International Narcotics Control Board 'out of step' with HIV/AIDS control efforts, opinion piece says

The International Narcotics Control Board "remains out of step" with the rest of the United Nations' efforts to fight the spread of HIV, especially among injection drug users, and its practices should be open for review, Joanne Csete of the Canadian HIV/AIDS Legal Network and Daniel Wolfe, deputy director of Open Society Institute's International Harm Reduction Development program, write in a Lancet opinion piece.

The control board is an independent body of 13 members who are elected by U.N. members and oversee the implementation of international drug control regulations, according to the authors. Although the board's annual reports "repeatedly note that injection drug use is driving severe HIV epidemics," the board has "failed to criticize" countries where methadone or buprenorphine are illegal or "express concern" about countries where the medications to treat drug addiction are "effectively unavailable," Csete and Wolfe write. They add that the board also has not "spoken out" against the "many instances where addiction treatment -- required under the U.N. conventions -- is incarceration by another name, including forced labor, prolonged institutionalization, and unproven and punitive procedures." The board also "does nothing to highlight" the lack of access in many countries to clean needles or the "many instances where police use needle exchanges to target" IDUs for arrest, Csete and Wolfe write. In addition, the board would "do well to highlight and promote" the countries -- such as China, Malaysia and Indonesia -- that have good HIV/AIDS practices and policies regarding IDUs, the authors add.

The board is a "relic" of a time when "criminal law and crackdowns" were enough to deal with the health challenges of illegal drug use, Csete and Wolfe write, noting that an "ideal way" for the United Nations to show that drug policies need to be amended in the "era of HIV" would be for U.N. Secretary-General Ban Ki-Moon to commission an independent evaluation of the board's work. In addition, the United Nations should make board deliberations -- which are "held in secret" -- open to member states and civil society, according to the authors. "Such measures would contribute to making 2008 a milestone of real global progress toward dealing with the health consequences of drug dependence," Csete and Wolfe conclude (Csete/Wolfe, Lancet, 5/31).