Drugs and HIV in Southeast Asia Regional Analysis of HIV/AIDS Infection among Injecting Drug Users and of National Programme Responses in Cambodia, China, Lao PDR, Myanmar, Thailand and Viet Nam. Prepared by Sonia Bezziccheri and Wayne Bazant For the 2nd meeting of the China Multisectional Task Force on Drug Abuse and HIV/AIDS Beijing, February 2004 Regional Project for Reducing HIV Vulnerability from Drug Abuse (AD/RAS/02/G22)

Contents IDU Regional Prevalence Programme Responses Policy Issues Barriers to Programme Responses and Consequences Everywhere – Criminals or Patients? Drug Treatment Issues Positive Regional Breakthroughs United Nations International Policy Support Recommendations from Regional Review

Intervention v. Prevention Needs Regional Prevalence HIV/AIDS among Injecting Drug Users: Highest Rates Reported (2003): China: 85% - 3 to 3.5 Mill IDUs Myanmar: 96% - 150 to 250,000 IDUs Thailand: 54% - 100 to 250,000 IDUs Viet Nam: 89% - 70,000 IDUs In Lao PDR and Cambodia, IDUs are not believed to be numerous but studies have to still be carried out to confirm this perception.

Programmes Responses Harm Reduction Services in Place Drug Substitution Therapies: present only in China and Thailand. Methadone for detoxification is only present in Thailand, Lao PDR and China (pilot level). Methadone for maintenance only in China and Thailand NSEPs: present in China, Viet Nam and Thailand. IDU Peer led approaches: present in China, Viet Nam and Thailand. Although no policy barrier for these programmes has been identified, considerable reluctance at the political level hampers leadership and infringes on implementation.

Policy Issues In all countries reviewed, except Thailand, injecting drug use is addressed in the latest national HIV/AIDS strategy. However, HIV/AIDS is addressed in the last national drug master plan only by Viet Nam, Cambodia and Lao PDR.

Barriers to Programme Responses Implementation Lack of political will, direct leadership and responsibility in advancing an IDU/HIV strategic integrated national plan of action; Skepticism, prejudices and preference for zero-tolerance criminal justice approaches; When present, programmes are only available at pilot levels; scaling up present challenges. Lack of national priority with regard to the urgency given by national prevalence.

Relevance and priority of project participant interest in comprehensive services for the reduction of drug related harm Number of Delegations Based upon opinion of national experts at G22 inception meeting

Consequences of Barriers to Programme Responses 1. Slow delivery of prevention and intervention strategies; 2. Continuation of inappropriate populations’ coverage: Presently at best, programmes covers 5% of drug users; but to reverse the HIV/AIDS epidemic, 60% of injecting drug users need to change their behaviour; hence, programmes should aim at reaching about 80% of them. 3. Increase in new HIV infection and AIDS related deaths: In 2003, over 1 million people became HIV positive in Asia and the Pacific bringing to 7.4 million the number of people living with HIV/AIDS; 500,000 have died of the disease in 2003 alone.

Consequences of Barriers to Programme Responses – cont’ Low level of dialogue, cooperation and coordination between drug control and public health agencies

Everywhere Criminals or Patients? Research has shown that in order to curb the HIV/AIDS epidemic, drug users need to be seen as patients. Wherever drug users are placed – prisons, compulsory drug treatment centres, communities, ect. – they have the right to access health care facilities specific to drug dependence. In confined settings – where drugs are available but injecting equipment is not – syringe sharing and HIV/AIDS infection spread are very high. UNODC, WHO and UNAIDS are aligned in advocating for access to services that reduce the harm from drug use also in confined settings for drug users.

Drug Treatment, Outreach and Relapse Prevention Relapse rates (from first recognized) Rx nears 100% in Southeast Asia; Overall quality and accessibility of drug treatment centres are not appropriate; Overall understanding of drug addiction and treatment options by drug control agencies is lacking; Overall outreach programmes are not adequate.

Positive Regional Breakthroughs Cambodia: Cambodia’s Prime Minister has pledged to ‘extend a hand to drug users’ and treat them not as criminals but as patients that need help. (Cambodia workshop on harm reduction – 5-6 May 2003. 26 actions were produced to pursue a national plan)

Positive Regional Breakthroughs – cont’ China: China has opened up to methadone maintenance and & syringe social marketing and exchange programmes in 2003. Relevant stakeholders are increasingly seeking cooperation channels to advance the availability of services to reduce HIV/AIDS vulnerability from drug use.

Positive Regional Breakthroughs – cont’ At the international level, more donors are interested in investing in the harm reduction approach especially the priority countries such as China, Myanmar and Viet Nam. Increased coordination mechanisms among all relevant stakeholders are needed.

United Nations International Policy Support The Position Paper of the UN System on Preventing the Transmission of HIV among Drug Users. The 2001 Declaration of Commitment on HIV/AIDS at the UNGASS on HIV/AIDS The 1998 Declaration on the guiding principles of drug demand reduction at the UNGASS on Countering the World Drug Problem Together

Recommendations Strong need of massive scaling up of efforts to change the behaviour of at least 60% of injecting drug users; Strong need to foster an ‘enabling environment’ – appropriate policy and legal structure under which assertive harm reduction facilities can be implemented and can succeed; Need to foster a holistic approach exampled by the full cooperation of drug control agencies and their health counterparts;

Recommendations – cont’ Implementation of comprehensive packages rather than ‘bits and pieces’ of programmes; Exchange of best practices and increased collaboration in the region; Increase advocacy efforts; Increase of training for human resources to adequately address the HIV/AIDS – IDU interface;

Recommendations – cont’ A Regional Monitoring Mechanism To assess the progress, coverage, effectiveness and accessibility and quality of services that reduce the harm from drug use in all settings including prisons and compulsory drug treatment centres; To advocate for science-base and effective practices; To identify best regional practices; To provide an update ‘mapping’ of ‘who is doing what and where’ in the region to foster collaboration, maximize ‘know how’ synergies as well as financial and human resources.

Thank you For more information please visit our website: Adapted from original anti-drug Vietnamese poster “Think and Prevent” by Do Thi Ngan, Hanoi Thank you For more information please visit our website: www.unodc.un.or.th Regional Project for Reducing HIV Vulnerability from Drug Abuse (AD/RAS/02/G22)