Foreword

Message of the Executive Director of UNAIDS

Some 34.3 million men, women and children worldwide face currently a future dominated by a disease unknown just a few decades ago. In 1999, there were 2.8 million deaths from HIV/AIDS - a higher global total than in any year since the beginning of the epidemic. With the HIV-positive population still expanding, adding 5.4 million new infections in 1999 alone, the annual number of AIDS deaths can be expected to increase for a number years before leveling off.

The overwhelming majority of people living with HIV, some 95 per cent of the global total, live in the developing world. That proportion is expected to grow even further as infection rates continue to rise in countries where poverty, poor health systems and limited resources for prevention and care fuel the spread of the virus. In Asia and the Pacific alone, there are already over 6 million persons living with HIV/AIDS.

Effective prevention programmes have reduced HIV risk and lowered or stabilised HIV transmission rates in some countries of Asia. At the same time, however, warning flags have been raised after information from new data collection efforts have revealed that injecting drug use is spreading and that condom use is uncommon, including among clients of sex workers and men who have sex with men. In many places prevention efforts are hampered by the shame and stigma attached to AIDS.

Drug use and HIV vulnerability remain issues of great concern for many countries in Asia and the Pacific because surveys indicate that in some geographical areas more than sixty per cent of all injecting drug users are HIV-positive. In several Asian countries, injecting drug users represent the largest group of those who are HIV-positive.

In 1997, in response to this situation, the UNAIDS Asia-Pacific Intercountry Team established a Task Force, comprised of a team of experts in drug control and public health. The Task Force designed and commissioned the present study on national drug control and public health policies that could facilitate or impede the implementation of interventions to reduce the risk of HIV transmission among drug users. Study-countries included China, India, Malaysia, Myanmar, Nepal, Thailand and Viet Nam. Data collection for the survey was completed in May 1999 and the report was distributed to governments and concerned agencies for their review and comments.

The results of the study, which are documented in this monograph, indicate that in many countries serious legal and political barriers exist, which impede the implementation of effective preventive interventions for the spread of HIV infection among injecting drug users. Such interventions include needle and syringe exchange or distribution and drug treatment as part of comprehensive package of interventions.

High-risk behaviour is commonplace among drug users in all the study countries and there is an observable trend of multiple drug use. Measures to prevent the spread of HIV among drug users are often localised, short-term, under-funded and insufficient in scope. Adherence to traditional values is strong, making the debate on HIV/AIDS prevention and sexual behaviour sensitive. With the exception of law enforcement, drug problems are not generally accorded high funding priority. There is inadequate dialogue between drug control and HIV/AIDS prevention agencies. Consequently there are only a few programmes in the region, which directly address problems presented by the interface between drug use and vulnerability to HIV infection. In general, drug policies in the study-countries do not support effective prevention of HIV transmission among drug users.

On the positive side, however, results of the survey indicate that governments are, under certain circumstances, ready to review their policies concerning interventions to reduce the risk of HIV transmission among injecting drug users. In many countries only minor modifications to the drug control legislation are necessary in order to implement more effective HIV/AIDS prevention among drug users. In all the study-countries there were many opportunities for the development of interventions to enhance the efficacy of HIV/AIDS prevention among drug users. Change will inevitably have to be incremental, building on, modifying and expanding interventions that are already in place. The researchers strongly recommended improving the collaboration of drug control and public health sectors in developing and implementing policies and programmes targeting drug users.

This monograph is intended to serve as a practical source for professionals working in the fields of policy and programme development, both in the drug control and the public health sectors. Whether government officials or staff of non-governmental organizations, they are the ones who face the challenge of developing new or modifying existing policies and programmes to reduce the risk of HIV transmission among injecting drug users, a task which requires a high degree of courage, patience and stamina. It is hoped that the information provided in this monograph will contribute to the success of their endeavours at this critical stage of the epidemic in Asia and the Pacific.

Peter Piot
Executive Director
Joint United Nations Programme on HIV/AIDS