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AIDS Conference: New Voice Needed in Eastern Europe and Central Asia

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The International AIDS Conference, a global gathering in Washington DC of 25,000 people, kicked off last week with a ray of light for those fighting to reduce the spread of HIV.

The United Nations announced the appointment of Dr Michel Kazatchkine, the former head of the Global Fund to fight AIDS, Tuberculosis and Malaria, as the UN Secretary-General's new Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

Yet, while Dr Kazatchkine's skills will be principally devoted to a handful of EU Member States and some neighbours, all of Europe would be wise to heed his guidance on the importance of sensible drug policies in the HIV response. As a member of the Global Commission on Drug Policy - a body of experts from politics, health, academia and business - Dr Kazatchkine reminded leaders that "the war on drugs has fuelled the HIV epidemic."

Last month, the Global Commission on Drug Policy wrote, ''Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated. Mass incarceration of non-violent drug offenders also plays a major role in increasing HIV risk."

The Global Commission's members include, Aleksander Kwasniewski, former President of Poland; George Papandreou, former Prime Minister of Greece; Javier Solana, former EU High Representative for the Common Foreign and Security Policy and Jorge Sampaio, former President of Portugal, among others.

In announcing Dr. Kazatchkine's appointment, Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said, "Eastern Europe and Central Asia are still facing huge challenges in responding to HIV. With his experience and leadership I am convinced that Mr Kazatchkine will do an excellent job in helping to reverse the epidemic in this pivotal region."

But such reversals cannot happen without a change in drug policy.

This lesson has been painfully experienced in many countries in Eastern Europe and Central Asia, which should serve as cautionary tales for all of Europe's leaders - especially in this critical time of austerity.

In fact, as austerity threatens successful services and some leaders revert to "tough on drugs" rhetoric, EU Member States are already witnessing increases in the number of new HIV infections among people who inject drugs.

For example, in Greece, the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) identified 113 new cases among people who use drugs as of July 2011, up from between 3 and 19 per year from 2001 to 2010. The EMCDDA wrote, "This increase in the reported cases is consistent to a more than ten-fold increase in the incidence of diagnosed cases of HIV infection among IDUs [injecting drug users]."

The Greek government has responded by ramping up its services for drug users yet the EMCDDA concluded, that "the level of activity is still insufficient to meet the demand within the injecting drug using population."

Moreover, similarly alarming numbers are being reported in Romania. The EMCDDA recently wrote of that country, "While reporting 3 to 5 cases annually from 2007 to 2009, HIV infections among IDUs [injecting drug users] increased to 12 cases in 2010 and to 62 cases in 2011, as of September."

What is so discouraging about all this is that we know what works. When those most at risk of HIV do not fear criminal sanctions, they are far more likely to access life-saving services and treatment programmes.

In Portugal where drugs were decriminalised twelve years ago, new HIV infections among people who use drugs dropped from 1,430 (or 52% of all new infections) in 2000 to 164 (15% of all new infections) in 2010.

Similarly successful results were seen in the Czech Republic when that government overhauled its drug policy.

However, austerity is threatening to dismantle these incredible gains.

In Portugal harm reduction services fear being shut down and successful government bodies that provided treatment have been dissolved.

Europe and its neighbours to the east have long reflected the best and worst of drug policy. It's been the staging ground for some of the world's most successful experiments in drug policy (Portugal, Czech Republic, Netherlands) as well as some of its greatest emergencies (Russia and Ukraine).

Experts such as Dr Kazatchkine have warned against punitive legislative frameworks in saying as a member of the Global Commission on Drug Policy, "Aggressive law enforcement practices targeting drug users have also been proven to create barriers to HIV treatment."

It is hoped that as the EU produces its own drug strategy it listens to its better angels and heeds the positive lessons of its recent history.

Kasia Malinowska-Sempruch is the director of Open Society Foundations Global Drug Policy Program