Lisa Campbell and Eric Oulster
Global rates of HIV infection are still skyrocketing even though we have all the tools to stop the spread of HIV. Stopping AIDS means treatment not just for the few that can afford it, but universal treatment available to affected populations and people living with HIV. In achieving universal treatment, we can stop the spread of HIV and make sure that people living with HIV have the support they need.
Even if we had universal treatment available, what are the factors that block access to treatment? People living with HIV who are incarcerated, use drugs, or engage in sex work face stigma and discrimination from the health care system and are therefore less able to access HIV services, including prevention, treatment, and harm reduction. These types of stigma can be augmented by other forms of oppression, including colonialism, racism, classism, sexism, and homophobia. On World AIDS Day, CSSDP examines how criminalization fuels the spread of HIV and why we need to end the racist War on Drugs.
It is essential that on World AIDS Day we reflect on how stigma fuels bad HIV policy in Canada and around the world. Not only is Canada one of the worst countries in criminalizing People Living with HIV, in the last year the Harper Government has also passed mandatory minimum sentences for nonviolent drug related crimes. It is obvious that criminalization and stigma are not stopping the spread of HIV, yet Canada continues to further criminalize the most marginalized in our society. Bill C-2, The “Respect for Communities Act” is on its way to passing through the House of Commons and becoming law in Canada. Bill C-2 seeks to further restrict harm reduction services, stigmatizing people who use drugs and creating more red tape in establishing health services, such as safe injection sites, which are proven to reduce the rate of HIV and overdose.
In Canada, the province of Saskatchewan has one of the highest rates of new HIV infections, now triple the Canadian average. When people are diagnosed with HIV, it is often much later than when they contracted the virus, so they are starting treatment long after is recommended. This means that in Saskatchewan, less people living with HIV are unaware of their status, which can lead to higher rates of infection as a result. If you look at the breakdown of new HIV infections in Canada, oftentimes they are populations who face discrimination due to poor social determinants of health. For example, in Saskatchewan 74% of new HIV infections in 2012 came from the Aboriginal population, whose experience of racism in Canada, including in the healthcare and justice systems, is well documented in recent studies. Aboriginal Peoples in Canada are disproportionately overrepresented in prisons, with the Aboriginal incarcerated population increasing 40% between 2001-02 and 2010-11. Aboriginal Peoples face violence from the Canadian state and experience overwhelming stigma when accessing treatment, prevention, and harm reduction services. Thus, in order to combat HIV infections in Saskatchewan, challenging state violence against Aboriginal people is essential. As drug policy reform advocates, we must fight to end stigma in all forms, from the systematic oppression of the drug war to racism and colonialism. Check out the Global Indigenous Youth Call for Action on World AIDS Day below:
Just as Aboriginal people face racism accessing health services in Canada, people who inject drugs are stigmatized in the Canadian health care system even though they are more at risk of health complications like overdose and blood borne infections. In Saskatchewan, 76.1% of all new HIV infections are attributed to injection drug use. If we know that people who inject drugs are increasingly at risk in Saskatchewan while HIV infection rates are dropping in other regions and populations in Canada, then what is the missing piece? Harm reduction is an evidence-based public health strategy that has been adopted by provinces across Canada to curb the rates of blood borne infections like HIV and Hep C. As an evidence-based public health strategy, harm reduction is included as a pillar of Saskatchewan’s Provincial HIV strategy (2010-2014):
“The profile of HIV increase in Saskatchewan is unique in Canada. A sudden increase in HIV in British Columbia in the late 1990s had similar characteristics to the current trend in Saskatchewan. The epidemic in Saskatchewan is associated with poverty, risk factors making populations of Aboriginal descent more vulnerable to HIV, and a large number of cocaine intravenous users who inject frequently each day. The provision of clean needles through Saskatchewan’s Needle Exchange Programs (NEPs) reduces the likelihood of transmission and hence, the number of new cases. Annually approximately 3.9 million clean needles are distributed in Saskatchewan with approximately 94% of the needles returned.”
Harm reduction services for people who inject drugs do exist, but there are a lot of challenges in accessing them and scaling up services to meet demand. According to harm reduction worker Alicia Slywka, “Saskatchewan is very far behind other provinces, and behind B.C., and there’s a lot that we can do to improve it. Yes, our programs are good, but I still think there’s a whole bunch that needs to be done in order for things to be reversed, and for HIV rates to go down.”
We know what works and what doesn’t work to curb the spread of HIV. Canada is not the only country where stigma against people who use drugs affects HIV rates. At the end of 2010, over half a million people with HIV were registered in Russia, with the majority of these infections fueled by intravenous drug use. Accounting for a total of 59.2% of new cases, the conditions of drug use have a large impact on public health. 70% of people living with HIV in Russia have injected drugs, and 37% of people who inject drugs are HIV positive. There are around 5 million drug users in Russia, 1.8 million of those using intravenously. Yet despite these figures, a 2008 report from UNAIDS projected just 7% of all people who inject drugs in Russia as having access to needle exchange services.
Russia still fights against services to prevent the spread of HIV, banning opioid substitution therapy and harassing both services providers and participants. In 2011, the Russian government spent upward of $100 million USD attempting to enforce drug laws, which doesn’t include the costs of incarceration. As documented by human rights activists, such as Pussy Riot band member Nadezhda “Nadya” Tolokonnikova, Russian jails are similar to forced work camps where prisoners face assault and torture. While the government spends hundreds of millions on criminalization, they only spend $20 million USD on HIV and HCV prevention.
Canada can learn from Russia’s failing policies: making it more difficult to access harm reduction services ultimately leads to more drug risks. It’s up to Canada to put safety first. We only need to look as far as BC for world renowned research around harm reduction and HIV. British Columbia is a global leader in evidence-based drug policy reform, and it was in Vancouver where CSSDP mentor Donald MacPherson came up with the four pillar approach to drug policy: Prevention, Harm Reduction, Treatment and Enforcement. When you balance what Canada spends on each pillar, it is not hard to see how the scales have tipped towards enforcement through the Harper government’s National Anti-Drug Strategy. It is clear that focusing government dollars on enforcement violates human rights and leads to HIV rates skyrocketing in prisons and amongst people who inject drugs. In order to fight HIV, we must fight our current Canadian drug policies and advocate for sensible drug policies based on research.