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Drug Use and HIV in Asia

The Fifth International Congress on AIDS in Asia and the Pacific, Session TCD03
Tuesday, 26 October, 1999

Despite the fact that drug use is driving the HIV/AIDS epidemic in many Asian countries, it was still poorly addressed in the last national HIV/AIDS plan of a few affected Asian countries, delegates heard today at the session entitled "Mapping The Beat: Drug Use And HIV In Asia."

India, Malaysia, Myanmar and Nepal only gave "inadequate" attention to the drug use issue in their AIDS plans, said Christian Kroll, a consultant with UNAIDS and the WHO who gave a presentation on his study entitled "Policies Related To Drug Use and HIV/AIDS In Asia."

Moreover, HIV/AIDS was not addressed in the national drug plan of affected countries, such as China, Malaysia, Myanmar and Nepal. Indeed, only Vietnam addressed the issue in its national drug plan.

Drug use lies behind the bulk of the HIV/AIDS epidemics in China, Malaysia and Vietnam, accounting for a respective 69 per cent, 77 per cent and 66 per cent of infections in these countries, estimates indicate. These same countries, as well as Myanmar, have treatment which is abstinence-oriented, said Kroll.

While it is not unlawful to carry syringes and needles in nearly all countries, the police still arrest people for the possession of injecting equipment in India, Malaysia, Myanmar and Nepal, Kroll said. Only one affected country - Vietnam - has a needle and syringe exchange available, (although India and Nepal have limited programmes).

In a country that promises a mandatory death penalty for drug importation and trafficking, it is no surprise that harm reduction for current drug users is a rather political topic. In this session, Palani Narayanan of Malaysia gave a presentation entitled "Moving Harm Reduction Forward."

Although there is plenty of evidence as to the effectiveness of needle exchange from around the world, an understanding of this remains to be reflected in national [Malaysian] policy. While projects such as IKHLAS provide some peer support services in Kuala Lumpur, the 5,000 injecting drug users reached are only a fraction of the estimated 400,000 users in the country, and with minimal funding and other resources, programs are often not sustainable.

Calling for policies that are based on research, not perceptions, Narayanan said that struggling harm reduction programs are in need of training assistance in a number of areas including public speaking, working with the media and influencing policy, religion and culture.

Several delegates at the 5th ICAAP were very critical of government-run rehabilitation centres in Malaysia where drug users receive mandatory two-year sentences, but the issue of human rights abuses in relation to the treatment of those being held inside was not one that made it onto the official conference program.

Policy-makers are also currently against substitution therapy in all countries except Thailand and Vietnam, although some, such as India and Nepal, are considering it.

Kroll said a 1961 convention on narcotics, which calls for drugs only to be used for certain purposes such as medical reasons, still influenced many countries.

Other presentations heard at the session were also very interesting. In the light of recent discussions between UNAIDS and UNDCP (United Nations Drug Control Programme), the presentation from UNDCP's Wayne Bezant drew special attention. Bezant admitted that enforcement agencies need to have policies that acknowledge "special needs" and should provide alternatives to conviction and imprisonment.

He also said national drug control policies should address HIV/AIDS and the range of programmes available for drug users should be improved.

S.S. Lee discussed methadone treatment, particularly in Hong Kong. He said the island's extensive number of methadone clinics had helped it maintain a low HIV infection rate. He called for more studies on methadone to be done in Asian countries.

Narayanan gave an impassioned speech on the treatment of drug users in the region. He said that there was a need for research, as policies were currently perception-based.

He also suggested that one way to move the harm reduction agenda forward would be to include drug user issues in a number of related areas, such as within PLWHA organisations, and on human rights and religious agendas, both nationally and around the region.

Youth acts up with HIV/AIDS

It was encouraging to see many young faces showing up in the different ICAAP sessions.

In the plenary session, Rody Lalmingmawii, a young women from Manipur, India, recounted her story of being infected with HIV in early 1990 through sharing infected needles. Her touching story raised the question: What can we do for the next generation?

Responses came from several sessions today, especially the sessions closely related to youth, for example, "Community Response, Development and Impact" and "Sexuality Education". Though sex is still a taboo in most Asian communities and conducting sex education is always a tough job, the presentations in the Sexuality Education session exhibited a number of innovative and promising actions in different countries such as China, Nepal, India, Indonesia and Vietnam. These included school-based education, as well as educational activities in a youth Coffee Shop in Vietnam presented by Vinh Dang'thi Nhat. Run for 4 years, this coffee shop has 36,000 visitors each year, the majority of whom are students at high school or college. Although they did not report the results of the evaluation (the results will be released soon), their innovative activities are impressive.

The Chinese are always seen as the most conservative. Dr. Gao's report on "AIDS/STD/Safer sex peer education for youth in Beijing and Shanghai: an effective approach" aroused a lot of interest among the participants.

The most impressive thing in this session was that so many people were interested in the topic of youth. The venue was more than fully occupied. Many sat on the floor of the aisles. Quite a lot of the participants are young people from communities. When the forum opened to discussion, more young people came up with questions and discussion. They raise some questions from a unique perspective. For instance, a young guy from Malaysia simply observed that religious leaders and teachers do not want to tell the truth or impart information when they are asked about sex how we can do? he asked.

Youth's involvement brings a fresh air and energy to the conference. When we move to the next millennium, when we have to do some thing for next generation, we have to work with youth. They are our hope.