The White House

Office of the National Drug Control Policy

“The Twin Epidemics of HIV and Drug Use: Innovative Strategies for Healthy Communities”: Director’s Remarks at the International AIDS Conference

As prepared for delivery -

Thank you Mr. Bertrand Audoin for that kind introduction.  Let me extend my appreciation to the conference sponsors—the International AIDS Society and AMFAR—for inviting me to speak at this important event preceding what will no doubt be one of the most significant International AIDS Conferences to date.

Neither this meeting nor the International AIDS Conference that follows would be taking place in Washington without President Obama’s leadership to correct policy restrictions that banned individuals with HIV to travel to the United States. I am proud to serve in an Administration that relies on science rather than dogma to inform policy.

As a former Police Chief for two major U.S. cities and presently as the Director of National Drug Control Policy, I have come to fully appreciate the complexities involved in reducing drug use and its consequences and strongly support an approach that benefits and protects public health and public safety.

The Obama Administration’s new approach to drug policy does both, and it contributes to reducing the spread of HIV and helping people access needed services.

Over the past few years, the public debate on drug policy has lurched between two extreme views.  On one side are advocates who insist drug legalization is a “silver bullet” for addressing our Nation’s drug problem. On the other are those who insist a law-enforcement-only “War on Drugs” approach is the way to create a drug-free society.  More money for prisons and enforcement and increases in arrests and seizures will solve the drug problem.

The Obama Administration strongly believes that neither of these approaches is humane, compassionate, realistic, or – most importantly – grounded in science.  Neither acknowledges the complexity of our Nation’s drug problem or reflects what science has shown us over the past 2 decades. 

That is why our National Drug Control Strategy pursues a “third way” to drug control. This is a 21st century approach to drug policy. It is progressive, innovative, and evidence-based and defines the way ahead for drug policy.

The health consequences of drug use are many.  Today, drug-induced deaths are the number one cause of injury death, more than deaths from car crashes or gunshot wounds.  Injection drug use is a well-known route of transmission of blood borne infections, particularly HIV and hepatitis B and C. In addition, use of illicit drugs is associated with increased rates of TB and STDs.

These facts underscore the need for a different approach to drug policy – one that treats drug addiction as a disease and promotes interventions through the public health system.

Despite the fact that drugs and crime are intimately linked, we know we cannot arrest our way out of the drug problem.   We are taking action to reform our public health and safety systems so we can learn to recognize the signs of drug addiction and act before a substance use disorder becomes chronic and more likely to become a criminal justice issue.  We are also looking at smart law enforcement efforts and using our criminal justice system to get people needed drug treatment.

Reforming drug policy will take time.  But we’ve made progress. Over the past 3 years:   

  • We have spent more than $30 billion to support drug prevention and treatment programs, more than we spend on U.S. Federal law enforcement.
  • Recognizing that drug use is a public health issue, the Obama Administration last year released the first-ever National Prevention Strategy, which calls for eliminating health disparities and increasing education.
  • To help lift the stigma associated with drug addiction and support the millions of Americans in recovery from substance use disorders, we created the first-ever Recovery branch at the White House Office of National Drug Control Policy.
  • To break the cycle of drug use and crime, we’ve worked to divert non-violent drug offenders into treatment instead of jail through drug courts.  There are now more than 2,600 drug courts in the US, diverting 120,000 people into treatment annually. 
  • And the Affordable Care Act will, for the first time, make drug treatment a required benefit for all Americans who suffer from substance use disorders.

This “Third Way” approach to drug policy supports the Administration’s policies on HIV prevention and treatment.

Although we have made significant progress in reducing the number of new HIV infections among injection drug users and their sexual partners, the Centers for Disease Control and Prevention estimates that injection drug users represented 9 percent of new HIV infections in 2009 and 17 percent of those living with AIDS in 2008.

