Thailand has excluded injecting drug users (IDUs) from HIV/AIDS prevention and treatment programmes, rejecting proven strategies that can cut HIV transmission and save lives, a new study says.
The report, compiled jointly by Human Rights Watch and the Thai AIDS Treatment Action Group, said the high HIV prevalence among drug users - unchanged at 50 percent for nearly two decades - "mars Thailand's reputation as a success story in the global fight against AIDS".
Many Thai officials are deeply opposed to needle and syringe exchange programmes, labelling them "immoral" and an encouragement to drug use, even though they have been shown to reduce HIV transmission among drug users, the study said.
It alleged that peer outreach workers engaged in underground needle exchange efforts - who are also often the exclusive source of HIV information for drug users - are subjected to routine police harassment, with "a direct impact on the health and lives of drug users".
As a matter of both policy and practice, many public hospitals and clinics share information on suspected drug users with law enforcement officers, the report said. This deters drug users from being upfront about their addictions, which compromises their health care and potentially exposes them to "dangerous drug-drug interactions".
Sharing needles is an extremely efficient way of transmitting HIV. The report called on the government to develop a clear national harm-reduction strategy of needle and syringe exchanges, along with methadone treatment, a synthetic opiate recommended by the World Health Organisation to help recovering drug users wean themselves off heroin.
Double jeopardy
"This is a horrible human rights story," said Rebecca Schleifer, of Human Rights Watch. "You have a group of people who, from the beginning of the [HIV] epidemic, have been the hardest hit, and nothing has changed for them."
However, Dr Patchara Siriwongrangsan, director of the health ministry's AIDS, Tuberculosis and Sexually Transmitted Diseases Office, denied that Thailand had ignored the epidemic among injecting drug users. She said HIV prevalence among drug users had dropped to 33 percent last year, down from the 50 percent cited in the report.
"I think the Thai government has done as best as they can," she commented. "We have many limitations regarding drug users - it's a hard-to-reach population."
In the capital, Bangkok, health centres have a policy of integrating methadone with life-prolonging antiretroviral (ARV) treatment; city officials told researchers they had between 600 and 700 drug users on methadone and ARV therapy at the end of 2006. Dr Patchara said health officials were looking for additional funds to scale-up programmes.
Thailand is often hailed as a model country in the battle against HIV. In the 1990s, Thai authorities' pragmatic acknowledgement of the country's large, if technically illegal, commercial sex industry paved the way for a massive condom promotion drive, credited with turning the tide of the epidemic and preventing hundreds of thousands of infections.
The government has also committed to providing ARV therapy, and has rolled out treatment to an estimated 180,000 people living with the virus - around 80 percent of those who need ARVs. It also ensures that nearly 90 percent of HIV-positive pregnant women receive therapy to help prevent mother-to-child transmission.
Criminalising dependency
However, when it comes to drug users, politicians have historically tended to treat addiction as a criminal scourge to be eradicated, rather than treated.
This drive peaked during former prime minister Thaksin Shinawatra's controversial 'war on drugs' in 2003, when an estimated 2,600 people accused of being drug users and peddlers were killed in a three-month wave of what human rights groups suspected were extrajudicial killings.
The slaughter, highly popular among Thai voters, has since stopped, but the current administration still sees drug dependency as a problem to be stamped out. "The drug war hasn't ended for many of the people we spoke to," said Schleifer. "Maybe we don't have the same kind of active shooting as you had before, but villagers get money to identify drug users."
Even today, the study found, "police regularly interfere with drug users' health-seeking efforts by harassing clients outside drug-treatment centres, and using the possession of sterile syringes, or presence at a methadone clinic, as a basis for drug charges."
Patrick Brenny, the UNAIDS country coordinator in Thailand, said international organisations, including UNAIDS, have expressed their concern about the inadequate prevention and treatment programmes for injecting drug users to the authorities, who have acknowledged these failings.
Walk the talk
Thai officials have admitted that HIV prevalence among drug users had "sustained itself at an unacceptably high level", and the country needed to "act quickly" to remedy these weaknesses by scaling up prevention and treatment services targeting drug-dependent Thais, the study noted.
But little has changed. "Official discourse is always 'yes, yes, yes, we agree,' but action doesn't necessary follow," Brenny said. "They talk the talk; now they need to walk the walk as well."
The government has sought to remove some barriers to access to medical treatment: in 2004 it rescinded a policy that permitted the exclusion of drug users from the national treatment programme.
However, the study found that especially outside Bangkok, drug users still faced "serious obstacles to obtaining needed care", including discrimination by health workers, who often deny treatment to drug users - even if they are in methadone programmes - based on the conviction that they will be 'unreliable' patients.
