Pence, Putin, Mbeki and Their HIV/AIDS-Related Crimes Against Humanity: Call for Social Justice and Behavioral Science Advocacy.

Indiana, a large rural state in the Midwestern United States, suffered the worst North American HIV outbreak among injection drug users in years. The Indiana state government under former Governor and current US Vice President Mike Pence fueled the HIV outbreak by prohibiting needle/syringe exchange and failed to take substantive action once the outbreak was identified. This failure in public health policy parallels the HIV epidemics driven by oppressive drug laws in current day Russia and is reminiscent of the anti-science AIDS denialism of 1999-2007 South Africa. The argument that Russian President Putin and former South African President Mbeki should be held accountable for their AIDS policies as crimes against humanity can be extended to Vice President Pence. Social and behavioral scientists have a responsibility to inform the public of HIV prevention realities and to advocate for evidence-based public health policies to prevent future outbreaks of HIV infection.

Supervised injection facilities in Canada: past, present, and future.

Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada's first sanctioned SIF opened in 2003. However, while a large body of evidence highlights the successes of this SIF in reducing the health and social harms associated with injection drug use, extraordinary efforts were needed to preserve it, and continued activism by local people who inject drugs (PWID) and healthcare providers was needed to promote further innovation and address gaps in SIF service delivery. A growing acceptance of SIFs and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada. While much progress has been made in that regard, there is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation. Further innovation in SIF programming should also be encouraged through the creation of SIFs that accommodate assisted injecting, the inhalation of drugs. As well, peer-run, mobile, and hospital-based SIFs also constitute next steps needed to optimize the impact of this form of harm reduction intervention.

From West End to Eastside: The Vancouver HIV/AIDS Epidemic, 1983-2013.

Traditional histories of AIDS have used a few major American urban centres as proxies for the North American epidemic more broadly and have tended to frame the epidemic as a quintessentially gay and American experience. A careful examination of how the epidemic unfolded in Vancouver, British Columbia, however, reveals considerable differences, including the relative absence of local gay activist traditions prior to HIV/AIDS and the relative prominence of interventions such as Insite, North America's first sanctioned needle exchange program and safe injection site. An investigation of such differences emphasizes the local character of the epidemic and adds a Canadian perspective to the existing AIDS historiography.

Federal funding for needle exchange programs.

The HIV/AIDS pandemic has affected millions across the globe. The sharing of needles, for reasons of economy or social relations, has become the most common mode of HIV transmission among injection drug users. Needle exchange programs, which provide many services in addition to the exchange of clean needles for contaminated needles, have proven effective in reducing HIV rates among injection drug users in their communities. Although these programs have proven to be one of the most effective strategies in the efforts to reduce HIV rates, there has been a federal ban on the use of federal money for needle exchange programs since 1989. This ban was introduced by Congress in accordance with the drug war ideology, a narrow and elusive plan to completely eradicate drug use in the United States. Although there are a significant number of government reports supporting needle exchange programs, including support from the CDC, American Medical Association, the National Institutes of Health, it appears as If public health and the lives of others have become a secondary concern to strong federal policy on eradicating drug use. Lifting the federal ban would save the country millions of lives and billions of dollars in healthcare costs. Needle exchange programs should be an integral part of HIV prevention strategy, and are ethically imperative as well, restoring human dignity to the clients that so often need it.

Harm reduction and HIV-prevention among injecting drug users in Australia: an international comparison.

In response to the threat of HIV transmission via drug injection with shared needles, Australia developed a needle and syringe exchange program that became one of the most comprehensive in the world. Originally health professionals and pharmacists were given the responsibility of implementing the program. However, community-based AIDS organizations were soon also funded to distribute sterile injecting equipment, alcohol swabs, puncture-proof disposable containers, condoms, and safe sex information. Nearly all of the programs operated on a no-need-for-exchange basis, during hours and from outlets (both fixed and mobile) that were convenient for users. Their success in preventing the widespread transmission of HIV among injecting drug users was demonstrated in international studies that found a large discrepancy between the rates of HIV infection in cities with, and without, needle and syringe exchange programs, and was reflected in the continued low level of HIV infection among injecting drug users in Australia. Australia's success in preventing HIV transmission among drug users suggests the merits of the "harm reduction" approach to controlling drug use as well as funding community-based needle and syringe exchange programs.

Australia's response to HIV among people who inject drugs.

Australia's prompt and effective response to HIV among people who inject drugs is recognized internationally. In the early 1980s, there was growing awareness of the evolving threat presented by HIV. Despite erroneous but commonly held assumptions that people who inject drugs generally disregard their health, injecting drug users contributed significantly to Australia's response to HIV. They formed peer-based organizations which advocated for: engaging affected communities in policy development and implementation; funding for peer education; and access to sterile injecting equipment. While government fear of appearing to condone injecting illicit drugs delayed the bi-partisan political support needed to implement programs to provide readily accessible sterile injecting equipment, needles and syringe programs were established relatively quickly. Strong evidence supports the effectiveness, safety, and cost-effectiveness of Australia's early, decisive, and pragmatic public health and human rights-based approach. Without a comprehensive package of harm reduction and peer-based responses, HIV epidemics can develop rapidly among and from people who inject drugs.