By reallocating budget savings from reduced spending on prosecuting drug users to expanding treatment programmes for people living with HIV and harm reduction services in the EECA region, the HIV epidemic can be defeated by 2040. This goal can be achieved without additional funding, according to the authors of the study from The Economist.
In March 2021, the results of the first EECA region-wide study on the economic, social and community impact of drug policy, conducted by The Ecomonist and commissioned by the Public Health Alliance, were presented.
The EECA region is the only region in the world where new HIV cases (+51%) and mortality rates (+29%) have been steadily increasing since 2010. 56% of new HIV cases in the region are people who inject drugs. Despite these figures, this is not a crisis situation for the governments of the region. The global goal of overcoming HIV by 2020, set by UNAIDS, was not reached by any country in 2019.
According to Andrei Klepikov, executive director of the Public Health Alliance, criminalisation of drug users is the main barrier to development in the region. Also critical is the extremely low coverage of harm reduction services.
The full text of the study in English is available here.
Dr Chrissy Bishop, from The Economist’s research department, explained that the aim of the project was to understand the barriers that prevent HIV incidence from declining in the region, as well as to assess the cost of scaling up ART (antiretroviral therapy for people living with HIV) and OST (opioid substitution therapy for people who inject drugs) services and harm reduction programmes, and to analyse law enforcement practices in the region and their impact on the effectiveness of drug policy.
The study used a modelling approach for four countries in the region, Kazakhstan, Kyrgyzstan, Belarus and Russia, based on open-source data. The researchers assessed the potential benefits to public health and the economy of the four countries from saving money currently spent on criminalisation and prison costs, as well as from investing additional resources in ART and OST programmes.
The results of the study suggested the following three scenarios for modelling the countries’ development up to 2040:
Scenario 0 – Status quo.
Under this scenario, current repressive policies will not change and the level of spending on ART and OST programmes will not change until 2040. Thus, 74-97 per cent of all spending is prison spending rather than funding for social interventions. Each year, states spend between €534 and €2555 on prosecuting one drug user, and people who use drugs will spend between 15% and 36% of their drug use experience behind bars. At the same time, HIV incidence rates in each country will continue to rise steadily.
Scenario 1 – Decriminalisation.
This scenario involves reforming national legislation and removing criminal sanctions for drug use and possession of illicit substances for personal use. These changes alone would reduce the prison population by 25-46% and thus significantly reduce the costs of criminalisation and prisons.
Over 20 years of decriminalisation policy Kyrgyzstan will save 38 million euros, Belarus – 431 million, Kazakhstan – 773 million, and Russia – a record 11 billion euros!
Scenario 2 – Public health programmes.
The savings from decriminalisation, under the second scenario, could be reinvested in expanding ART and OST programmes in the four countries to the coverage levels recommended by the OIE and UNAIDS protocols – 81% coverage for ART and 40% for opioid substitution therapy programmes. The study found that the costs of expanding such programmes in Russia are still lower than the costs of prosecution in the null scenario.
The researchers also analysed the impact of expanding harm reduction and ART programmes on the labour market and estimated the potential productivity gains from the fact that the living standards of people living with HIV would improve and they would be able to work and pay taxes. This amount is an additional cost saving in the second scenario.
Since OST is banned in Russia, the study authors analysed the cost of expanding needle and syringe exchange programmes to reach 60% of all PWID (out of a total of 1.8 million people). This level of coverage would cost the Russian government €46.5 million per year.
Conclusions
The study showed that investing decriminalisation savings in scaling up ART and harm reduction programmes will help the EECA region to effectively control the HIV epidemic and achieve the global targets without additional funding!
As stated by Chrissy Bishop, governments are reluctant rather than unable to implement drug policy reform, as the main issue is reallocating funds rather than finding new ones. The study has shown that it is possible to achieve effective results without incurring additional costs.
The next step is to promote the results of the study at the level of government officials in the region and use these findings to change the structure of public health funding and reform repressive anti-drug legislation.
Aleksander Kwasniewski, a member of the Global Commission on Drug Policy, said: “Our society pays a high price because of drug prohibition. In 2021, we realise that the paradigm of prohibition and the very tools of the fight against drugs are outdated, although politicians in the EECA region still place all the blame on users alone. The study confirmed that criminalisation undermines efforts aimed at economic development in the region. While the costs of repression are rising, the problems with drug trafficking are also only increasing.”
According to Michel Kazatchkine, there is great doubt that the situation can change dramatically in the near future at the level of national governments in the EECA region. “However, the process of decriminalisation can start even before laws are passed – at the local level. At the level of cities or neighbourhoods. It is already working.”
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