At the same time, health professionals complain that they lack sufficient knowledge or training on how ARV drugs would interact with either methadone or illicit drugs, the study said. Some health workers, reluctant to provide information about a patient's drug use to law enforcement authorities, operate on a 'don't ask, don't tell' policy when providing AIDS drugs to suspected drug users.
ak/oa/he
The report, compiled jointly by Human Rights Watch and the Thai AIDS Treatment Action Group, said the high HIV prevalence among drug users - unchanged at 50 percent for nearly two decades - "mars Thailand's reputation as a success story in the global fight against AIDS".
Many Thai officials are deeply opposed to needle and syringe exchange programmes, labelling them "immoral" and an encouragement to drug use, even though they have been shown to reduce HIV transmission among drug users, the study said.
It alleged that peer outreach workers engaged in underground needle exchange efforts - who are also often the exclusive source of HIV information for drug users - are subjected to routine police harassment, with "a direct impact on the health and lives of drug users".
As a matter of both policy and practice, many public hospitals and clinics share information on suspected drug users with law enforcement officers, the report said. This deters drug users from being upfront about their addictions, which compromises their health care and potentially exposes them to "dangerous drug-drug interactions".
Sharing needles is an extremely efficient way of transmitting HIV. The report called on the government to develop a clear national harm-reduction strategy of needle and syringe exchanges, along with methadone treatment, a synthetic opiate recommended by the World Health Organisation to help recovering drug users wean themselves off heroin.
Double jeopardy
"This is a horrible human rights story," said Rebecca Schleifer, of Human Rights Watch. "You have a group of people who, from the beginning of the [HIV] epidemic, have been the hardest hit, and nothing has changed for them."
 You have a group of people who, from the beginning of the [HIV] epidemic, have been the hardest hit, and nothing has changed for them Rebecca Schleifer - Human Rights Watch |
"I think the Thai government has done as best as they can," she commented. "We have many limitations regarding drug users - it's a hard-to-reach population."
In the capital, Bangkok, health centres have a policy of integrating methadone with life-prolonging antiretroviral (ARV) treatment; city officials told researchers they had between 600 and 700 drug users on methadone and ARV therapy at the end of 2006. Dr Patchara said health officials were looking for additional funds to scale-up programmes.
Thailand is often hailed as a model country in the battle against HIV. In the 1990s, Thai authorities' pragmatic acknowledgement of the country's large, if technically illegal, commercial sex industry paved the way for a massive condom promotion drive, credited with turning the tide of the epidemic and preventing hundreds of thousands of infections.
The government has also committed to providing ARV therapy, and has rolled out treatment to an estimated 180,000 people living with the virus - around 80 percent of those who need ARVs. It also ensures that nearly 90 percent of HIV-positive pregnant women receive therapy to help prevent mother-to-child transmission.
Criminalising dependency
However, when it comes to drug users, politicians have historically tended to treat addiction as a criminal scourge to be eradicated, rather than treated.
This drive peaked during former prime minister Thaksin Shinawatra's controversial 'war on drugs' in 2003, when an estimated 2,600 people accused of being drug users and peddlers were killed in a three-month wave of what human rights groups suspected were extrajudicial killings.
The slaughter, highly popular among Thai voters, has since stopped, but the current administration still sees drug dependency as a problem to be stamped out. "The drug war hasn't ended for many of the people we spoke to," said Schleifer. "Maybe we don't have the same kind of active shooting as you had before, but villagers get money to identify drug users."
Even today, the study found, "police regularly interfere with drug users' health-seeking efforts by harassing clients outside drug-treatment centres, and using the possession of sterile syringes, or presence at a methadone clinic, as a basis for drug charges."
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Walk the talk
Thai officials have admitted that HIV prevalence among drug users had "sustained itself at an unacceptably high level", and the country needed to "act quickly" to remedy these weaknesses by scaling up prevention and treatment services targeting drug-dependent Thais, the study noted.
But little has changed. "Official discourse is always 'yes, yes, yes, we agree,' but action doesn't necessary follow," Brenny said. "They talk the talk; now they need to walk the walk as well."
The government has sought to remove some barriers to access to medical treatment: in 2004 it rescinded a policy that permitted the exclusion of drug users from the national treatment programme.
However, the study found that especially outside Bangkok, drug users still faced "serious obstacles to obtaining needed care", including discrimination by health workers, who often deny treatment to drug users - even if they are in methadone programmes - based on the conviction that they will be 'unreliable' patients.
At the same time, health professionals complain that they lack sufficient knowledge or training on how ARV drugs would interact with either methadone or illicit drugs, the study said. Some health workers, reluctant to provide information about a patient's drug use to law enforcement authorities, operate on a 'don't ask, don't tell' policy when providing AIDS drugs to suspected drug users.
ak/oa/he
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