Criminalisation+is+Not+the+Key+to+Creating+a+World+Free+of+HIV

Student Name: Kaitlin Innocend Student Number: n8797471 Tutor: Michelle Newcomb

**Cultural Artefact** media type="custom" key="24267710" align="center"

The cultural artefact I have selected is an assortment of interviews with various professionals, including epidemiologist Elizabeth Pisani, whom discuss the ramifications that the criminalisation of drugs has on the ongoing HIV pandemic. A mutual opinion viewed by the professionals is the belief that the current strict punitive drug laws ought to be reviewed. Additionally, the commentators acknowledge countries that are striving to reduce HIV infection amongst drug users. The British Medical Journal (BMJ), an international general medical journal, generated this collation of interviews in 2010. The BMJ is renown for their influential and peer-reviewed academic medical journals. **Public Health Issue** The prevalence of HIV associated with drug users is an international public health concern. The global drug war intensifies the HIV pandemic through the implementation of repressive drug laws, thus deterring drug users from seeking medical attention. Australia is one of few countries that have addressed the issue via the implementation of strategies to reduce the incidence of HIV in drug users, particular those whom utilised intravenous methods. However, a significantly high proportion of countries, including the United States, have chosen to ignore the evidence that harm minimisation and treatment methods are beneficial, and continue to strive for prohibition. Consequently, the spread of HIV via intravenous drug users remains a global public health concern, particularly in the countries lacking methods to reduce HIV prevalence. **Literature Review** According to the World Health Organisation (WHO), among the estimated 16 million people injecting drugs, 3 million of them live with HIV (WHO, 2013). The prevalence of HIV is of great concern in Eastern Europe, East and South East Asia, and Latin America. UNAIDS, the joint United Nations programme on HIV/AIDS, reported that over 40 percent of intravenous drug users within these countries contract HIV. The criminalisation of drug users is recognised as a leading precipitating factor contributing to the spread of HIV. Twenty low- to middle-income countries reported that the incidence of HIV is greater than 10 percent among prison inmates (GCDP Report, 2012). The United Nations Office on Drugs and Crime claims that the incidence of HIV is greater in prison than it is the community of almost every country (UNODC, 2013). The proportion and source of the HIV epidemic varies significantly depending on the country. (Victorian Aids council, n.d.) The HIV/AIDS pandemic among drugs users and their subsequent sexual partners is driven by the criminalisation of drugs. Research continues to illustrate that the enforcement of oppressive drug laws cause drug users to refrain from seeking medical attention from public health services. As an alternative, the drug users enter into hidden environments where the risk of HIV is significantly higher. Furthermore, the consequences subsequent to becoming busted, in conjunction with the actions displayed by some police officers when handling drug users is continually reported to increase needle sharing and additional dangerous injection methods. Consequently, the risk of HIV contraction is increased due to sharing needles or syringes. These police practices include violence, torture and harassment of drug users, confiscation of clean needles, and the arrest for possessing needles. The 2012 Global Commission on Drug Policy (GCDP) Report interviewed a young woman of Moscow whom described her fear of the punitive drug laws: “Fear. Fear. This is the very main reason. And not only fear of being caught, but fear that you will be caught, and you won’t be able to get a fix. So on top of being pressured and robbed [by police], there’s the risk you’ll also end up being sick. And that’s why you’ll use whatever syringe is available right then and there.” In addition, the enforcement of harsh drug laws and high rates of incarceration is creating barriers against HIV testing and treatment. Barricades that arise include stigma and discrimination within healthcare settings, refusal of services, breaches of confidentiality, requirements to be drug-free as a condition of treatment, and the use of registries that lead to denial of such basic rights as employment and child custody. A successful method of treating HIV is the utilization of antiretroviral therapy. This treatment acts by reducing the proportion of human immunodeficiency virus within the blood and sexual fluids. Despite the successfulness of this treatment, research illustrates that due to the development of barriers the rates of antiretroviral therapy decline and mortality rates due to HIV rise. The arrest and incarceration of non-violent drug offenders provides an ideal environment for HIV. Imprisonment is a significant factor contributing to the burden of HIV. This distressing public health concern is present in many countries, including the United States, where the incidence of HIV is higher in prison then it is amongst the general population. The high incarceration rates due to criminalisation of drug users, whom are infected or at risk of HIV, is a concern due to syringe sharing, unprotected sex and HIV outbreaks in prison, globally. Countries reporting that incarceration is a primary risk factor for the contraction of HIV include western and southern Europe, Russia, Canada, Brazil, Iran and Thailand. Sharing of used needles has been identified as the prominent cause of HIV within the prison environment. Research has found that enclosed environments provide an ideal setting for the spread of HIV. Drugs should be considered a public health issue rather than a criminal justice matter to eliminate the contributing risk factor to HIV – incarceration. A point that is repeatedly noted is that majority of prisons fail to incorporate evidence-based addiction treatment or HIV care for drug users. Despite the continual evidence that treatment and harm minimisation strategies reduce the incidence of HIV, some countries choose to be resistance and strive for prohibition. (Global Commission on Drug Policy, 2012) A combination of prevention, care, and treatment services for HIV are advised to reduce the incidence of HIV among intravenous drug users and treat those whom are living with the infection. These recommended services include the implementation of sterile injecting equipment, antiretroviral therapy, opioid substitution therapy, and additional health services. Education, counselling, STI management and access to condoms are also required for the injecting drug user and their subsequent sexual partners (UNAIDS, 2013). Research support by the National Institute of Drug Abuse illustrated that the implementation of drug abuse treatment plans may decrease the risk oft HIV transmission. There is sufficient evidence concluding that the criminalisation of drugs is increasing the risk of HIV (National Institute on Drug Abuse, 2005). **Cultural and Social Analysis** Social factors are important to identify when analysing the association of drug use with the spread of HIV. The social groups that have been identified as having the highest risk of HIV contraction include intravenous drug users and their sexual partners, drug abusers whom participate in unsafe sex, prisoners, and sex workers who inject drugs. The social economic status of the individual is a contributing factor to the risk of HIV. These social groups are important to identify as it allows for the recognition of a focal target audience to incorporate when developing HIV prevention strategies. Low socioeconomic status is associated with poor education and poor health. At disproportional rates, the risk of HIV affects individuals of low socioeconomic status. Research illustrates that insufficient socioeconomic resources are associated with significantly high rates of risky health behaviours, subsequently leading to the contraction of HIV. In addition, the risk of HIV infection due to injecting drugs and unsafe sexual activity has been associated with unstable housing. According to the American Psychological Association, individuals whom have unstable housing arrangements are at greater risk of contracting HIV than those with stable housing. Furthermore, due to the high rates of HIV infection among individuals of low social economic status, HIV treatment becomes an issue. The chance of survival of HIV infected individuals of low socioeconomic status is reduced, due to the delay of the initiation of treatment. Consequently, morbidity and mortality rates are greatest among HIV-infected individuals of low socioeconomic status. In order to rectify this disproportionality, strategies to approach this public health must accommodate for the individuals of low socioeconomic status. (APA, 2013) Additionally, socio-cultural factors are important to recognise when addressing this public health concern. Cultures vary in their norms and practices, more specifically relating to sexuality, which increase the risk of HIV infection. One problem in particular is the refusal to wear condoms. South African men reported that they refuse to wear condoms due to their belief that complete flesh contact is required in sex, as it equates with masculinity, and is required for the health of males. This a distressing issue, as those South Africans whom inject drug harmfully, not only put themselves at risk, but subsequently place their sexual partners at high risk of contracting HIV. (Conjoh, Zhou, & Xiong, 2011) **Analysis of the Artefact and Your Own Learning Reflections** I selected the artefact shown above, as it visually and verbally communicates the opinions of professionals, particularly health experts, of the association of the criminalisation of drugs with the prevalence of HIV. This video demonstrated various experts’ opinions that support the claims that I have conveyed throughout this report. The commentators agreed that drug criminalisation was fuelling the HIV pandemic and that the punitive drug laws should be revised. This video was interesting and captivating as I believe in harm minimisation rather than prohibition as the population of using drugs is far to large to cease all drug use. Thus, in an attempt to reduce the burden of disease, and danger of using drugs, I think it is important that harm minimisation strategies are implemented. The commentators in the video confirm the harms of prohibition. HIV is an incurable disease, which no individual should suffer from. Thus, I believe that it is unrealistic to prohibit all drug use and that treatment should be accessible to drug users living with HIV, in conjunction with harm minimisation programmes to prevent HIV. It was particular interesting identifying the social and cultural aspects associated with HIV contraction. It illustrated the importance of understanding the cultural and social aspects to allow for the correctly targeted treatment and harm minimisation strategies.

