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| Introduction:
|
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Injecting drug users
inject drugs into veins. Drug injecting is often
a group activity among IDUs. The common practice
is to use the same syringe and needle for all the
members of the group. If one member of the group
has HIV infection, the infection would readily enter
the other members. The chances of infection through
the injecting route are much higher than sexual
route of transmission. Thus once HIV enters into
the circuit of IDUs, the spread within the IDU community
is rapid.
Many issues complicate TIs with IDUs. Drug taking
is a strongly disapproved socially. In India and
many other countries drug taking is a criminal act
and punishable under law. Criminalisation of drug
taking makes the IDUs hard to reach.
The key strategy for TIs with IDUs is needle exchange
programme. This strategy ensures that the drug users
always have sterile needles and syringes for injecting. |
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| It is estimated that there were 13.2 million injecting drug users (IDUs) worldwide at the end of 2003. Around 78% of these people were living in developing and transitional countries. |
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| Around 25% of all injecting drug users live in South and South-east Asia, and a further 18% in East Asia. Each of China and India is home to more than a million IDUs. 5%-10% of HIV infections globally are attributed to drug use.The world's highest rates of HIV infection among IDUs are found in Asia. By 1999, drug-dependent individuals comprised about 77% of HIV infections in Malaysia and 69% in China, and 66% of AIDS cases in Viet Nam. |
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| Back
to Top |
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| Issues
in IDU |
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| The spread of HIV among IDUs highlights many development
issues. It is notable that some of the countries
and communities most at risk from HIV and injecting
drug use are often some of the least developed.
Drug use and HIV affect the most vulnerable and
marginalised groups within communities: from slum
populations in India and hill tribes in Northern
Thailand, to disadvantaged young people in Central
and Eastern Europe. When IDUs are women, the stigma
and vulnerability they face is even worse. |
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| Development problems foster drug problems. Communities
in remote areas, which are marginalised and have
little control over their economic and social development,
are natural habitats for the cultivation, trafficking
and consumption of narcotic drugs. Drug production
leads to economic dependence on drug traffickers,
not to social and economic development. Increased
drug use also leads to increased health problems
in producer countries, especially where the use
and sharing of needles for injecting drugs facilitates
the spread of HIV (Ahmed, 1988). |
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| Risk behaviours leading to HIV transmission through
shared needles and syringes are closely linked to
development problems such as poverty and lack of
sustainable livelihoods, exploitation, inadequate
education and political repression. The exact nature
of the links between risk behaviours and specific
development problems remains unclear. Exploring
these links, potentially, could make a significant
contribution to increasing understanding of both
development and the epidemic. |
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| Injecting drug use destroys social cohesion and
erodes social capital. Through the cumulative loss
of potentially important contributors to society,
ultimately, injecting drug use undermines sustainable
human development. |
| |
| Injecting drug use poses an enormous threat to
sustainable human development. In countries such
as China (which has as many as 3.5 million IDUs), Indonesia
(over one million IDUs), Pakistan (180,000+ IDUs), and India
(500,000+ IDUs) the current scale of injecting drug
use creates a potentially massive group of susceptible
individuals for the further spread of HIV. |
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| Experience from other countries demonstrates that,
once HIV enters the injecting population, countries
can expect large and sustained HIV epidemics. This
is now the case in China, Malaysia, Vietnam, countries where injecting drug use
accounts for more than 60% of all HIV infections.
The impact this will have on the Human Development
Index in these countries will
be considerable.In Indonesia nearly 20% of IDUs are HIV positive while in Thailand HIV prevalence among IDUs is estimate to be 54%.In Myanmar alone HIV positive IDU's are estimated to be 65%.World Drug Report 2005 |
| |
| In Asia, economic, social and political instability
is similarly paving the way for increases in drug
production, injecting drug use, sex work and cross
border migration - all recognised factors in the
spread of HIV. Shifts in trade, transportation and
communication networks across Asia are also facilitating
the spread of drug injecting, needle-sharing and
consequently, of HIV (Rhodes et al, 1999). |
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| Back to Top |
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| Social and
Ethical Issues |
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| As is the case with drug use in general, injecting
drug use often provokes moralistic or judgmental
attitudes and responses. Perceiving (and treating)
drug users as a 'species apart' may reinforce a
sense of moral superiority, but it is unproductive
and indefensible. Potentially, anyone could become
an injecting drug user or find himself or herself
the parent, partner, child, sibling, colleague or
friend of a user. Stigmatising and marginalising
injecting drug users are likely to leave them alienated,
fearful, and out of touch with the support and services
they may most need. |
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| Legal and ethical factors are also creating challenges
to the enabling environment. For example, the illegal
nature of drug use can lead young people to hide
their drug consumption, preferring to inject rather
than risk detection through the smell of smoking.
