The United Nations needs to reconsider its current strategy on dealing with HIV and with illicit drug, according to the coauthors of a Comment released on May 30, 2008 in The Lancet.

Member states of the UN have been asked to spend time this year reflecting and gauging the progress made since the 1998 UN General Assembly Special Session on the worldwide drug problem, named 'A drug-free world -- we can do it'. This meeting resulted in a goal for complete eradication of opium poppy, coca, cannabis, primarily using police and criminal law. The declaration did not, however, focus on HIV infection or other health problems for people who are unable or unwilling to discontinue drug use.

The coauthors, Joanne Csete, of the Canadian HIV/AIDS Legal Network, Toronto, ON, Canada, and Daniel Wolfe, Open Society Institute, New York, USA, say: "In 2008, the UN must do better. Epidemics of HIV and hepatitis C driven by injected-drug use should weigh heavily in the considerations of member states on whether they really can -- or should try to -- achieve a drug-free world."

They analyze the importance of the International Narcotics Control Board (INCB), a body of experts funded by the UN with the intention of enforcing international drug control treaties. The authors say this undermines recognition of HIV prevention measures for drug users. Additionally, INCB failes to criticise countries where addiction medications, such as methadone, are illegal, for example Russia. This is despite the recommendation of the board to ensure that these medications are legal and available to those undergoing rehabilitation. They continue: "Nor has the board spoken out about the many instances where addiction treatment -- required under the UN conventions -- is incarceration by another name, including forced labour, prolonged institutionalisation, and unproven and punitive procedures, such as partial lobotomy or flogging... Indeed the INCB congratulates countries with repressive practices for their commitment to cracking down on the drug problem."

They call for a reconsideration of the INCB's role and purpose, concluding: "The INCB is a relic of time when criminal law and crackdowns were deemed sufficient to deal with the public-health challenge of illicit drug use. In 2008, an ideal way for the UN to show that drug policy needs another look in the era of HIV would be for the UN Secretary General to commission an independent assessment of the activities of the INCB. The UN should also require that the deliberations of the INCB, which are held in secret, be opened to member states and civil society. Such measures would contribute to making 2008 a milestone of real global progress toward dealing with the health consequences of drug dependence."

Progress or backsliding on HIV and illicit drugs in 2008?
Joanne Csete, Daniel Wolfe
The Lancet, Vol 371, May 31, 2008
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Anna Sophia McKenney