A giant banner with an AIDS awareness red ribbon is displayed on the European Commission headquarters on World Aids Day in Brussels on December 1, 2009.

(London) - Governments worldwide should take urgent action to reform punitive drug laws, disproportionate penalties, and harsh and discriminatory law enforcement practices as part of their efforts to address HIV among people who use drugs, Human Rights Watch and the International Harm Reduction Association said today, World AIDS Day. Current policies also cause needless suffering among people living with HIV/AIDS, the two groups said in a joint briefing note released today.

"The ‘war on drugs' is fueling HIV epidemics among people who use drugs around the world, and condemning millions of people with terminal cancer and with HIV/AIDS to needless suffering,"  said Professor Gerry Stimson, Executive Director of the International Harm Reduction Association.

In many countries, drug control efforts block lifesaving HIV services to people who use drugs, even where they are legal, Human Rights Watch and the International Harm Reduction Association said.  Overly strict, complex drug laws and regulations block access to cheap, effective pain medications, like morphine, relegating  hundreds of thousands of people living with HIV/AIDS, and millions with terminal cancer, to suffer severe pain.

Outside of sub-Saharan Africa, as many as 30 percent of all new HIV infections occur among people who inject drugs and within sub-Saharan Africa, injection drug use is increasing. In some countries, in particular in Central and Eastern Europe and East Asia, injecting drug use is the primary driver of HIV epidemics.

International health and drug control agencies - including the UN Office on Drugs and Crime, UNAIDS, UNICEF, the United Nations Development Program, and the World Health Organization - all endorse comprehensive harm reduction services as the best ways  to address HIV among people who use drugs, including those  in detention. These services include needle and syringe exchange, medication-assisted therapy (for example, with methadone), and peer outreach and education programs. Notwithstanding broad endorsement and overwhelming scientific evidence that these approaches work, they are out of reach for the vast majority of people who need them.

In the joint briefing note, Human Rights Watch and the International Harm Reduction Association also expressed concern that criminal laws, disproportionate penalties, and law enforcement practices drive people away from lifesaving HIV services that do exist, and impede access to pain treatment for tens of millions of people who need it.  Some laws concerning the possession and use of drugs, and the possession of drug paraphernalia, can keep many people who use drugs from carrying sterile syringes or other injecting equipment, even where it is legal to do so, and cause them to avoid drug treatment or harm reduction services altogether out of fear of arrest and conviction.

Laws creating criminal penalties for incitement to use drugs or facilitating/encouraging drug use likewise interfere with peer outreach services. The pressure on police officers to meet arrest quotas as a measure of success exacerbates police abuse of drug users by encouraging them to seek out easy targets, like drug users, for arrest.

In some countries, people who are identified as, or suspected to be, drug users are detained, sometimes for years, in locked facilities for "drug treatment," regardless of whether they need treatment and without due process of law. Basic medical services are often unavailable, and "treatment" often consists of forced, unpaid labor, and in some cases, physical and psychological abuse. The impact of drug control is often disproportionately focused on vulnerable groups and marginalized communities, such as African Americans in the United States.

Human Rights Watch and the International Harm Reduction Association also expressed concern that laws concerning drugs and syringe possession, together with associated policing practices targeting people who use drugs, may increase HIV risk. The organizations called for greater discussion among governments and relevant United Nations agencies on these issues.

"Of course these are complex and controversial issues," Rebecca Schleifer, advocacy director of Human Rights Watch's Health and Human Rights Division said. "But we must have the courage to discuss them openly if we are to fully understand what is needed to halt and begin to reverse drug-related HIV/AIDS."