This is despite the risk that injecting poses for
HIV transmission through clandestine sharing of
injecting equipment (Parnell and Benton, 1999). |
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| Back to Top |
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| Current
Responses |
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| In the face of these difficulties, there is a
growing body of experience in the development and
implementation of effective HIV prevention responses
among IDUs and willingness on the part of many policy
and programme designers to consider the various
strategies that could be tried. These include drug
and HIV/AIDS policy reform, methods for involving
affected communities in developing responses, outreach
and peer education, needle and syringe exchange,
and drug substitution programmes to decrease injecting.
|
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| Countries experiencing these epidemics may lack
the capacity to develop policy and programmatic
responses, which deal appropriately with injecting
drug use. Where responses are developed, they mainly
target the long-term goals of eradication of drug
supply and drug use, rather than the more pressing
problem of HIV transmission. |
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| Redressing this imbalance is a major challenge
for the development community. The relationship
between IDU and HIV transmission is also different
in each location. Changes to policies and programmes
must therefore be developed separately through a
process of ongoing analysis, policy dialogue and
monitoring of responses. |
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| Back to Top |
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| Challenges
to Development |
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| Despite recent expansion of responses, within
individual countries, these tend to be several years
behind the pace and scale of the actual epidemic.
This appears to be the result of a range of factors
closely linked to development and including: |
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- The current policy environment, making it
difficult for community-based programmes to
prevent HIV among injecting drug users
- Lack of policy dialogue between sectors of
government responsible for responses to HIV
and drug use
- Economic, social and political dislocation,
leading to increases in drug injecting, needle
sharing and, consequently, HIV
- Low community capacity, in terms of skills,
resources and experience to respond to HIV among
IDUs
- Injecting drug users, especially women, being
demonised for their drug use, rather than supported,
placing them at particular risk of both human
rights abuses and HIV infection
- Donor agencies and countries alike failing
to recognise the long-term threat to development
posed by HIV and injecting drug use.
|
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| The challenge then, is twofold. Firstly, new ways
need to be found to build the capacity of communities
to understand and respond more effectively to this
emerging development problem. |
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| At the same time, donors, governments and the
international community need to be persuaded to
make HIV prevention among injecting drug users a
much more urgent global priority, as well as a local
reality. |
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| The major consequences of drug use are: |
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- transmission of blood borne diseases such as HIV/AIDS and Hepatitis B and C
- overdose
- various medical and psychological conditions
- the social costs of widespread drug use such as crime and other anti-social activities
- economic costs of treating people infected with HIV/AIDS
- legal costs of imprisoning drug users
- the criminalisation of drug use leading to the denial of basic health care and other social services
|
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| Back to Top |
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| HIV and Injecting
Drug Use: Highlights |
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- In many developing countries, HIV epidemics
among injecting drug users (IDUs) are preceding
larger epidemics in the broader population.
- Uncontrolled HIV epidemics among IDUs threaten
many of the gains made elsewhere in terms of
human development.
- Few governments or agencies are currently
implementing or even exploring the policies
and programmes needed to slow the HIV epidemic
among drug injectors.
- Dynamic changes in drug use - including increases
in drug supply, changes in drug trafficking
routes, and shifts towards injecting and needle-sharing
- contribute to the spread of HIV
- Social, cultural and economic factors are
precipitating the spread of both injecting drug
use (IDU) and HIV. These factors include economic
and political instability, migration, poverty
and homelessness, women's position in society,
the stigma facing drug users and legal, ethical
and human rights issues.
