HEALTH-THAILAND: Injecting Drug Users Still Ignored in AIDS Fight

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

CHIANG MAI, Thailand, Mar 11 2005 (IPS) - For over a week, a Thai language newspaper published in this city has been running an advertisement that spells hope for the men and women hooked on heroin.

The man behind the advertisement is Nantapol Chuenchooklin, or ”North” to his friends. The 27-year-old former heroin user is part of a pioneering effort to help save injecting drug users (IDUs) in this northern Thai city from becoming the next victims of the killer disease AIDS.

The advertisement seeks staff to man a new centre due to open its doors in May. The centre aims to counsel and offer harm reduction alternatives to the hundreds of IDUs in this area. It will be the first of four due to be set up across the country by the Thai Drug-Users’ Network (TDN), an independent group that lobbies for the rights of this South-east Asian country’s drug users.

”IDUs in Chiang Mai are very much at risk of getting infected with HIV and need help,” Nantapol said on a recent afternoon in his home, which is in the same middle-class neighbourhood where the planned harm reduction centre will appear. ”The centre will not try to change people’s habits. But it will offer information that drug-users need for their safety.”

Nantapol, who enjoys soft drugs such as marijuana, is confident that the new centre will achieve the target it has in mind: to help at least 1,000 IDUs annually. ”There are a lot of heroin users here and those I know have received the idea of the centre very well.”

The TDN’s pioneering efforts come at a time when most public health and HIV/AIDS activists admit that Thailand’s success at controlling the spread of the killer disease will be stalled in its tracks if the vulnerability of IDUs to HIV is ignored.

Reports about AIDS in Thailand bears this out. Between 1989 and 2002, IDUs have accounted for between 40 to 50 percent of the Thais infected with HIV annually, states one study released by the United Nations Development Programme (UNDP).

This infection rate stems from the IDUs, 90 percent of whom are male, not using clean needles. ”Unsafe injecting drug use is one of the most efficient modes of HIV transmission,” adds the report. ”Because many injecting drug users are also sexually active, high levels of HIV infection among them do not stay confined to this group.”

The vulnerability of IDUs is stark when compared with the HIV prevalence rates among other groups that have been affected by AIDS, such as commercial sex workers, clients of the sex workers and the partners of the sex workers’ clients.

”The numbers have come down or stabilised among all the groups with the exception of IDUs,” Swarup Sarkar, an adviser at the South-east Asia and Pacific division of the Joint United Nations Programme on HIV/AIDS (UNAIDS), told IPS.

Currently, there are 604,000 people living with HIV/AIDS in Thailand, where the annual infection rate hovers around 19,000. Nearly one million people have been infected with HIV, the virus that results in AIDS, since it was first detected here in the early 1980s.

And during the past two decades, 460,000 people have died of AIDS in this country, with the annual death toll in the past two years estimated to be above 50,000.

Thailand’s success at containing the AIDS pandemic has been attributed to a vigorous public health campaign advocating ”100 percent condom use” among sex workers and also a refreshing openness in discussing sex and sexually transmitted diseases across a broad spectrum of society.

Yet the country has ignored IDUs at its own peril. ”Even if Thailand eradicated HIV transmission among all its other groups, excluding IDUs, there would still be up to 20,000 new infections every year due to IDU-related causes,” Karyn Kaplan, international advocacy coordinator for the Thai AIDS Treatment Action Group, a grassroots organisation, told IPS.

So an announcement made by Thai Prime Minister Thaksin Shinawatra during the International AIDS Conference, held last July in Bangkok, was seen as major concession by the government towards the previously marginalised IDUs.

Thaksin not only promised to end discrimination against IDUs but also declared his government’s commitment to implement harm-reduction programmes for them.

Members of the TDN like Nantapol welcomed this shift in policy towards drug users, since it came on the heels of a harsh campaign the Thaksin administration had launched the previous year to eradicate the country of narcotic drugs. During the 2003 ‘war on drugs,’ over 2,400 people were murdered, many of them victims of extra-judicial killings.

”His announcement was remarkable. We found his words hard to believe,” said Nantapol. ”But we felt he needed to be given a chance to prove himself.”

But has the Thaksin administration lived up to its pledge to IDUs eight months later?

The reviews are mixed, with officials at UNAIDS sounding more hopeful than Thai drug users fighting to secure effective harm reduction initiatives. ”The government’s harm reduction working group, which includes U.N. agencies, is planning to launch an outreach programme for IDUs by April or May,” Patrick Brenny, UNAIDS country coordinator for Thailand, said in an interview.

Yet at the same time there are disagreements over what the term ”harm reduction” means, he admits. ”The government sees it as treatment to get people off drugs, but the TDN wants to give out clean needles.”

But for Paisan Suwannawong, the promises held out by the government appointed group Brenny referred to – the National Working Group on Harm Reduction – offer little hope to Thai IDUs. ”It seems to have been set up merely as window dressing before the AIDS conference in Bangkok,” Paisan, a founding member of TDN, told IPS.

”There are many other ways that the government is sending a clear message in contradiction to the one presented at the AIDS conference,” he added. ”For example, universal health care, known here as the ’30-baht (75 U.S. cents) scheme,’ does not cover drug treatment.”

Consequently, grassroots groups such as TDN have been left with little choice but to give shape to a life-saving initiative, such as the harm reduction centre to be opened in May. ”We cannot just sit around and wait for the government to act,” says Nantapol. ”It will not be fair for drug-users in the country because of AIDS.”