Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug;4(8):e357-e374.
doi: 10.1016/S2352-3018(17)30073-5. Epub 2017 May 14.

HIV and the criminalisation of drug use among people who inject drugs: a systematic review

Kora DeBeck  1 , Tessa Cheng  2 , Julio S Montaner  3 , Chris Beyrer  4 , Richard Elliott  5 , Susan Sherman  4 , Evan Wood  3 , Stefan Baral  6
Affiliations

HIV and the criminalisation of drug use among people who inject drugs: a systematic review

Kora DeBeck et al. Lancet HIV. 2017 Aug.

Abstract

Background: Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment.

Methods: Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language.

Findings: We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects.

Interpretation: These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use.

Funding: Canadian Institutes of Health Research and US National Institutes of Health.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

JSM reports grants from the Ministry of Health of the Province of British Columbia, the US National Institute on Drug Abuse (NIDA), the US National Institutes of Health (NIH), AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, ViiV Healthcare, and the MAC AIDS Fund, outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2
Criminalisation indicators Some studies reported on multiple criminalisation indicators. OST=opioid substitution therapy. NEP=needle exchange programme. SIF=supervised injection facility.
Figure 3
Figure 3
HIV treatment and prevention indicators NEP=needle exchange programme. OST=opioid substitution therapy. ART=antiretroviral therapy. IDUs=injection drug users.
Figure 4
Figure 4
Effect of criminalisation of drug use on HIV prevention and treatment (112 indicators from 106 studies)
See this image and copyright information in PMC

Comment in

References

    1. World Drug Report 2016. New York, NY: UN Office on Drugs and Crime; 2016.
    1. The gap report. Geneva: UNAIDS; Jul 16, 2014.
    1. Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733–1745. - PubMed
    1. Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet. 2010;376:355–366. - PubMed
    1. Degenhardt L, Mathers BM, Wirtz AL, et al. What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries. Int J Drug Policy. 2014;25:53–60. - PubMed

Publication types

MeSH terms