One in five of the estimated 1.2 million individuals in the US who are HIV-positive are unaware of their infection, so it is imperative that we enhance efforts to make HIV screening—and linkage to care for those found to be infected—more readily available, particularly among the most affected groups.

ONDCP works closely with the White House Office of National AIDS Policy and the Department of Health and Human Services, and was involved in the development and implementation of the National AIDS Strategy, released in 2011.  Through a collaborative process, we were able to ensure compatible goals and actions in our respective national strategies.

For example, the National HIV/AIDS Strategy recommends coupling HIV screening with substance abuse treatment programs.  This is a key action step in our Nation’s overall effort to prevent the spread of HIV in communities where it is most heavily concentrated. Advances in rapid HIV testing technology allow for HIV testing to be offered in a wider variety of settings, including substance abuse treatment programs, as well as correctional settings.  

This is particularly meaningful because approximately 14 percent of all people living in the US with HIV in 2006 were released from a correctional facility that year.

In addition to disproportionate rates of HIV, inmates have a high prevalence of other infectious diseases, substance use, and mental illness.  Thus, the criminal justice system provides a unique opportunity to address HIV among those who might not otherwise receive HIV testing or treatment or HIV risk reduction counseling, which can improve not only the health of the individual but potentially the community as a whole. 

Furthermore, the vast majority of inmates will be released after incarceration back into the community. And although individuals infected with HIV may receive adequate treatment while incarcerated, they often fail to maintain treatment upon release. So it is important to focus efforts on re-entry services.

However, we fully support the interventions listed in the PEPFAR Technical Guide for countries on strategies for a comprehensive approach to HIV prevention, treatment, and care for injection drug users.  This guide focuses on three central elements: community-based outreach programs, sterile needle and syringe programs, and drug treatment, including medication-assisted treatment.

Let me take a moment and clarify our policy on needle exchange programs. In December 2009, President Obama signed the 2010 Labor, Health and Education Appropriations billinto law, ending the longstanding ban on most Federal funding for needle exchange programs. 

In the Administration’s inaugural National Drug Control Strategy in 2010, we made specific reference to the importance of informing public health systems on implementing needle exchange programs as part of a comprehensive strategy to reduce HIV transmission among injection drug users. 

Unfortunately, Congress reinstated the ban on the use of Federal funds for needle exchange programs conducted in the United States.  Despite this, we are continuing to work with Federal and local policy makers on this policy and understand that needle exchange is an important component of a comprehensive HIV prevention strategy for injection drug users.

Before I conclude, let me stress that the United States condemns human rights violations of drug users, and has raised concerns about practices that we consider human rights violations.  Our concerns are based on the absence of due process, ineffective practices, and reported levels of abuse in facilities that contribute to malnutrition, HIV, TB, and other preventable diseases.

Where countries continue to engage in human rights abuses of drug users and/or refuse to adopt effective programs, we will continue to work with them while reaching out to civil society and others to ensure access to services.  Our objective in every country in which PEPFAR works is to save lives by keeping HIV infected drug users healthy so they may live long enough to benefit from effective treatment, preventing every new infection we possibly can, and promoting an inclusive approach to service delivery that is respectful of human rights.

Respect for human rights and elimination of stigma and discrimination are key priorities for the United States. In many countries, legal, regulatory, and policy reforms are needed to ensure an environment is created that supports prevention, treatment, and care.  In other countries, the issue may be a need for greater coordination between public health and public safety officials to ensure consistent application of the law.  Finally, stigma and discrimination remain challenges everywhere and training and capacity building need to take place to combat them.

The United States is committed to supporting a balanced, public health and safety approach to reducing drug use and its consequences.  We applaud the work of the International AIDS Society and AMFAR to promote policy discussions between public health and public safety government officials and other stakeholders. 

We hope we will come out of today’s meetings and this week’s conference with a renewed understanding that debate around HIV and IDU is not a zero sum game between public health and public safety interest, but rather a critical convergence between the two. 

Thank you.