Intravenous Drug Use ‘Fueling’ HIV Epidemic in Southeast Asia, Report Says
The rising rate of intravenous drug use in Southeast Asia is "fuel[ing] an explosion in the region's HIV/AIDS epidemic," according to a new World Bank report released Friday. Chris Beyrer, director of the AIDS Training Program at Johns Hopkins University and a contributor to the World Bank's report on Thailand's HIV/AIDS crisis, said that even though intravenous drug use is up in all Southeast Asian countries except Cambodia, the problem "has not been recognized" in many of the nations. The rise has been attributed to "cheap heroin supplies, deepening poverty and social despair ... as well as a lack of effective law enforcement." In Bangkok, IV drug users now account for 40% of new infections as opposed to 2% in 1990. And in south Thailand, more than half of IV drug users are HIV-positive (World Bank release, 11/3). The study, titled "Thailand's Response to AIDS: Building on Success, Confronting the Future," is the fifth part of the Thailand Social Monitor series. The report commends Thailand for having "one of the most successful approaches to HIV/AIDS" and for its success "in slowing the spread of HIV, particularly among commercial sex workers and their clients through the 100% condom-use program." The authors, however, state that Thailand must adapt to the changing nature of the epidemic -- the rate of transmission through commercial sex has declined while infection rates among IV drug users and children are increasing. To address these changes, the report poses three main recommendations to Thailand's government:
- The country's condom distribution program should be targeted to broader segments of society, including high-risk groups such as "indirect sex workers, ... men who have sex with men, prisoners, male sex workers," fishermen and youth. The report also laments the recent budget cuts the government has made to Thailand's national AIDS program.
- The government should make the "same effort" to prevent infections through IV drug use that it gave to preventing transmission through commercial sex. It also should work to prevent the spread of HIV in prisons and "improve the legal environment for behavior change among IV users," Beyrer said.
- Finally, the government should "ensur[e] access for people with HIV/AIDS to cost-effective prevention and treatment of opportunistic infections." The most important disease to prevent is tuberculosis, the report notes (Development News, "Confronting AIDS in Thailand," 11/3).