Incarceration a major cause of spread of HIV to drug users

By treating drug use as a crime instead of a medical problem, Thailand inadvertently increased the number of people who became infected with HIV, and the toll is rising, according to the latest UNDP report.

RICHARD S. EHRLICH
BANGKOK, Thailand

The government's "war on drugs" in which more than 2,000 people died, also locked thousands of suspects in prisons rife with AIDS, allowing the disease to spiral out of control, according to a United Nations report.

During the harsh crackdown, thousands of other illegal drug users hid from authorities to avoid arrest or execution, making it difficult for doctors to protect them from the Human Immunodeficiency Virus (HIV) which can cause Acquired Immunodeficiency Syndrome (AIDS), it said.

The blunt, 76-page report by the United Nations Development Program (UNDP) was titled, "Thailand's Response to HIV/AIDS: Progress and Challenges".

It was released on Thursday, July 8, ahead of the 15th International AIDS Conference which meets from July 11 to July 16 in Bangkok.

By treating drug use as a crime instead of a medical problem, Thailand inadvertently increased the number of people who became infected with HIV, and the toll is rising, the UNDP said.

The government conducted its "war on drugs" throughout 2003 to contain methamphetamines and heroin which spread from the lower-class into middle-class and high society where "ya ba" (crazy drug) speed pills and opium-based heroin became trendy among students, entertainers and others looking for cheap thrills.

During the 2003 crackdown, more than 2,000 people were mysteriously shot dead, according to police and human rights groups.

The government described most of the killings as smugglers murdering rivals and informants.

But human rights groups insisted police may have killed most of the victims in extrajudicial slayings to satisfy official quotas.

The bloodshed and imprisonment, however, fueled an alarming increase in AIDS.

"In Thailand, a large proportion of prisoners had been convicted for violating the country's narcotic control laws, especially with the recent war on drugs campaign," the UN report said.

Of Thailand's 220,000 inmates, an estimated two-thirds have been convicted on drug-related charges during the past several years, it said.

"Prisons enable previously unconnected, injecting drug-user networks to interact, allowing the virus to spread to groups of users with comparatively low HIV prevalence," it said.

"Unsafe injecting drug use is an increasingly significant cause of new HIV infections in Thailand."

Throughout this Southeast Asian nation, inside jails or on the streets, "about one-quarter of all new infections are occurring through unsafe injecting drug use.

The proportion could rise as high as 40 percent in the next few years," the UNDP warned.

Most Thai prisoners who secretly inject drugs in their jail cells, share virus-contaminated needles due to scarcities.

Many also have unprotected sex while in jail.

The UNDP cited statistics which showed 25 percent of inmates in Bangkok's overcrowded Klong Prem Central Prison were HIV-positive, having contracted the virus in various ways before or after confinement.

Much of the HIV which spread through the prison population, however, did so because "fully half the prisoners surveyed were regular injecting drug users, and 70 percent of those users had injected drugs while jailed."

Among inmates who injected drugs in prison, 95 percent shared needles or syringes at least once, allowing the virus to spread.

The spiral of AIDS among prisoners also threatens people who live in or visit Thailand -- including foreign tourists -- because most inmates eventually finish their sentences and are released, and then often engage in unprotected sex with prostitutes, sex-buying customers, friends or spouses.

Meanwhile, fear of arrest and extrajudicial killings also prompted countless addicts to hide from medical personnel because illegal drug use could be discovered during AIDS tests.

"The punitive approach to drug use, along with mass media campaigns, has probably reinforced the status of drug users, particularly those who inject, as social outcasts.

"The net effect has been to generate a climate of fear that could be driving injecting drug users deeper underground and undermining the potential of outreach projects and compromising the HIV/AIDS response," the UNDP said.

The report echoed concerns expressed by the Thai Drug Users' Network, which recently received a one million US dollar grant from the respected, Geneva-based, Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

"The Thai Drug Users' Network argues that the war on drugs campaign is misguided and could lead to an increased risk of HIV infection among drug users," the UNDP noted.

"They have urged the authorities to focus less on punitive action and more on ensuring that appropriate services, such as harm reduction and needle exchange programs, reach drug users -- most of whom are poorly informed and equipped to protect themselves against HIV/AIDS," it said.

"Generally, the government has not been supportive of such projects," the UNDP said.

During the past two decades, more than one million people in Thailand contracted HIV, including 460,000 who died of AIDS and 604,000 who are surviving as best they can.

* Richard S. Ehrlich is a former UPI correspondent who has reported from Asia for the past 25 years.