The Interconnected Epidemics of Drug Dependency and AIDS

Drug dependence and human immunodeficiency virus (HIV) are America\u27s two most pressing epidemics, interconnected by a cycle of urban poverty, physical dependence and a culture of sharing needles and syringes. Extant political strategies to curb these interconnected epidemics involve two traditional approaches. The first--law enforcement and interdiction--is designed to limit the supply of illicit drugs to the marketplace. This strategy is advanced by broad criminal sanctions against importing, selling, distributing, medically prescribing, or possessing illicit drugs or drug paraphernalia. The second strategy to combat the drug and HIV epidemics involves reducing the demand for illicit drugs. Education, counseling, and treatment (detoxification, maintenance, and rehabilitation) are all designed to reduce dependence on drugs, and are called demand-side policies. For those who cannot stop drug use, public health strategies seek to alter dangerous sharing behavior or to encourage the sterilization of works. The uniting theme of this article is that government should pursue a consistent policy on drug use that explicitly prefers therapeutic and public health goals to law enforcement goals when these two are in conflict. Such a preference for therapeutic goals is needed because of the seriousness of the HIV epidemic and because the sweep of criminal prohibitions and government regulation often renders public health measures ineffective. A preference for public health over law enforcement is justified on both conceptual and empirical grounds. The raison d\u27Jtre of the supply-side policies is to protect the health of the user and of the public. Thus the human tragedy of the drug and HIV epidemics is not simply that people are acting unlawfully or immorally, but that drug dependency is destructive to a person\u27s health and to the health of the community. The goal of supply-side policies should be to protect the health and safety of the individual and the community, not simply to punish immoral, self-gratifying behavior. Thus, the measure of effectiveness of those policies should be whether they succeed in lowering rates of drug dependency and needle-borne transmission of infection. If supply-side policies fail this test, they defeat the very objective for which they were formulated and lose their validity