- Women and men are differently affected by
HIV whether as drug users, partners, caregivers
or children. Understanding these gendered differences
will be critical to developing effective responses.
|
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| Gaps in responses: We know how to stop HIV transmission
among injecting drug users but are struggling to
do so in most developing countries. Reasons for
this include: |
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- Failure to recognise IDU as a factor in national
HIV epidemics
- Lack of capacity to develop the necessary
policies, dialogue and programmes for reducing
HIV among IDUs
- Limited capacity in terms of skills, resources
and experience, for understanding and responding
to HIV among IDUs
- Lack of easily accessible treatment services
(UNDCP, 2000)
- Insufficient understanding of the developmental
dimensions posed by HIV and IDU
- Poor networking and integration between sectors
and agencies responsible for drug control and
HIV prevention
- Marginalisation of drug users
- Failure to recognise and respond to the particular
effects and impact of IDU and HIV upon women
- Failure to address legal, ethical and human
rights issues among IDUs.
|
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| Current responses: Whilst current responses lag
years behind the epidemic, there is increasing evidence
to show that HIV can be prevented among IDUs. Proven
approaches include: |
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- Community-based harm reduction programmes
including needle and syringe exchange programmes,
primary health care, peer education and counselling
- Methods for reducing the demand for drugs,
including abstinence-based approaches, drug
treatment and drug substitution programmes
- Policy dialogue and engagement involving different
sectors of government and community-based organisations
- International harm reduction networks and
research centres for building capacity in relation
to programmatic and policy responses (Deany,
2000).
|
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| From a public health perspective, this shift is
disastrous, as injecting drug use fuels the rapid
spread of injection-related diseases such as HIV
and hepatitis. |
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| World wide, the commonest injected drugs are heroin,
amphetamines and cocaine, though many other drugs
are also injected, including tranquillisers and
other pharmaceuticals. The particular drug injected
depends on availability and cost (which, in turn,
often depend on geographic proximity to production
areas or trafficking routes), personality traits
and peer group norms, among other - poorly understood
- factors. |
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| Another feature of the growth in drug trafficking
has been the close relationship between the spread
of HIV infection among injecting drug users and
the routes of drug trafficking. These trafficking
routes have become more unstable over time as intense
efforts by law enforcement to control drug supplies
have resulted in the movement of these routes to
new areas where there are temporarily lower risks.
Unfortunately this instability of drug trafficking
routes exposes additional large populations to the
risk of HIV infection among injecting drug users.
|
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| What is Harm Reduction? |
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| Harm reduction can be defined as reducing the harms of drug use to drug users and the wider community. It is about reducing the adverse consequences of drug use without necessarily reducing consumption. |
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| Harm reduction is a key in preventing HIV/AIDS and saving lives. As long as people continue to spread HIV through drug injecting and unsafe sex, harm reduction will be needed. The term harm reduction refers to various strategies and approaches for reducing the physical and social harms associated with risk-taking behaviour. Harm reduction among injecting drug users (IDUs) can take many forms such as abstinence, education programmes, counseling, drug substitution, needle exchange, etc. |
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| Principles of harm reduction |
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1. Harm reduction places emphasis on immediate, feasible goals over vague, long-term ideals, such as that of a drug-free society. The rapid, potentially explosive spread of HIV infection must be prevented first and prevention activities are best begun before the HIV prevalence among injecting drug users (IDUs) is greater than five percent. Otherwise, abstinence and vocational rehabilitation will be meaningless.
2. A hierarchy of risks must be established to avoid HIV infection from drug use.
3. The alternative strategies of harm reduction are complements to demand and supply reduction approaches but its focus is on public health rather than law and order. Research suggests that to prevent HIV transmission, multiple interventions are required, such as:
- Information sharing
- Drug treatment and pharmacotherapy (substitution)
- Outreach and peer education
- Needle and syringe exchange programme (NSEP)
- HIV voluntary counseling and testing
- Primary health care
- Advocacy to remove barriers to safe injecting
- Targeting marginalised groups (prisoners, women, ethnic groups)
4. Current and rehabilitated drug users are central in designing, promoting and delivering health care and HIV prevention services they need. Harm reduction meets them where they are, and involves them in policy-making and advocacy. It considers what, according to their opinion, will work for them, and accepts, encourages and nurtures any improvements they may be capable of making.
