Turning a Page in Drug Control and Public Health: Advancing HCV/HIV Prevention Through Reform of Drug Law and Policy

Joanne Csete; Daniel Wolfe


Future Virology. 2015;10(1):17-26. 

In This Article

Abstract and Introduction


A major UN summit on the world drug problem in 2016 is an opportunity to rethink punitive drug policies that have not succeeded in stemming drug demand or supply and have undermined HIV and HCV responses in many countries. Experiences of some countries demonstrate that treating drug use and minor drug possession in the health rather than the law enforcement sector can dramatically improve access to HIV and HCV services. Alternatives to incarceration for minor drug infractions are particularly important in this regard. The voices of health professionals in national and international debates leading up to this important summit are crucial to making the case for public health-based and human rights-oriented drug policy reform.


The first UN General Assembly summit on controlling illicit drugs in almost 20 years will take place in 2016. The last such summit in 1998 had as its theme 'A drug-free world – we can do it!' By the UN's own reckoning, the world in the lead-up to the 2016 summit is much further away from being 'drug-free' than in 1998. The UN's 1998 estimate of the number of persons having consumed drugs in the past year was 8 million for opiates, 13.3 million for cocaine and 141 million for cannabis.[1] The corresponding figures from the 2014 World Drug Report were 16.4, 17.2 and 177.6 million – that is, increases of 105, 29 and 26%, respectively.[2] Increased consumption shadowed significantly increased drug supply over this period, which resulted from many factors. These included dramatic increases in opium production in Afghanistan[3] and southeast Asia[4] and in cannabis cultivation in many parts of the world[2] and, as we will argue here, policies that were largely ineffective to reduce demand or supply. The optimism of 'we can do it!' seems misplaced.

If the prohibitionist pursuit of drug eradication has not succeeded in reducing drug supply and demand, has it at least contributed to the environment for advancing prevention of HIV and HCV? We consider this question and make some recommendations for currently dominant criminal law-oriented drug policies based on lessons from the experience of countries that have reshaped some elements of their prohibitionist policies. Some of these experiences came about as responses to HIV epidemics linked to injection drug use. We focus on the global situation but also highlight developments in the USA in view of the influence the USA has had in global drug policy debates.