution Therapy (OST) form the core of what public health and public policy officials call "harm reduction," and they have become a central facet of many European and North American governments' strategy in fighting HIV transmission through intravenous drug use over the past ten to twenty years.

In a handful of countries with the most progressive drug policies, such as Canada and Switzerland, further harm reduction services employ techniques and treatments such as supervised injecting facilities and the provision of pharmaceutical heroin and morphine, which researchers say are highly successful in ending drug dependence and limiting HIV infection.

But outside the West, it's a different picture.

"Right now, almost one third of all HIV infections outside of sub-Saharan Africa are associated with the sharing of drug injection equipment," said Dr. Don Des Jarlais, director of the Baron Edmond de Rothchild Chemical Dependency Institute in New York, "And that leads to sexual transmission from drug users to the general population."

Dr. Des Jarlais is at the global HIV/AIDS conference being held in Vienna this week to launch The Vienna Declaration, a two-page policy "call to action" that he has drafted along with some 30 other preeminent HIV scientists and specialists around the world. The declaration's core demand is that governments reform their drug policy, moving away from policies that view drug users as criminals and toward policies that see them as patients.

This, Dr. Des Jarlais and his colleagues argue, will help Western countries drive down their stabilized HIV infection rates even further and enable states in Eastern Europe, Russia and Central Asia to put the brakes on a burgeoning HIV epidemic among drug users there.

Russia, Central Asia and Eastern Europe need more harm reduction policies, researchers say

According to the Joint United Nations Programme on HIV/AIDS, Russia has an estimated 1.6 million intravenous drug users, and 37 percent of them are thought to be HIV positive. They make up some 80 percent of Russia's total HIV epidemic and this grim picture is replicated throughout eastern Europe and central Asia. The framers of the Vienna Declaration and other HIV experts directly attribute these statistics to the what they describe as "draconian" drug laws in effect in the region.

"People are afraid to use health services. They are afraid to go to the hospital because they don't want to be exposed to the fear of police arrest or abuse from police and so on," says Anya Sarang, president of the Andrey Ryklov Foundation for Health and Social Justice, in Moscow. "In this atmosphere of fear and terror and risk, it will be impossible to achieve very high level of activeness of HIV treatment or prevention programs."

So far, needle exchange programs have been successful in North America and Western Europe, and now researchers want to expand this policy in other regions: particularly Eastern Europe, Russia and Central Asia. The declaration also calls for further legal reforms in Western countries as well.

In fact, just last week, the Obama Administration announced a new strategy in the fight against HIV in America – setting itself the target of reducing infections by 25 percent in five years.

Ethan Nadelmann, executive director of the Drugs Policy Alliance, a reform advocacy group, says this new attitude will bring federal funding to existing harm reduction services across the country which have been typically funded on the state level. This is a positive move, he says, but it is tempered by America's enormous incarceration rates. In America today, as elsewhere, the war on drugs is locking horns with the fight against AIDS.

"In the U.S. we have less than 5 percent of the world's population but almost 25 percent of the world's incarcerated population," he said. "We've gone from 50,000 behind bars for drug offense in 1980 to half a million today almost a ten-fold increase. We lock up more people in the U.S. for violating a drug law than all of Western Europe locks up for everything and Western Europe has 100 million more people than we do."

Nadelmann and other HIV/AIDS policy activists and researchers say that the American drug policy needs to be re-thought, and brought more into line with Western Europe.

One drug user is grateful for needle exchange

Back at the Vienna needle exchange, Stefan says he feels fortunate to live in Austria. He's nearing his third year of addiction to heroin but, he says, recovering from it would be impossible – and dangerous – if it weren't for facilities such as the needle exchange.

"I don't want to die from this," he said. "My brother already died from drugs and I was silly enough to start taking them. I want to stop and facilities like this can be very helpful on my way out. There should be facilities like this in every country."

Author: Don Duncan
Editor: Cyrus Farivar