5. Harm reduction is an evidence based approach. Scientific data has been accumulating to support harm reduction programmes and projects. The evidence indicates that harm reduction is effective in reducing the rate of transmission for blood borne infections, mortality rates, social and economic costs related to drug use, all the while being cost-effective and safe. No studies have shown an increase in drug use with regards to harm reduction programmes. (www.ahrn.net)
|
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| New section on Women and Drugs |
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| Over the years, as a result of social and economic development, women now play new roles in addition to their traditional roles as wives and mothers. The stresses and strains of rapid change have contributed to an increase in the levels of drug abuse in most societies, including among women. The factors responsible for the increase in drug abuse among women are related to the roles and responsibilities of women in each society. The real extent of the impact of drugs on women is only gradually gaining the attention of policy of policy makers dealing with matters related to substance abuse and drug trafficking. |
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| Women drug users differ from male users in background, their reasons for using drugs, and their
psycho-social needs, particularly because women users are viewed quite differently from men users by the wider society. Women abusing drugs are more likely to be stigmatized by society than men abusing drugs. Women IDUs, who are dependent on men, often fear rejection by their partners if they do not inject drugs.
|
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| Women in general are centrally involved as sexual partners of male IDUs, as carers of people with HIV/AIDS. The links between drug use, HIV and gender in developing regions are not yet well understood and needs further exploration. It is clear however that the problems surrounding HIV and gender are greatly compounded when drug use is an added factor. |
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| There is less documentation about women as drug users than about male users, and most does not focus on women drug users as a distinct group. Many in-patient drug-abuse treatment facilities do not admit women, particularly if the women are pregnant or HIV-positive. |
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| Factors placing women drug users at high HIV risk |
- Being drug users themselves
- Sexual relations with drug using partners
- Engaging in commercial sex to support drug use
- Being (girl) children of injecting drug users
- Lack of education and vocational skills.
|
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| Women have increasingly become involved in all forms of drug-related problems and are likely to suffer more severe consequences than men as a result of this involvement. Women IDUs are at increased risk of HIV infection over male IDUs for several reasons, but principally because of their generally subordinate status in society. |
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| When drug-using women are also involved in sex work, the risk of acquiring HIV infection through unprotected sex, compounds the existing risk of transmission through the reuse of needles and syringes. Women may also be introduced to drug use by sexual partners who inject their drugs for them. If the sexual partner becomes ill or is imprisoned, these women are at risk for overdose if they are unaware of the dosage they have been injecting, and at risk for HIV, if they must rely on others to inject them. |
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| A woman who uses drugs for whatever reason and who is infected by HIV seldom receives the sympathy and support that she needs (Deany 2000). |
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| The Growth in Illicit Drug Use |
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- According to the World Drug Report 2005 more than 200 million
people have used drugs at least once in the last 12 months
- Over 26.2 million people use amphetamineo and 7.9 million people use ecstasy
- Over 13.7 million people use cocaine
- A wide range of substances can be injected
including cocaine, amphetamines, tranquillisers,
barbiturates, as well as a variety of opiates,
of which heroin is currently the most common
and well known
- It has been estimated that 500,000-1 million
people in Bangladesh are addicted to drugs.
The number of injecting drug users in drug treatment
centres increased from 6% in 1993 to 17% in
1995 (UNDP, 1999B)
- 2.59 million drug users in Thailand use amphetamineo
- Pakistan has an estimated 4.48 million drug users,
with perhaps 180,000 injecting drug users, although
this figure may be increasing.
