The AIDS epidemic has devastated injection-drug users worldwide, and their plight—and the neglect of it—is stealing headlines this week at the 19th International AIDS Conference in Washington, DC. "AIDS 2012" has attracted 20,000 scientists, advocates, media, Big Pharma and big names—from Hillary and Bill Clinton, Laura and George W. Bush, and much of Obama’s cabinet to Bill Gates, Elton John and Whoopi Goldberg. Even the entire AIDS Quilt is on display—all 1.3 million square feet, memorializing the 600,000 Americans killed by AIDS. But the relatively small contingent of drug-use activists has set much of the agenda—above all, on needle exchange—with some crafty early actions. Along with sex workers and men who have sex with men, drug users are among “criminalized groups” in most of the world; it’s no coincidence that these groups include most of the 33 million people with HIV.
On Sunday, the activists disrupted the opening press conference to protest federal laws blocking current or former IV-drug users from entering the US. President Obama, who won praise from the AIDS community in 2009 for lifting the longtime travel ban against people with HIV, refused to grant a blanket waiver for advocates for IV drug users (many are former addicts) to attend the bi-annual conference. The protesters’ slogan—“Nothing about us without us”—immediately became AIDS 2012’s mantra. “Drug users run our own clean syringe programs and have had real success, but are not being used as models of success,” said Alan Clear, executive director of the Harm Reduction Coalition. “Why? Stigma.”
Activists followed up by dropping a banner reading “Clean Needles Stop AIDS” at the Washington Nationals baseball game on Monday night. Then on Tuesday, at a large multi-issue march, protesters upped the ante, demanding, "End the Drug War" in order to end the AIDS epidemic.
Anecdotal evidence suggests, though, that the Obama administration quietly allowed even self-admitted drug users to enter the US for the conference—effectively issuing a silent waiver, dodging the political fallout that would likely have resulted from an official act. (Alexandra Volgina, Russia’s leading activist for the nation’s IV-drug users, who suffer the highest rate of new HIV infections in the world, writes about the ban here.) Yet rather than testing the law, many drug-user advocates announced a boycott of AIDS 2012, holding their own conference-approved “hub” in Kiev two weeks ago, where they videotaped personal messages of protest that are airing at the conference.
The entry ban serves as a potent symbol of stigma, which fuels the discrimination and criminalization that, in all but the most progressive nations, limits HIV prevention to abstinence. Clean needle swaps, despite many studies over 20 years proving their effectiveness at cutting HIV transmission, remain widely outlawed, with opponents making false claims that the exchanges increase drug use. At AIDS 2012, two major studies add still more weight to that pro-exchange case. A long-term study of drug users in Amsterdam, where the world’s first syringe giveaway was set up in 1984, found HIV incidence among the city’s IV drug users close to zero by 2011. A cost-benefit analysis conducted by US researchers concludes that even a 10% expansion of the swaps, costing $64 million a year, would prevent 500 new infections—saving $193 million in unnecessary treatment with HIV cocktails, which average $15,000 a year per person.
Stigma, discrimination and criminalization of drug users are targets for the top-billed speakers at AIDS 2012. Secretary of State Clinton, who was interrupted by protesters as soon as she started speaking at the opening plenary, seemed to welcome the noise. “What would an AIDS conference be without a little protesting?” she asked, to cheers and applause. “We understand that.” Referencing “the needs of injection-drug users,” she vowed that the US will “fight for the resources to achieve an AIDS-free generation.” Rep. Barbara Lee (California—D), a longtime congressional firebrand for progressive AIDS legislation, called for an end to the federal ban on funding needle exchanges, and a litany of other policies like condoms in prisons. Mark Dybul, who was President George W. Bush’s openly gay appointee to head the much-lauded PEPFAR (the President’s Emergency Plan for AIDS Relief), went even further—supporting both syringe swaps and opioid substitution therapy as cornerstones of HIV prevention.
For continuing news on drug user issues and actions during the remaining days of AIDS 2012, check out HIVandhepatitis.com.