ABSTRACT: Quoting a report of the British Government's Advisory Council on the Misuse of Drugs, the author warns on the negative consequences that a punitive law for drug consumers could have on the diffusion of AIDS.

(Il Manifesto, 21 February 1989)

The British Government's Advisory Council on the Misuse of Drugs published a report in March 1988 on the topic "AIDS and drugs".

The Report confirmed the fact that intravenous drug users who share needles are a group exposed to a very high risk for the diffusion of the HIV virus, and that they represent a vehicle for the transmission of the infection to heterosexuals. This mechanism of contagion is a cause of extreme concern for public health:

"...We have no hesitation in concluding that the diffusion of the HIV virus represents a greater danger for individual and public health than drug abuse. As a consequence, priority should be given to the services that use all available means to curb the behaviours that determine HIV infection risks [...]. In particular, we must acknowledge the fact that many "drug misusers" are not sufficiently motivated to practice abstinence, and that many intravenous drug users are not motivated to change the administration means. This is why we must be prepared to work on those who continue to abuse of drugs, in order to help them reduce the risks of their behaviour, especially the risk of contracting the disease or of spreading the HIV virus".

This statement confirms what had been stated by the "Advisory Group on AIDS and drugs" of the World Health Organization in October 1986:

"In each country, maximum priority must be given to the prevention of HIV contagion among drug misusers (...). The policies aimed at the reduction of the use of drugs cannot jeopardize the measures to be taken against these risks".

The Report stresses the problem between institutions and intravenous drugs users:

"A change in the public and professional behaviours toward drug abuse is necessary; attitudes and policies which induce the drug misusers to remain hidden will jeopardize the effectiveness of the measures to check the diffusion of the HIV virus. [...] The services must establish a contact with as many subjects as possible of the hidden population of drug misusers".

The fundamental goal must be that of "reducing the damage", while respecting a "hierarchy of goals" which, according to the individual, may be abstinence, the reduction of the use of drugs, the passage from intravenous use to oral use, and finally the relinquishement of needle sharing. In this vision, the Report recommends the prescription of methadone in the long term as an intermediate goal, but also, in more serious cases, the prescription of opiates or amphetamines to inject intravenously.

The Report then tackles the problem of prisons. In spite of the fact that the use of drugs in prisons is marginal, there is an increased risk represented by the use of shared needles; there is also a considerable diffusion of homosexual practices. For this reason, the Report recommends to reduce to minimum the number of drug misusers to be sent to prison (cit. Russel Newcombe: "Drugs AIDS: Radical Proposals Shelved" on "Mersey Drugs Journal Volume 1 n.6, March-April 1988, Liverpool).

The Report reaches the following conclusions:

"...It is fundamental for drug misusers who will not be convinced to stop using drugs intravenously to have access to sterile needles and syringes. The Report (...) believes that a combination of needle exchange programmes and of needle sale in pharmacies is the best solution".

"The most effective way to educate the drug misusers to change their behaviour in order to drastically reduce the risks, consists first of all in establishing a contact with a sanitary structure. At present, only a small minority of drug misusers are in contact with these services. The Report discusses the manner in which the subjects can be brought in contact with the service"

(ACMD Report, Overview pp.1-3).

At a moment in which the discussion of the Vassalli-Jervolino law is about to land in Parliament, we believe it useful to point out the document published by one of the top British sanitary institutions. It focuses on a problem which has been until present completely ignored in the debate on the law on drugs: the problem of AIDS, which is connected, in Italy (even more than in Great Britain) to the condition of drug addiction.

Obviously, the contents of the Report of the ACDM raise alarming questions with respect to a law which on the one hand tends to discourage any relation between drug addicts and sanitary structures, and on the other hand envisages a massive flow of drug addicts into prisons.