Reference List
American Psychological Association.(2013). //HIV/AIDS & Socioeconomic Status//. Retrieved October 30, 2013, from http://www.apa.org/pi/ses/resources/publications/factsheet-hiv-aids.aspx  Conjoh, A. M., Congkui, Z., & Xiong, J.(2011). Socio-Cultural factors affecting the spread of HIV/AIDS among adolescents in sierra leone. //The social sciences, 6//, 269 – 276. doi: 10.3923/sscience.2011.269.276 Global Commission on Drug Policy.(2012). //The war on drugs and HIV/AIDS: How the criminalization of drug use fuels the global pandemic//. Rio de Janeiro: Global Commission on Drug Policy. National Institute on Drug Abuse.(2005). //Drug abuse & HIV/AIDS: The complexities of linked epidemics//. Bethesda, Md: National Institutes of Health. UNAIDS.(2013). //Global report: UNAIDS report on the global AIDS epidemic 2013.// Retrieved October 28, 2013, from http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf Victorian AIDS Council.(n.d.). //HIV Fact Sheet//. Retrieved October 26, 2013, from http://www.vicaids.asn.au/hiv-fact-sheet World Health Organisation.(2013). //Injecting drug use//. Retrieved October 26, 2013, from http://www.who.int/hiv/topics/idu/about/en/index.html

**Reflection** **Beat the Blues! Depression in Women** **ATTENTION shoppers! Beware of that bargain..**