B. Drug users’ vulnerability to HIV/AIDS

Drug use has serious social and health consequences. The majority of drug users in Asia are extraordinarily poor and often jobless or relegated to doing odd jobs. Homelessness is widespread. Many of them beg, borrow, or even steal. They are criminalized, stigmatized, and discriminated against. Such factors, combined with low self-esteem and little trust in authorities, make drug users a population to which traditional health and social services have little access.

Social consequences of drug use

Source: AHRN Clearing-house

The health status of drug users, particularly that of injecting drug users, is a matter of great concern: blood borne diseases such as hepatitis and HIV infection, abscesses and serious wounds from inadequate injecting equipment, and death from overdose are common. With the onset of the HIV/AIDS epidemic in the late 1980s, drug use in Asia entered an even more serious phase and became a major public health concern. Drug use has an intricate relationship with HIV/AIDS: HIV is transmitted through the sharing of contaminated needles and syringes and other equipment employed by drug users. In addition, alcohol and stimulant abuse often lower resistance to high-risk behaviour such as unprotected sexual intercourse.

Social consequences of drug use

Source: AHRN Clearing-house

Table 1. Drug use in selected countries of Asia (estimates)

N/E = no estimates

Source: Regional Task Force on Drug Use and HIV Vulnerability, Drug Use and HIV Vulnerability Policy Research Study

Drug users in Asia are highly vulnerable to HIV transmission because of the legal, political, socioeconomic, health service, and cultural situations in which they live. These situations, however, vary considerably from country to country, even from community to community in the same country. In many countries of Asia, as elsewhere in the world, drug policies are highly politicized and are influenced by historical, social, religious, cultural, and economic factors. Strongly held beliefs about drugs and their adverse effects on the society, national experiences with drug use in the past, the extent and seriousness of past and present drug problems, and the interpretation of international conventions all have an impact on the development of policies and legal instruments directed at drug use.

In a number of countries, the law prescribes severe punishments for all drug-related offences including not only drug use but also possession of drugs and drug-use paraphernalia (e.g. needles and syringes). The level of penalties and the stringency with which they are applied locally affect the feasibility of preventive interventions for drug users. Indeed, these penalties may actually preclude providing drug users with information or with the means to protect themselves against HIV infection.

Drug-use practices contribute significantly to the vulnerability of drug users. Many drug users in the region use narcotics such as opium and heroin, and a significant percentage inject. In some countries injecting drug users go to secluded shooting galleries, but in other countries injecting takes place in more public locations: in a designated area users can get an injection from a dealer or person whose job it is to inject users. In most cases, dealers and public injectors have little or no information about HIV infection. The sharing of needles, syringes, and other drug-use equipment is common.

Social consequences of drug use

Source: AHRN Clearing-house

In addition to sharing needles and syringes, the sexual practices of drug users is another important area that contributes to their vulnerability to HIV infection. Drug users tend to be sexually active, and their condom use is often very low. In some countries, condoms are often used in sex with commercial sex workers but not with regular partners. Unprotected sex is often perceived to be less risky than sharing needles and syringes. A high prevalence of sexually transmitted infections among drug users reflects their unsafe sexual practices. They and their partners often act as a bridge to transmit HIV to other populations such as commercial sex workers, clients of commercial sex workers, and then to the general population.

The HIV/AIDS epidemic began to spread in Asia in the late 1980s. In a number of countries - China, Myanmar, Nepal, Thailand, and Viet Nam - drug users were the first to be infected; the epidemic then spread from drug-using populations to other groups, and from there to the general population.

Treatment and rehabilitation centres are often not readily available to drug users. In many countries, services provide detoxification only, or treatment is mandatory and carried out in a military style with a strong penal element to achieve total abstinence - strong reasons for drug users to avoid attending. In many regions of Asia, outpatient and substitution treatment as well as aftercare services are virtually absent. If services are available, they are often provided by non-specialists with limited knowledge about drug treatment and HIV/AIDS prevention.