Is the war on drugs crippling the war on AIDS?

And might the AIDS epidemic make

governments more willing to treat drug abusers as suffering patients rather than as
hardened criminals?
Those questions came to the fore last week because of a fumbled news story. It was
announced incorrectly, it turned out that the United Nations Office on Drugs
and Crime, which oversees the fight against cross-border drug trafficking, was about
to do a startling about-face and advocate ending penalties for personal use of all
drugs.
The schisms revealed by the news U.N. agencies, not to mention nations and
political parties, are sharply divided over the issue showed how the debate is
shifting, in part because of H.I.V.
Continue reading the main story
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U.N. Report Did Not Endorse Legalization of Drugs, Agency SaysOCT. 19, 2015

The spread of the virus through needles may be the least-talked-about but most
intractable aspect of the AIDS epidemic. In North America and Western Europe,
H.I.V. is mostly transmitted through gay sex. In Africa, the focus of most Western
aid, it is spread through heterosexual sex.
But in many countries notably Russia and Eastern Europe, and across swaths of
Asia where the opium poppy flourishes, the greatest H.I.V. risk is injected heroin.
Our position is very clear, said Michel Sidib, the executive director of Unaids, the
U.N. agency fighting AIDS. Of the 12 million people who inject drugs, 1.7 million are
infected. We need to take these people out of the shadows and into services, or we
will never control the epidemic.
Studies done decades ago on groups with different H.I.V. risk factors prostitutes in
Nairobi, gay men in San Francisco and addicts in Bangkok, for example showed
that needle-sharing was the fastest way the virus spread when it entered a new
population.
Around the world, users who inject drugs are 28 times more likely to be infected
than people who do not.
Global Health
A column by Donald G. McNeil Jr. about global health news.

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Taking away the fear of arrest after being caught with a syringe or a gram of heroin
makes it possible for addicts to sign up for risk-lowering interventions: clean
syringes, condoms for those who sell sex for drugs,antibiotic treatment for venereal
diseases, methadone to help addicts lead less chaotic lives, antiretroviral treatment
and pre-exposure prophylaxis.
Jailing users, by contrast, increases risk. Many prisons are H.I.V. hotbeds because of
drug needles, tattoo needles, unprotected male-male sex and rape.
No two countries have matching policies on the nonmedicinal use of drugs.
In the United States, marijuana is legal in four states while heroin is universally
outlawed; 30 states allow syringe exchanges while 20 do not. InSwitzerland, by
contrast, voters in 2008 effectively made heroin a medical problem, but kept
marijuana illegal.
Iran permits clean syringes and methadone, even to prisoners. Heroin addicts, who
once faced the death penalty, are immune from arrest while in treatment.

Study after study has shown that countries that reduce penalties and offer
treatment have reduced H.I.V. infections. China, for example, dropped a zerotolerance policy on heroin in favor of clean syringes and methadone. It now has 700
clinics treating 200,000 patients, and new H.I.V. cases among those patients have
dropped by 90 percent, Mr. Sidib said.
In 2001, Portugal made the possession of up to 10 days worth of any drug legal.
Only 78 H.I.V. cases there were attributed to drug use in 2013. (Also,overdose
deaths are now among the lowest in Europe 3 per million Portuguese versus 45
per million among residents of Britain, for example.)
In Germany, arrests on charges of possession of small amounts may be dismissed.
Most addicts are in treatment, and pharmacies sell syringes cheaply.
Germany has about 3,300 new H.I.V. infections a year with only about 100 of them
from drug use down from 1,200 in 1986. Many are in recent migrs from former
Soviet countries, according to a 2012 Unaids report.
In Russia, by contrast, under President Vladimir V. Putins traditional values
campaign, the police crack down hard on addicts. Syringe exchanges and
methadone are illegal. State hospitals rely on detoxification and group therapy.
Lord Fowler, a former British health secretary, said in a recent BBC magazine
article that the chief of Moscows major narcology research hospital told him that
half the addicts she treated relapsed within a year, and 90 percent within eight
years.
Russia has 85,000 new H.I.V. infections a year, and the head of Moscows Federal
AIDS Center said in May that 57 percent were from drug injection.
Questions over drug policy have split U.N. agencies. The World Health
Organization and Unaids openly favor ending criminal penalties to fight H.I.V.
But U.N.O.D.C., the drug and crime agency, rooted in law enforcement and the 1946
U.N. Commission on Narcotic Drugs, is more conservative. Its executive director,
Yury Fedotov, is Russian; high U.N. officials rarely flout the views of the governments
that nominate them.
The agencys H.I.V. division did produce a briefing paper last week saying that
possession of small amounts could be made permissible under anti-trafficking
treaties and human-rights law. An agency representative denied that it amounted to
a reversal of 70 years of policy and said such a momentous change would not be
announced by a midlevel official at someone elses conference in Kuala Lumpur.
However, a shift by the United Nations as a whole may be in the wind.

Even Secretary General Ban Ki-moon recently treaded close to the line, saying, We
must consider alternatives to criminalization and incarceration of people who use
drugs.

Filtered sunlight is a cheap, effective way to treat infant jaundice, according to a

study by Stanford researchers.
Jaundice caused by an excess of bilirubin in the blood leads to brain damage or
death in about 150,000 babies a year in poor countries. The problem is common in
newborns, whose livers sometimes need several days after birth to generate the
enzymes needed to break down bilirubin, which is released when red blood cells
break down. Yellow skin and eyeballs are common symptoms.
In wealthy countries, jaundiced newborns are placed for several days under
sunlamps that emit extra blue wavelengths of light and minimal ultraviolet or
infrared ones.
It was established during World War II that artificial sunlight cures jaundice, which
more than 28,000 soldiers developed after getting yellow fever vaccine made from
human blood.
Continue reading the main story
RELATED COVERAGE

Small Fixes: For Neonatal Jaundice, a New Option in Resource-Poor NationsSEPT. 26,
2011

For years, American research focused on drugs to block bilirubinformation, while

hospitals relied on lamps and, in extreme cases, transfusions to treat patients.
But hospitals in poor countries may be unable to afford lamps or may lack a steady
electricity supply to run them.
The Stanford team, whose work was published last month in The New England
Journal of Medicine, tested whether real sunlight which is plentiful at many

hospitals in tropical climes could be made safe enough for babies to lie in for
hours a day.
They treated 433 babies for jaundice at a hospital in Lagos, Nigeria. Half received
sunlamp phototherapy, and half slept in outdoor cribs or their mothers laps under
canopies of plastic film that filtered out ultraviolet and infrared rays.
The sunlight treatment was slightly more effective, and the children did not have
more sunburn, dehydration or overheating.
The researchers have designed a small greenhouse to be used in windier or colder
climates.