- The value of the global ilicit drug market for the year 2003 was estimated at US$ 13 billion at the production level, $94 billion art the wholesale level & US$ 322 billion at the retail level.
|
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| Injecting Drug Use and HIV Transmission |
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The global spread of injecting drug use since the
1960s has set the scene for massive outbreaks of
HIV infection among injecting drug users, their
sexual partners and children. According to recent
estimates by the United Nations International Drug
Control Programme and the World Health Organisation,
114 countries are now experiencing HIV transmission
among IDUs (Ball, 1999): more than double the number
in 1992.
It is now estimated that the cumulative number of
HIV infections among injecting drug users could
have risen to a figure as high as 3.3 million (UNDCP,
2000). Stimulated by changing economic and social
conditions, the rise of drug injecting is adding
another dimension to the vulnerability of people
to HIV.
Injecting a substance contaminated with HIV directly
into the blood stream is a particularly efficient
means of transmission than occurs for example through
sexual activity. Injecting drug use can play a critical
role in determining how and when the epidemic begins
within a region together with the ways in which
it unfolds (Cowal, 1998).
The most rapid increases in HIV among IDUs, have
been in developing countries and in countries in
transition. In some countries - such as Malaysia, Vietnam
and China - drug injecting is the major cause of
HIV infection. |
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| Understanding the Problem |
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| Why are most developing countries failing to respond
adequately to the development challenges posed by
HIV among injecting drug users? Why are a small
number of countries succeeding? What are the reasons
behind successful and unsuccessful responses? And
what are the particular challenges to development
posed by injecting drug use and HIV? |
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| This section provides a framework for analysing
some of the social, cultural, political and economic
factors surrounding injecting drug use and HIV transmission. |
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| In many developing countries injecting is a relatively
new way of transmitting infectious disease. It is
also behaviour about which relatively little is
known. HIV infection among injecting drug users
is a new phenomenon in many places and current policies
and programmes may be insufficiently relevant to
the specific challenges posed by contemporary drug
use. |
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| The factors precipitating these new epidemics
are multiple, but most are directly linked to sustainable
human development. The wider social, economic and
policy environment surrounding illicit drug use
probably has more impact on HIV transmission and
illicit drug use than any other factor. Syringe
sharing, for example, is not merely a product of
individual risk 'calculus' and immediate setting,
but is also contextually determined by: |
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- Paraphernalia laws, injecting equipment availability,
policing and law enforcement
- Gender, ethnic and health inequalities
- The political and social economy; and
- Public health policy (Rhodes et al, 1999).
|
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| To understand more fully why drug injecting and
needle-sharing behaviour are increasing in developing
countries and why these countries are failing to
respond appropriately to the associated health and
development threats, it is necessary to explore
some of the contextual and development factors which
affect drug use and HIV. |
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| Drug Use and Developing Countries |
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| Developing countries suffer far more, both numerically
and socially, from the consequences of drug misuse
in comparison with developed countries. While developed
countries have structures and mechanisms to deal
with drug addiction, developing countries may lack
necessary "know-how", infrastructure and
resources to address adverse social and health consequences
associated with drug addiction. At the same time,
disintegrating social conditions in urban areas
often provide fertile ground for the spread of substance
use among young people and the economically disadvantaged
(DOH International, undated). |
| |
| An understanding of the micro and macro risk
environments in which HIV epidemics occur is an
important element of developing effective responses.
|
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| Key macro factors, which create the environmental
conditions for new and continuing epidemics, include:
|
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- Spread of illicit drug use and increases
in the size of IDU populations
- Transitions towards drug injecting associated
with law enforcement and interdiction activities
which restrict drug supply and production
- Transitions towards drug injecting associated
with the transference of new drug production
and distribution technologies
- Transitions towards drug injecting associated
with the 'globalisation' of drug markets and
distribution networks
- Population migration, mobility and mixing
- Lack of public health tradition
- Insufficient revenue and infrastructures
- Lack of structures or resources for mobilising
non-governmental and community organisations
- Rapid transitions in economic, health and
welfare status (Rhodes et al, 1999B).
|
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| It has become increasingly apparent that
developing countries are more seriously affected
by the problems of drug use, drug trafficking
and organised crime than was previously imagined.
