Dying From a Slow Learning Curve: Drug Use and HIV/AIDS in Miami

This piece first appeared on the Drug Policy Alliance Blog.

Coming of age in Miami in the 1980s and 90s, the HIV/AIDS epidemic felt omnipresent, as everyone's life was touched by it in one way or another.  When one of my childhood friends died of AIDS-related complications in 2009, I felt I could at least take some solace in the notion that this disease was largely a product of that bygone era.

How wrong I was.  There’s a new explosion of HIV – all over the country, but particularly in the South – and it’s shaking me and many others from such illusions.  Miami-Dade and neighboring Broward County are now #1 and #2 in the country for new HIV cases. 

This has largely been driven by an increase in heroin use following "crackdowns" on prescription opioids in recent years, as people struggling with addiction switched to heroin, which is cheaper and often more accessible than prescription pills. 

The frustrating thing about this new epidemic is that we've known for decades that there are practical, common-sense solutions to preventing HIV among people who use drugs. But we've let our fears and misconceptions about drug use and addiction stand in the way.  

Throughout the world, research has consistently shown that repressive drug law enforcement practices force people who use drugs away from public health services and into the hidden margins where HIV risks are significantly elevated.  Mass incarceration also plays a major role in spreading the epidemic, as inhumane conditions and lack of HIV prevention or treatment in prison lead to HIV outbreaks and AIDS cases behind bars – and among families and communities once those imprisoned are released. 

Health interventions like sterile syringe access programs have a proven track record of effectiveness and cost-efficiency in reducing new HIV cases. They also link people to health care and connect people to addiction treatment, which in turn reduces overall drug use. 

A new study published earlier this month in the journal AIDS and Behavior found that in the first two years after Washington, D.C. enacted a syringe access program, new HIV cases related to injection drug use fell by 72% – averting 120 new infections and saving people $45.6 million, much of which would have been absorbed by publicly-funded programs.

According to the CDC, injection drug use has historically accounted for more than one-third (36 percent) of AIDS cases in the U.S.  Yet Congress still bans federal funding for sterile syringe access programs. 

This refusal to adopt an evidence-based prevention strategy has cost us hundreds of thousands of lives, not to mention billions of taxpayer dollars.  Ethan Nadelmann of the Drug Policy Alliance has long called this “the costs of a slow learning curve.”

Some U.S. cities and states have passed reforms to allow syringe access, as Kentucky and Indiana recently did, yet much of the U.S. remains stuck in the Dark Ages.  

Florida is one of these places. That's why medical professionals like Dr. Hansel Tookes, a resident at Jackson Memorial Hospital in Miami, have been working with Broward Rep. Katie Edwards to pass the Infectious Disease Elimination Act.  The law would authorize the University of Miami and its affiliates to establish a pilot syringe exchange program and it would remove criminal penalties for people who pass out sterile syringes.

Rep. Edwards has just introduced this bill for a second time. In the last legislative session, it died in committee. But Edwards is not giving up.

And she shouldn't give up, because there's good reason for hope.  In places where addiction is treated as a health issue, the fight against HIV/AIDS is being won.  Countries like Germany, England, Portugal, Australia, Switzerland, and even Brazil have significantly reduced and in some cases nearly eliminated new cases of HIV among people who use drugs. 

We have the ability to end this epidemic, but not until we end the war on drugs and the mentality that gave rise to it.  This notion may make some of us uncomfortable, but we need to embrace it as soon as possible.

The costs of a slow learning curve are simply too great.