Inter Press Service - November 29, 2007
Marwaan Macan-Markar

Such marginalisation prevails despite the government being aware of the reality, adds the study released Thursday by the New York-based Human Rights Watch (HRW) and the Bangkok-based Thai AIDS Treatment Action Group (TTAG). "The Thai government estimates that 40 to 50 percent of injecting drug users are living with HIV in Thailand -- virtually unchanged over the past two decades."

The hostile reception that HIV-positive Thais who inject heroin receive at health clinics across the country typifies the prevailing atmosphere, says Kreignkrai Atempreasert, executive director of TTAG, who is, himself, a drug user living with HIV. "Being a drug user is not easy. When we wait in front of clinics, we are harassed by the police. I have seen many of my friends being denied treatment by doctors because they were drug users."

"There is no space for drug users to exchange information about drug use or available treatment that they can get from health care providers," adds Rebecca Schleifer, advocate with the HIV/AIDS and Human Rights Programme at HRW. "Many health care providers release information about drug users who come to them to the police and security officials."

Consequently, drug users who are receiving the life-prolonging anti-retroviral (ARV) therapy fear disclosing their drug habits to their respective doctors. "Information sharing between drug users and clinicians is a dangerous 'catch 22': in a context where police both formally and covertly gain access to hospital's information about individual drug users," reveals the 57-page report, 'Deadly Denial: Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand'.

This report, which was released on the eve of World AIDS Day, marked on Dec. 1, comes on the heels of a disclosure Tuesday by a leading public health school in the United States that the strain of HIV prevalent in Thailand is more deadly than other HIV subtypes. "People infected with HIV in Thailand die from the disease significantly sooner than those with HIV living in other parts of the world," revealed two studies conducted by researchers at the John Hopkins Bloomberg School of Public Health.

"The shorter survival time measured in the studies suggests that HIV subtype E, which is the most common HIV subtype in Thailand, may be more virulent than other subtypes of the virus," notes a news release that appears on the public health school's website about the two studies. The first of them followed 228 young military recruits over a 14-year period, beginning in 1991.

"The median time from HIV infection to death for Thai men was 7 - 8 years compared to 11 years for HIV-positive men living in North America and Europe," it adds. "The survival rate for the Thai men was also lower than studies of similar populations living in low and middle-income countries in sub-Saharan Africa where subtypes A, C, D and G circulate."

But progressive measures pursued by Thai public health authorities and civil society organisations during the 1990s helped save the country from seeing HIV and AIDS numbers reach the disturbing rates witnessed in Sub-Saharan Africa. Public campaigns, such as those that urged sex workers to use condoms regularly, saw the country slash new infection rates by nearly 80 percent over a 15-year period.

As impressive has been the country's ability to deliver both first- and second-line anti-AIDS drugs to Thais who need it through the public health system. Currently, some 140,000 Thais are receiving first-line ARVs and a further 10,000 are due for second-line treatment soon.

Last week, the country's disease control department confirmed that close to one million people had been infected with HIV since the killer virus was first reported here 23 years ago. Over the past two decades, 558, 895 have died due to AIDS, the health officials added.

But as the HRW report warns, the drug users in this South-east Asian country could change that picture, converting it into a more dismal one, if they remain excluded from the health system. After all, an estimated three million people, or five percent of the country's population, are hooked on drugs, it states. "While the majority of drug users take methamphetamines, an estimated 100,000 to 275,000 use heroin, 80 percent of whom inject it."

"In stark contrast to other groups at risk of HIV, such as sex workers and military recruits, HIV prevalence among Thailand's injecting drug users has never shown significant decline," it adds. "(A U.N. agency) reported in 2004 that one-quarter of all new infections occurred among injecting drug users."

"Prevalence among injecting drug users may be as high as 60 percent in some regions," it observes of a group that was among this country's "first wave" of HIV infection. "HIV prevalence among this group skyrocketed from virtually nil to 40 percent in a single year when it was first identified in 1987-88."

Help for drug users should range from the government, police and health authorities respecting the formers' rights and declaring that drug users seeking health services "will not be penalised," urges the report. Equally important, it adds, is to "establish and integrate needle and syringe exchange, methadone maintenance therapy, and other evidence-based harm reduction interventions."

"The government should also be clear about what treatment of drug users means," says Paisan Suwannawong, director of the Thai AIDS Treatment Action Group. "Even though the government says it treats drug users as patients, it actually treats drug users as criminals, punishing them."
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