Source: New York Times

Author: Donald G. McNeil Jr.

23 July 2010

VIENNA — Some of the world’s top AIDS experts issued a radical
manifesto this week at the 18th International AIDS Conference: They
declared the war on drugs a 50-year-old failure and called for it to
be abandoned.

No one heard.

Officially, the theme of the AIDS meeting, the world’s largest public
health gathering, is the need to attack the rapidly growing epidemic
among addicts in Eastern Europe, Russia and Asia. It was held in
Vienna because this city is the doorway to the East and, in this
German-speaking country, all the conference signs are in English and Russian.

(In a lovely ironic touch, the conference hall is only a few steps
from the Ferris wheel in the Orson Welles film noir classic set in
postwar Vienna, “The Third Man.” On it, a cynical dealer of
counterfeit drugs tells his pursuer to look down at the people below
and says: “Victims? Don’t be melodramatic…. Would you really feel
any pity if one of those dots stopped moving forever?”)

But the organizers’ efforts to get publicity for the [Vienna
Declaration->http://www.viennadeclaration.com/the-declaration.html], which calls for drug users to be spared arrest and
offered clean needles, methadone and treatment if they have AIDS,
have come to naught. Almost no one here talks about the war on drugs.

Instead, everyone is publicly worrying that the war on AIDS is
falling apart. Donor money is evaporating in the recession, and it is
looking likely that only about a third of the 33 million infected
people in the world will have any hope of treatment.

Frustration is high. Speakers like Bill Gates were interrupted by
demonstrators in Sherwood Forest green calling for a “Robin Hood tax”

— a tiny fee on the $4 trillion in currency transactions made daily
by banks and hedge funds that could raise billions for AIDS.

Many activists blame the Obama administration, which is shifting its
priorities to mother-and-child health. The halls are decorated with
posters comparing Mr. Obama unfavorably with George W. Bush. On
Wednesday, Archbishop Desmond Tutu criticized Mr. Obama in an Op-Ed
article in The New York Times.

In his speech here, former President Bill Clinton said Ambassador
Eric Goosby, the administration’s global AIDS coordinator, “ought to
get some kind of Purple Heart for showing up.”

However, a new report from the Kaiser Family Foundation shows that
the United States still gives more for AIDS assistance than all other
countries put together, accounting for 58 percent of contributions.
Its donations are still going up slightly, while those from Europe,
Canada, Japan and Australia are flat or falling.

Officials from the Global Fund to Fight AIDS, Tuberculosis and
Malaria say they fear they will not come close to the $17 billion
target they set for their next donors’ meeting in September.

The other, more welcome, distraction has been the exciting results of
a South African clinical trial in which a vaginal gel with an
antiretroviral drug protected 40 percent of the women using it. This
is the first good news about microbicides in decades of work. A gel
women can use secretly has long been sought, since many men disdain
condoms and many women want to get pregnant.

The Vienna Declaration is only the second time that the International
AIDS Society has issued such a document. The last was the 2000 Durban
Declaration, which reaffirmed that H.I.V. was the cause of AIDS. It
was a response to the government of South Africa, the conference’s
host, which at the time denied that the virus caused disease and
refused to buy medicine for its citizens.

Outside of Africa, almost a third of all H.I.V. infections stem from
drug injections.

The declaration contends that arresting drug users forces them into
hiding, spreading the epidemic. It backs “science-based public health
approaches” proved in clinical trials, which can include everything
clean needle swaps, 12-step recovery programs and methadone.

Dr. Evan Wood, an AIDS policy expert at the University of British
Columbia and the chief author, cited Portugal’s approach. According
to a 2009 report by the libertarian Cato Institute, in the decade
since Portugal legalized possession of up to 10 days’ worth of any
drug, including cocaine and heroin, its AIDS rate dropped by half,
overdose deaths fell, many citizens sought treatment, drug use among
young people fell and drug tourism did not develop. The institute
called the policy “a resounding success.”

The declaration is largely aimed at countries of the former Soviet
Union. In Russia, for example, close to 1 percent of its adult
population is infected.

Nonetheless, the country forbids all methadone-type treatments, and
the national health plan offers only abrupt detoxification, which has
a high failure rate. The most frequent victims — prisoners and
people not living in their assigned residence areas — are the least
likely to get AIDS drugs, and activists say markups vastly inflate
the prices of medications bought cheaply by foreign donors.

“The government says everything is fine,” said Aleksandra Volgina,
31, the leader of Candle, a Russian AIDS organization based in St.
Petersburg. “We’re even donors to the Global Fund, but we don’t have
treatment; we don’t even have prevention.”

She has stayed off heroin thanks to a 12-step program her family paid
for, she said, but every month she worries about whether the
government pharmacy will have all three drugs she needs, and some of
her friends have died for lack of them.

“What’s going on in Russia is being silenced,” she said. “You can’t
even knock on the Health Ministry’s door.”

Despite the quasi-Russian cast to the conference, no one from the
Russian government attended, sponsors said.

Only two governments reacted to the declaration: Canada, which
rejected it, and Georgia, whose first lady signed it in a public
ceremony. The tiny former Soviet republic has a history of brutal
treatment of drug addicts, Dr. Wood said. But it also has taken to
defying Russia, with which it fought a brief war in 2008.

In the large American delegation here, almost every top official
refused to discuss the declaration. Finally, one government official,
speaking on the condition of anonymity, said he had just called the
White House for guidance and was told no one had read it yet and
there was no time to respond.

He did note that Dr. Goosby recently announced that countries getting
American help to fight AIDS can use it to buy clean needles for
addicts, a change from Bush administration policy.

The one exception to the official American silence was Dr. Nora D.
Volkow, the normally low-profile director of the National Institute
on Drug Abuse, who said she personally agreed with the declaration’s premise.

“Addiction is a brain disease,” she said. “I’m a scientist. The
evidence unequivocally shows that criminalizing the drug abuser does
not solve the problem. I’m very much against legalization of drugs or
drug dealing. But I would not arrest a person addicted to drugs. I’d
send them to treatment, not prison.”

Asked if she feared being attacked by Congressional conservatives,
she said: “I took this job because I want drug users to be recognized
as people with a disease. If I don’t speak about it, why even bother
to gather the data?”

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