The AIDS Pandemic and The Opioid Crisis

Growing up in the 80’s and 90’s, it was impossible to not hear about AIDS once you were old enough to start learning about sex. A condition resulting from contracting the HIV virus, it was deadly, and if you had sex without a condom you were playing russian roulette. There was no cure, and for a time, no effective treatment.

Yet with such a dire prognosis, it was ignored by governments, both in the West and parts of Africa. When it was finally mentioned by then U.S president Ronald Reagan, he refused to assure the public you could not get AIDS by casual contact, against the recommendations of government experts such as the Center for Disease Control (CDC). The rift between Reagan and the CDC was so great, they hosted their own press conference to spell out the truth about HIV transmission and dispel some of the fear and panic that Reagan had created.

Nelson Mandela avoided addressing AIDS directly, and his successor, Thabo Mbeki, actively courted AIDS deniers and continually expressed his belief that HIV did not cause AIDS. What was different about AIDS? Why did it chill governments to the bone?

The answer tells much about how the AIDS pandemic and the opioid crisis we currently face became global concerns so quickly. The basic process of naming the disease showed societal bias, it was sometimes referred to as ‘gay cancer’, and often referred to as GRID (Gay Related Immune Disease). The first groups impacted by AIDS were groups that were societally ostracized and seen as ‘other than’ : gay men, injection drug users, sex workers and immigrants (in particular the Haitian community). Even in the midst a mounting crisis in new HIV infections and AIDS deaths, government officials actively impeded efforts to slow the spread down. Senator Jesse Helms famously stood on the Senate floor and expressed his outrage that AIDS educational material (not paid for with tax dollars) in his words, ‘promoted the homosexual lifestyle’. He went on to blame gay men for the spread of the disease, and was successful in passing a bill that prevented any federal funding going to educational programs that were unambiguous in their description of sexual acts, a law which persists to this day.

AIDS is still among us, and by some accounts is getting worse, especially in marginalized populations. There is also the question of equitable treatment in marginalized populations, as early detection, post-exposure prophylaxis and anti-retroviral medication are much harder to access from those without the means or insurance coverage. There is another epidemic that dominates the news cycle however, that of the opioid crisis. In North America we are seeing increasing mortality rates from overdoses of opioids, in particular a drug supply tained by fentanyl and fentanyl analogues. Not coincidentally, this epidemic is disproportionately affecting one of the same groups that AIDS did, drug users. The stigma is different, but still undeniable.

Here in Canada, Stephen Harper’s government actively fought supervised injection sites, which have been proven to reduce overdoses. After losing at the Supreme Court, they passed a bill with the usual rhetoric around ‘Respect’. Respecting taxpayer, respecting communities, the refrains of both the federal Conservatives and their provincial counterparts, such as the recently election of Doug Ford and Jason Kenney as provincial premiers. Unfortunately yet predictably, both Kenney and Ford are taking steps to reverse the progress on drug policy that has been made in Alberta and Ontario. These moves are a direct parallel to the obstacles faced by needle exchange programs during the height of the AIDS pandemic.

Needle exchanges attempt to stem the flow of bloodborne disease transmission by offering a clean needle for a used one. The same rhetoric supervised injection sites face was also directed at needle exchanges: They were promoting illegal activities, they would make drug addicts shoot up in suburban neighbourhoods, and the solution was as simple as rehab.

Let’s not forget that ‘Rehab’, is short for rehabilitation, and is an oft cited panacea of short-sighted drug policy. It is, to many, a magic doorway that once walked through ensures curing drug users. The reality, as it often is, does not match up to this simplistic and moralistic interpretation. The best tools that we possess in the West are still largely band-aid solutions that stem some of the metaphorical bleeding, and yet there is something proven to achieve more dramatic results.

Many were skeptical when Portugal decriminalized all drugs in 2001, but the results have justified the policy. Rates of drug-induced deaths plummeted by 85% after the country starting treating drug abuse as a public health issue and not one to be handled by the criminal justice system.

Here in Canada, multiple organizations and cities have called on the federal government to decriminalize all drugs, and ensure a safe supply. From the Liberals, there is reluctance to be seen to push the drug legalization agenda even further given the political risks of legal cannabis. From the Conservatives, there is moral outrage and family values rhetoric. Most striking of all, from some public health stakeholders, there are many quizzical facial expressions.

If during the height of the visibility of the AIDS crisis, a vaccine or cure was available, would any government have rejected it? Say it was ‘too radical’? Unlikely, but that is what we see from virtually every other government besides Portugal’s. Even legalizing cannabis, one of the less harmful substances we know of, provoked controversy from the rest of the world, and fanatical outrage from the Conservatives and all manner of procedural attempts to kill the legislation.

The same reasoning behind half-measures in the 80’s is also now given for not decriminalizing : the country isn’t there yet, politics isn’t ready for it, etc. And the same images of people suffering and dying necessitates that we do more than practice comfortable politics. When you’re dealing with an open wound, a band-aid can help but you should really just close the wound. We’re still waiting on governments to give up on band-aids.