An unprecedented study by an SFU professor indicates that drug criminalization is a major driver in the HIV/AIDS epidemic and presents a barrier to eradicating the disease.

Kora DeBeck, an assistant professor in the SFU School of Public Policy and a research scientist at the BC Centre for Excellence in HIV/AIDS, along with research collaborators including Dr. Stefan Baral at Johns Hopkins Bloomberg School of Public Health, recently published a systematic review study on drug criminalization and HIV prevention.

The study found that “the evidence was overwhelmingly definitive that drug criminalization has a negative effect on HIV prevention and treatment,” said DeBeck.

DeBeck and her colleagues analyzed 106 studies published between 2006–14 in the first systematic assessment of the effect of laws criminalizing drug use on HIV prevention and treatment outcomes among people who use injection drugs.

“Health and social science researchers have been documenting the serious adverse impacts of the criminalization of drugs for decades now; however, no systematic review or synthesis in this area had ever been conducted, which was a significant gap in the evidence,” said DeBeck.

The study focused on incarceration, street-level policies, drug paraphernalia laws, and the effects of such criminalization. Drug criminalization endangers the health of people who use drugs in many ways, including limiting access to needle and syringe programs and HIV antiretroviral therapy, according to DeBeck.

Not only that, drug criminalization decreases the number of syringes available on the street, which induces people who use drugs into needle sharing. This increases the probability of acquiring and transmitting bloodborne diseases, primarily HIV/AIDS.

“Out of the 106 studies reviewed, 91 studies suggested that criminalization undermines HIV prevention while only six studies reported some type of beneficial effect with drug criminalization — but these benefits were minimal at best,” said DeBeck.                       

Another group of studies found that criminalization did not have a significant effect on HIV prevention and treatment, but DeBeck explained that these studies were looking for an overall reduction in the use of drugs. “For example, one study examined policing levels, with the expectation that there would be a reduction in substance use associated with increased policing. However, no measurable improvement or reduction in substance use was observed with increased policing. Similarly, one of the studies examined incarceration among people who use injection drugs and found that periods of incarceration were not effective in deterring subsequent substance use,” DeBeck noted.

Supervised injection facilities and heroin prescription can be conceptualized as reduced criminalization. These initiatives have demonstrated positive impacts on HIV prevention, including a significant reduction in syringe sharing — a driving factor in HIV transmission, she continued.

One concern with supervised injection facilities is that they may serve as a social hub for drug users — drawing people who use drugs from other communities, which could compromise the security of the surrounding neighbourhood. However, research from Vancouver’s supervised injection facility found that public order improved after the establishment of the facility.

Despite this encouraging evidence, “supervised injection facilities are a limited intervention and just one piece of the puzzle,” DeBeck claimed.

The federal government is currently developing an approach towards regulating cannabis which is a significant move away from drug criminalization. Some health advocates including DeBeck are hoping this model will be applied to other areas of substance use as well.