People who inject drugs (PWID) are at risk for acquiring HIV infection. Criminalization of drug use may reduce HIV transmission by discouraging use in general. On the other hand, it may encourage risky use and create barriers to accessing preventive services and treatment. Researchers completed a systematic review of the literature from 2006 to 2014 exploring this topic.
- 106 articles met inclusion criteria: 49 cross-sectional, 29 longitudinal, 22 qualitative, 4 mathematical modeling, and 2 mixed methods studies. Study locations included North America (40%), Asia (25%), Eastern Europe (11%), South America (9%), Middle East (8%), Western Europe (5%), and Oceania (1%).
- The studies reported on a variety of indicators of criminalization, including street-level policing (37%), incarceration (36%), drug paraphernalia laws (12%), national drug strategies (10%), and prohibitions or restrictions on opioid agonist treatment, needle exchange, or other HIV prevention interventions (9%).
- Among the included studies, 80% suggested that criminalization of drug use has negative effects on HIV prevention and treatment, 9% found no association, 5% both null and negative effects, and 1% beneficial and negative effects.
Comments: The preponderance of the evidence suggests that criminalization of drug use has a negative effect on HIV prevention and treatment. This has to be added to the tremendous financial and social costs of criminalization. In order to best address the problem of HIV infection among PWID, we need to move away from punitive policies.
Darius A. Rastegar, MD
Reference: DeBeck K, Cheng T, Montaner JS, et al. HIV and criminalisation of drug use among people who inject drugs: a systematic review. Lancet HIV. 2017;4:e357–e374.