The Evolution of Spanish HIV Prevention Policy Targeted at Opiate Users: a review

Abstract

Spain is the European country with the highest cumulative AIDS caseload and presently has an estimated population of at least 120,000 persons living with HIV. Most Spanish HIV and AIDS cases are due to needle sharing in the context of intravenous drug use. This article traces the development of targeted HIV prevention policy in the field of drug use, exploring the reasons for the time-lag in making harm reduction among drug users a policy priority. Reports about dramatically high HIV prevalence rates among Spanish drug users had already emerged by 1986-1987. However, the Spanish government began to devise large-scale harm reduction programmes for drug users only in the years 1992-1994. This new development has led to the establishment of Europe's largest methadone maintenance programme. In the meantime, though, the central government (as opposed to health authorities in some of Spain's regions) continued to treat public health concerns as secondary to a drug policy focused on the goal of abstinence. The article argues that both (a) the rapid diffusion of HIV among drug users in the late 1970s and early 1980s and (b) the time-lag in elaborating an adequate policy reaction to the emerging AIDS crisis were related to the country's transition from an authoritarian regime to democratic government. Rather than in terms of direct continuity, it is argued, authoritarianism left its mark on HIV epidemiology and policy in terms of the fast social change triggered by its demise.