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ABSTRACT A major UN summit on the world drug problem in 2016 is an opportunity to rethink punitive drug policies that have not succeeded in stemming drug demand or supply and have undermined HIV and HCV responses in many countries. Experiences of some countries demonstrate that treating drug use and minor drug possession in the health rather than the law enforcement sector can dramatically improve access to HIV and HCV services. Alternatives to incarceration for minor drug infractions are particularly important in this regard. The voices of health professionals in national and international debates leading up to this important summit are crucial to making the case for public health-based and human rights-oriented drug policy reform.

The use of criminal law to address HIV transmission and exposure has been misguided and ineffective. Criminalization of HIV transmission and exposure raises difficult legal questions: what is the appropriate degree of mental culpability to trigger criminal prosecution? Is it appropriate for the law to equate nondisclosure of (known) HIV-positive status to a sexual partner with rape (as the law does in some jurisdictions)? Can it be justified to treat mere nondisclosure of HIV status as equivalent to the intent to cause harm? To what extent will the law recognize circumstances that mitigate harm, risk of harm and mental culpability, such as safer sex practices and low viral load, in mitigating the application of criminal sanctions? Sound guidance on avoiding the misuse of the criminal law in this area has been developed, but unfortunately many criminal laws in this area allow for prosecution even in cases where there is little justification. It is reasonable to expect that the use of these laws contributes to HIV-related stigma and discrimination, particularly when cases are portrayed sensationally in mass media. The harm caused by unjustified prosecutions and convictions and stigma is not counterbalanced by any evidence of public health benefits of this use of criminal law. These laws should urgently be repealed or reformed as part of a shift to strategies centered on human rights.