THE HIDDEN CASUALTIES OF THAILAND'S WAR ON DRUGS
Get-Tough Policy Has Kept HIV Infection Rates High, Pushed Addicts
Underground, Far From Help,
BANGKOK -- Bored and despairing in a Bangkok slum, Paisan Suwannawong made
a slow but steady transition from smoking marijuana to smoking heroin 20
years ago. He was soon addicted, and one day when he was in withdrawal and
could not afford to buy more to smoke, a friend offered to share a needle.
Through the next few years of addiction, he started to hear talk that there
was some risk of contracting HIV from a shared needle. But Mr. Paisan, now
38, was in and out of police custody.
"I could not carry a needle around because if the police arrested me, the
charge would be more serious," he told delegates to the International AIDS
Conference in Bangkok last week. And so he continued to share. "When you
are craving heroin, you don't think about anything else," he said. "You
just want to inject." It took 13 years for him to kick the habit.
In a rehabilitation centre, he learned he had contracted HIV. He believes
he got it during one of his two stints in prison, where he injected "almost
every day" amid conditions so oppressive that even non-users were driven to
start taking drugs.
But Mr. Paisan quickly found that there was little help for an HIV-positive
drug addict. Although international AIDS experts have heaped praise on
Thailand because of the country's remarkable success in lowering its
infection rate -- the number of new infections declined by 80 per cent from
1990 to 2000, possibly the best turnaround in the world -- help for
intravenous drug users has not been part of Thailand's response plan. In
fact, it has been quite the opposite.
In early 2003, the government launched a harsh "war on drugs" that drove
injection users underground and helped to keep infection levels among
addicts at more than 40 per cent. (Research suggests there are anywhere
between 100,000 and 250,000 injection-drug users in Thailand today.)
Human Rights Watch says that there have been more than 2,000 unexplained
extrajudicial killings since the campaign against drugs began, and that
thousands more people have been arbitrarily arrested. Thai Prime Minister
Thaksin Shinawatra said when he kicked off the crackdown that drug users
would be considered "a security threat" and ordered his police to deal with
them in a "ruthless" manner, according to a recent Human Rights Watch
report on the issue.
Mr. Thaksin has since said that Bangkok's mind set has changed. "We now see
drug users as patients who require our support and treatment," he said,
promising to start harm-reduction efforts.
But it is unclear whether those efforts will include the provision of
methadone or clean needles, key elements of a harm-reduction plan. There is
still no needle exchange in Thailand, and drug use remains illegal. Those
who are arrested are given a choice of prison or military-run
Consequently, addicts hide and share needles, avoid being tested for HIV
and are unable to get treatment when they develop full-blown AIDS. Just 1
per cent of Thai drug users receive any HIV prevention services, according
to rights groups.
"It's amazing to me that you could do something so damaging as fast as they
did it," said Susan Sherman, a professor at Johns Hopkins University who
works with Thai drug users.
Thailand's combative position on drugs puts the country at odds with the
top international bodies working to check the spread of AIDS, all of which
have recognized that injection-drug users have to be specifically engaged
since they are such a huge source of infection.
"The government talks about prevention -- sure, with men who go to sex
workers. But it's not more than that. And if we weren't having an AIDS
conference here, they wouldn't be scaling up treatment," said Mr. Paisan,
who helped found the Thai Drug Users' Network in 2002. The plan was to
document abuse and mistreatment of drug users by police, but has grown into
a lobby effort for HIV-prevention services.
Mr. Paisan believes that the government's response illustrates a larger
failure to understand the importance of needle-and-blood-borne HIV
transmission. The addict-turned-activist said it is emblematic of
Thailand's treatment of other marginalized groups, such as migrant
labourers and sex workers, none of whom are perceived to be politically
"We live in a country dominated by corporate people . . . the public
perception is that drug users, or men who have sex with men, or migrant
workers, they are not important or influential," he said.
Earlier this year, Mr. Paisan's organization became one of only two
non-governmental organizations in the world to be awarded a grant from the
Global Fund to Fight AIDS, Tuberculosis and Malaria: $1.3-million (U.S.)
that will be used for services such as needle exchange. His group took the
step of applying on its own, the activist said, after the Thai government
refused to consider services for drug users in its own application to the fund.