This is especially the case in communities in
poverty stricken areas - such as those dependent
on cash crops to forge an existence - and those
in slum areas of cities where desperate, unemployed
individuals become drug dealers and users in order
to survive (Ahmed, 1998).
|
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| People who produce drugs often inhabit remote
areas, living on the margins, socially, geographically
and economically. For example, countries such as
Myanmar, in and around the golden triangle drug
production region are experiencing widespread HIV
epidemic among IDUs. |
| |
| In many locations, increases in drug use are directly
associated with lack of development and may even
be an indicator of this. Efforts to eradicate drug
production and trafficking can easily lead to increased
poverty in these areas, as it is may prove difficult
to generate income from alternative activities.
|
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| Problems associated with drug use contribute to
development problems. The cost of drugs, reduced
productivity from drug use, unemployment and associated
crime all contribute to poverty and social dislocation.
The consumption of drugs places street-children
in a downward spiral of poverty and exploitation.
In many countries the combination of involvement
in illicit drugs, crime, violence and sex work
has adverse effects on families and the social situation
of women (Ahmed, 1998). |
| |
| The causes and consequences of the HIV epidemic
among drug injectors are similarly linked to other
barriers to development including poverty, migration,
gender inequity and governance. For example, women
carry a disproportionate share of the burden of
social disruption and destabilisation. This has
resulted in increasing numbers of single parents,
alcohol and drug use and rising delinquency among
young people, all of which disproportionately affect
women (UNDP, 1999). |
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| Integrating Different Sectors of
Government |
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| How drug use and HIV are viewed may also depend
on the sector of government concerned with the issue:
|
| |
- Health departments may see HIV and drug overdose
as the fundamental problems posed by injecting
drug use
- The Police may be more concerned with crime
associated with illicit drugs
- Home Ministries or border patrols may be primarily
concerned with suppressing the supply of drugs
- Chief Ministers may be concerned with the
overall impact of drug problems on the community
|
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| The fact that injecting drug use can fall within
so many different areas of government illustrates
in part the difficulty which governments and others
often have in dealing with the broad implications
of illicit drug use. |
| |
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| Uncoordinated policies may lead to
a clash between the goals of different agencies
involved in combating drug use and HIV. Drug use
needs to be recognised both as a health and as a
legal problem. Governments must strike a balance
between the need to curb illicit drug use on the
one hand and the reality that drug use cannot be
eradicated overnight (if at all) on the other, so
it must be made safer. |
| |
| Declaring stringent bans on drug use,
or advocating imprisonment for all offenders may
sound like strong leadership, but in isolation from
other public health measures, may simply result
in more harm. |
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| Back to Top |
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| Legal,
Ethical and Human Rights Issues |
| |
The legal and social context can make it very difficult
for an HIV prevention programme or agency to make
contact with at-risk IDUs in an effort to educate
them about HIV and its prevention. The social and
legal situations around drug use can drive drug
users underground and make them difficult to reach.
It has been found many times that when a group of
people in a community is driven underground in this
manner, HIV transmission is enhanced. |
| |
| There may also be legal barriers,
aimed at enhancing drug control but unintentionally
promoting the risks of HIV transmission. An example
is the so-called 'paraphernalia laws', under which
possession of injecting equipment is criminalised.
Rather than deterring IDUs from injecting, such
laws simply promote the use and reuse of common
injecting equipment (and therefore of HIV transmission)
so that individuals will not be charged with crimes
relating to possession of needles and syringes.
