HIV, drugs and the legal environment

• Laws that criminalize drug use and possession undermine access to harm reduction and health among PWID.
• Policing practices are barriers to harm reduction programs that reduce transmission of HIV and viral hepatitis.
• Public health and criminal justice professionals can work synergistically to promote safe and healthy communities.

A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs’ behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs’ risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.