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HEALTH-ASIA: Taiwan Blazes a Trail to Help Drug Users with HIV
By Marwaan Macan-Markar
BANGKOK, Apr 25 (IPS) - Taiwan is emerging as a beacon of hope for countries across Asia grappling to
stop the spread of the AIDS epidemic among injecting drug users (IDUs), a
major risk group.
The Asian island came in for praise at an international conference here for a
successful public health initiative that saw an over 50 percent plunge in the
number of new HIV cases among IDUs over a three year period.
In 2005, Taiwan recorded its highest number of new reported cases of people
infected with the killer virus - over 3,300 - nearly twice the number recorded
the previous year. But, by the end of 2008, the new HIV cases had dropped to
1,752 cases.
The secret to the country’s success was a humane approach to help IDUs
through a nation-wide harm reduction campaign, Sheng Mou Hu, the health
minister at the time, told participants at the international Harm Reduction
conference, held in the Thai capital this week.
"Time proved we were right," he said. "Our approach was that harm reduction
should be based on human rights."
Consequently, the Taiwanese IDUs were not viewed as criminals for their drug
habit - they were presented to the public as "patients" in need of help. The
public health initiative launched in 2006 ranged from greater screening and
monitoring of drug users living with HIV, a needle exchange programme, and
a drug replacement therapy with methadone.
Yet, the initiative sparked a strong public outcry, according the former health
minister. "We had a lot of resistance from the media and parliament," he said.
"No other country in Asia can match Taiwan’s achievement in launching and
sustaining this harm reduction programme," said Ton Smits, executive
director of the Asian Harm Reduction Network (AHRN). "In most countries
across the region, drug control policies are in direct conflict with HIV-related
policy, undermining harm reduction programmes in the region."
"In southeast Asia, only three percent of people who inject drugs have access
to harm reduction services," added the head of AHRN, which is based in the
northern Thai city of Chiang Mai. Furthermore, "harm reduction funding in
Asia is facing a financial crisis. There is a 90 percent resource gap to be met
for 2009."
Encouraging signs have emerged in four Asian countries - China, Malaysia,
Thailand and Vietnam - which are heading in the same direction that Taiwan
has since 2006. They have taken tentative steps to help IDUs through a public
health approach, marking a break from the long tradition of dealing with
IDUs through strict law enforcement measures.
But, the region has a long way to go, given that IDUs are ranked as one of the
major vulnerable communities through which HIV is transmitted. "It is
estimated that in China in 2006, slightly fewer than half the people living
with HIV are to have been infected through use of contaminated injecting
equipment," states a 2008 report by the Joint United Nations Programme on
HIV/AIDS (UNAIDS). "Similar scenarios are estimated to be occurring in parts
of India, Pakistan and Vietnam."
Asia currently is home to over five million people living with HIV, out of the
global total of 33 million HIV cases.
IDUs number close to 16 million people across 158 countries, according to
information released by the International Harm Reduction Association (IHRA),
the hosts of the Bangkok conference. "The overwhelming majority [80
percent] live in low- and middle-income countries."
"The prevalence of HIV among injecting drug users varies considerably
around the world," added a conference background note. "It is estimated that
there may be three million injecting drug users who are HIV positive." Some
estimates put the number of IDUs at over 6.6 million.
Yet, resources to help this vulnerable community are limited, adding to the
burden IDUs face. "Only 2-3 percent [200-300 million U.S. dollars] of all the
available resources for AIDS is spent on harm reduction," says Gerry Stimson,
executive director of IHRA. "If we are serious about reducing HIV infection
amongst injecting drug users then we are going to need between two billion
U.S. dollars and three billion U.S. dollars this year and the next."
"Many of us who are drug users and activists are demanding treatment," says
Paisan Suwannawong, co-founder of Thai AIDS Treatment Action Group.
"Drug users are punished. Treatment should start by looking at us as human
beings."
Failure to help IDUs living with HIV condemns them to an earlier death than
those people living with HIV who are not drug users.
"For someone who is in their 20s with HIV in the developed world, access to
antiretroviral drugs ensures they can have 40 more years," says Michael
Kazatchkine, executive director of the Global Fund to Fight AIDS,
Tuberculosis and Malaria. "But IDUs live 12 years less," said the head of the
fund that finances health programmes through governments and non-
government organisations to combat the three killer diseases in the
developing world.
(END/2009)
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