Experience in developed countries shows that abolishing
paraphernalia laws does not increase participation
in drug use, but does remove a barrier to safer
use for the current drug use. |
| |
| At the societal level, imprisoning
drug users on the sole grounds of using drugs does
not diminish demand for drugs and potentially causes
major harm to users who are exposed to further harm
in prison (including a higher risk of HIV infection)
while typically unable to access drug treatment. |
| |
Acknowledgement of these factors can assist the
police and other law enforcement officers to assume
important roles in HIV prevention. For example,
in some countries, the police actively participate
in harm reduction by referring drug users to treatment
(rather than arresting them), and even by providing
them with clean needles and syringes. |
| |
| Costs from Lack of Action |
| |
| In most countries in Asia and Central
and Eastern Europe, HIV epidemics among IDUs are
still at a relatively early phase. Evidence from
other countries indicates that this will soon pass
and the opportunity to make a significant difference
will be lost. |
| |
Statistics on Drug Use and HIV |
| |
| Countries |
Estimated Drug Users |
Estimated Injecting Drug Users |
Estimated number of HIV infection in IDUs |
| Afghanistan |
Unknown |
Unknown |
Unknown |
| Bangladesh |
100,000 – 1.7 million |
20,000 – 25,000 |
2.5% of IDUs in detoxification centres are HIV + |
| Cambodia |
Unknown |
Unknown |
Unknown, rate of HIV via all routes
2.8% or 169,000 people |
| China |
860,000 registered drug users, unofficial
estimate 6 to 7 million drug users |
3.5 million |
HIV prevalence rates range from 1% to 80% according to the region |
| India |
Difficult to assess, well over 5 million |
In 5 cities alone well over 100,000 |
Overall the rate of is 4.16% but it is much higher in certain areas, e.g., 80% in Manipur, 44.8% in
Delhi, 31% in Chennai |
| Indonesia |
1.3 million to 2 million |
Over one million |
In 2001, 19% of total HIV infections
associated with IDU. |
| Iran |
1.8 million to 3.3 million |
200,000 to 300,000 |
1,841 IDUs infected with HIV, or 74.8% of all HIV infections are IDUs |
| Laos |
In 1998, 63,000 people addicted to opium. Prevalence rate of drug users could exceed 2%of the population |
Unknown but considered low |
2% of total HIV infections identified in IDUs |
| Malaysia |
180,000 to 400,000 |
200,000 |
HIV prevalence among IDUs is 76.3% |
| Mongolia |
Unknown |
10 known |
100 HIV positive among all groups |
| Myanmar |
300,000 to 500,000 |
150,000 to 250,000 |
HIV prevalence among IDUs is 63%, in some states as high as 90% |
| Nepal |
40,000 to 50,000 (official figures) |
20,000 |
0.5% of total 15-49 population HIV +, but in Kathmandu 50% of IDUs tested were HIV positive |
| Pakistan |
4 to 4.8 million |
180,000 (conservative) |
4% of HIV infections are
among IDUs |
| Philippines |
1 million |
10,000 |
4,000 HIV + IDUs or prevalence of 1% |
| Republic of Korea |
10,304 drug users arrested in 2000 |
Unknown |
2 known cases |
| Sri Lanka |
240,000 - 300,000 |
Of the 30,000 addicts (lowest figure), 2% are
injecting |
Prevalence among adults is 0.07%. HIV has not been found among IDUs but as a group they are not tested. |
| Thailand |
Two to three million or possibly nearly
5% of the population |
Currently unknown (In 1994: 100,000 –
250,000). |
The 2001 national sentinel
seroprevalence survey showed rates of 50% among IDUs |
| Vietnam |
185,000 to 200,000, possibly higher. |
In 1997, 69,000 (likely to be conservative) |
Prevalence of HIV infections among IDUs accounted for 65% of total reported HIV cases. |
|
| |
| * Revisiting ‘The Hidden Epidemic’ – a situational assessment of drug use in Asia in the context of HIV/AIDS, Centre for Harm Reduction, 2003 |
| |
| |
| Web Resources |
| |
| United Nations Office on Drugs and Crime |
| www.unodc.org |
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| Asian Harm Reduction Centre |
| www.ahrn.net |
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| Centre for Harm Reduction |
| www.chr.asn.au/ |
| |
| International Harm Reduction Association |
| www.ihra.net |
| |
| SARNet - South Asia Regional Network for Prevention of Substance Abuse and HIV/AIDS |
| www.wesouthasians.org |
| |
| Seven Sisters Coalition - Secretariat Co-ordinator |
| www.7sisters.org |
| |
| Related Information |
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| The Global Network of People living with HIV/AIDS (GNP+) and the International Community of Women Living with HIV and AIDS (ICW) recently released their Joint Position Paper on Injecting
Drug Users and Access to HIV Treatment.
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