1. Thai AIDS Treatment Action Group (TTAG)
Deadly Denial: Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand
Paisan Suwannawong
Thai AIDS Treatment Action Group (TTAG)
August 5, 2008
IAC Mexico

2. HIV Prevalence in Thailand National Sentinel Surveillance ‘89 – ‘04
Ministry of Public Health, Thailand

3. IDU in Thailand
Only group experiencing no decrease in HIV prevalence in 20 years
25% of all new infections
No comprehensive harm reduction or policy
Recent policy: “Drug users are patients, not criminals” but in reality drug use still treated as public security, not health problem
Most drug users in prison or military-run compulsory drug treatment centers (>50,000 in 2003)
Ongoing, violent wars on drugs (2,500 EJEs in 2003)

4. Government Commitments and Obligations
UNGASS 2006: “little has been done,” “must act quickly” National AIDS Plan 2007 – 2011 recognizes failures, commits to harm reduction and scale up
Constitutional right to equal access to health care, including “quality public health services” and protection “against dangerous infections diseases “free of charge” and in a “timely fashion”

5. ARV access in Thailand
People Living with HIV/AIDS including IDU and allies fought for 10 years to achieve universal access to locally-produced, generic ARV
More than 80% of all who need it receive ARV
Hundreds of comprehensive continuum of care centers (CCCs) provide ARV
Yet common for people who use drugs, including methadone clients (!), to be denied HIV services including ARV; CCCs do not meet the specific needs of people who use drugs

6. TTAG Documenting Violations of IDU since 2002

7. Partnership with HRW
Invite HRW to investigate violent war on drugs in 2003, including violations against people who use drugs
Blacklists, 2,500 extrajudicial executions; 10s of thousands forced into military-run drug treatment

8. Barriers HIV/AIDS Treatment for People Who Use Drugs in Thailand
Partnership with HRW HIV/AIDS Division
Two field visits
Interviews with 100 people, 50% people who use drugs (many HIV+ and IDU)
5 provinces in North, South and Central Thailand

9. Key Areas of Rights Violations Investigated
Right to health
Right to non-discrimination
Access to information
Failure to create conditions to promote health
Failure to protect confidentiality/Right to privacy

10. IDU Experiences Accessing Care
Don’t want to “risk my life” going to state hospital where information is shared with police
Police can and do ask for names of people in drug treatment, and laws allow this
Police interfere with drug users attending methadone clinics, and use clean needles as evidence of drug use despite legality of possession
Outreach workers feel unsafe carrying clean injecting equipment to distribute, fearing police

11. Though ARV treatment guideline amendments in 2004 no longer exclude IDU from accessing tx, in practise, across the countries, providers admit they expect active drug users, even methadone clients, to stop drugs in order to be eligible for drugs.
Reasons given include not wanting to “waste” ARV, fearing IDU will fail to adhere and spread “drug-resistant” HIV, or simply do not deserve it due to drug user status.
Some providers were unaware the guidelines had been updated

12. Services for IDU
CCCs unequipped to serve people who use drugs; harm reduction programs do not exist. Drug and HIV services are not integrated, and information such as ARV/Street Drug/methadone interactions, viral hepatitis coinfection, overdose and safer injecting practises are NOT provided. There are zero government programs providing clean needles. Clients do NOT feel safe disclosing drug use to providers.

13. “All my (IDU) friends are in prison or heaven”
IDU in custodial settings receive substandard health and HIV care
Most IDU in custodial settings repeatedly throughout life
Pre-trial detention = increased risk for HIV
Estimated 4,800 HIV+ in prison (pop. 160,000)
99% HIV/HCV co-infection
HCW shortage and lack of guidelines ensure high morbidity, mortality rates in prison

14. Prison (cont’d.)
Lack of harm reduction including opioid substitution therapy in prison
Denial of need, promotion of cold turkey withdrawal
Failure of referral system to ensure continuity of care post-release

15. Recommendations To government of Thailand:
Increase harm reduction services for drug users
Take concrete steps to reduce drug users’ fear of seeking health care, ensure rights to information, address structural barriers to care (develop clear national harm reduction policy)

16. To US Government:
Lift ban on needle exchange
Recognize importance of harm reduction and support int’l. efforts to implement h.r. including sterile syringes
To United Nations and int’l. donors to Thailand:
Take steps to ensure Thailand adopt harm reduction, ART and other HIV/AIDS services for DU and takes concrete steps to reduce drug users’ fear of seeking health services

17. TTAG/HRW Advocacy Monitoring government policy
Initiation of government-NGO prison and HIV health network to ensure health and HIV services including ARV
Shadow report submission to UN health and drug control agencies
Participation in international advocacy to address the health impacts of repressive drug control policies (UNGASS on drugs, UNAIDS PCB, etc.)

18. Acknowledgements
Thanks to Rebecca Schleifer, HRW, Karyn Kaplan, TTAG, and all the people who use drugs in Thailand who experience oppression, human rights violations, and sickness and death unnecessarily every day and shared their stories with us to help advocate for change.