New evidence that criminalization of drug use fuels HIV/AIDS
A special issue of the medical journal The Lancet,
produced for the International AIDS Conference, published a ground-breaking
series of articles and commentaries on the global HIV epidemic among people who
use drugs. Drawing on their comprehensive examination of hundreds of studies, the
journal’s editors called for an evidence- and rights-based response to HIV
among people who use drugs: “Criminalization
has reduced access to health care for people at risk of drug use…Put simply,
locking people up does not work.” The
journal’s articles provide evidence showing that the most neglected strategy, a
human rights-based approach, is the the most effective tool in reversing the
epidemic.
新证据表明，毒品利用有罪化加剧艾滋病传播
医学期刊《柳叶刀》上有期为国际艾滋病大会制作的专门话题，围绕话题发表了一系列有关全球艾滋病在吸毒者之间的感染情况的论文和评论，颇具开拓性。通过对这数百项研究进行综合考察，期刊的编辑呼吁，对吸毒人群艾滋病的回应应当有据且符合其正当权益，”有罪化，使得容易受到感染的吸毒人群接触健康治疗的途径减少……简单地说，将人锁起来是没有用的。”期刊的论文用相关证据说明，在对抗艾滋病时，最容易被人们忽视的方式，也就是以人为本的方式，其实是最有效的方式。
Some highlights of the journal:
- Steffanie Strathdee and colleagues documented the effectiveness of “triple therapy”
in preventing HIV among drug users: opioid substitution therapy (such as
methadone), needle and syringe exchange, and antiretroviral treatment
(ART). In support, the authors
points to studies in Pakistan and Kenya, where changes in policy and
access to healthcare have contributed to reversal of the epidemic. - Daniel Wolfe and colleagues examined access to ART for people who use drugs in
low-income and middle-income countries, and found that nearly half (47%)
of all injection drug users (IDUs) infected with HIV are in five nations –
China, Vietnam, Russia, Ukraine and Malaysia – where policies on drug use
make it difficult for IDU to access ART. They found that criminalization
of drug use, including imprisonment, compulsory detoxification and the
maintenance of registries of the names of drug users, create barriers to
the fight against AIDS. - Ralf Jurgens and colleagues reviewed over 900 studies on human rights and IDU
and found that abuses of human rights increase vulnerability to HIV
infection and negatively affect delivery of HIV programmes. These abuses
include denial of harm-reduction services, discriminatory access to
antiretroviral therapy, abusive law enforcement practices, and coercion in
the guise of treatment for drug dependence. Protection of the human rights
of people who use drugs therefore is important not only because their
rights must be respected, protected, and fulfilled, but also because it is
an essential precondition to improving the health of people who use drugs. - Finally, Chris Beyrer and colleagues, including Michel Sidibe (head of UNAIDS) and
Michel Kazatchkine (head of the Global Fund) called on states to expand
rights-based approaches to providing treatment and care to IDU with
HIV/AIDS.
Because of their scientific methodology, the articles in this issue of the journal will be valuable tools
for advocacy in countries where drug use is criminalized. This includes a
number of countries in Asia, such as Indonesia, Thailand and China.
期刊上的重点亮点如下：
l 斯蒂夫尼·斯初资蒂和他的同事探讨了在吸毒人群内预防艾滋病时，”三方疗法”的有效性。”三方疗法”包括类鸦片替代疗法（例如美沙酮），肌肉注射和静脉点滴交换以及抗逆转录疗法（ART）。作者以在巴基斯坦和肯尼亚的研究为依据，这两个国家的政策和获取健康护理的途径都有了相应变化，在对抗艾滋病的过程中有极大的贡献。
l 丹尼尔·沃尔夫和他的同事考察了在低收入与中低收入的国家中，吸毒人员获取抗逆转录疗法的途径。研究发现，在所有针注射毒品的人员（IDUs）中，将近一半（47%）的感染者分布在五个国家—-中国、越南、俄罗斯、乌克兰和马来西亚。这些国家在毒品使用方面的政策，使得IDU很难获得ART的治疗。研究者们发现，吸毒的有罪化，包括关押、强制戒毒和对毒品使用者名字记录的保存等，给对抗艾滋病的战役设置了屏障。
l 如阿夫·舟梗斯和他的同事回顾了有关人权和IDU人群的900项调查后发现，人权侵犯成为对抗艾滋病传染战役中的薄弱处，并对艾滋病项目的移交有着负面影响。这些侵权行为包括否认减低伤害（harm-reduction）服务，区别提供获取抗逆转录治疗途径，法律强制性措施的泛滥以及以治疗药物依赖为名的强制性措施。一方面，由于吸毒者的人权必须得到尊重、保护和满足，另一方面，作为提高吸毒人群健康素质的必要前提因素，保护吸毒者的人权显得非常重要。
l 最后，克里斯·贝尔和他的同事，包括迈克尔·斯蒂本（联合国艾滋病规划署署长）和迈克尔·科茨特凯恩（全球基金会会长）向各国政府呼吁，扩大以人为本的治疗渠道，关照感染艾滋病的IDU人群。
由于这些论文采用的是科学方法，它们将在以后向将毒品使用有罪化的国家—-包括亚洲的许多国家，如印度尼西亚、泰国和中国—-进行呼吁时，成为有用的工具。
