Different approaches to drug policy and the Asian HIV epidemic

A quarter of a century ago, Asia and the Pacific, home to almost half the population of the planet, were at great risk of a generalized HIV epidemic starting among people who inject drugs.

This had started among people who inject drugs and then spread to commercial sex workers, their sex partners and then the sex partners of their sex partners. The HIV epidemic in Thailand first started among prisoners who injected drugs but remained undetected while the problem was still only in jails. Many prisoners were released as part of a Royal amnesty to celebrate the King’s 60thbirthday, inadvertently releasing a large number of people recently infected with HIV and at a highly infectious stage.

The prevalence of HIV among people who inject drugs increased in the community from 1% to 40% in just ten months. Only a few years later, one in six male military recruits and one in eight pregnant women in the north west of the country had HIV infection. HIV does not respect national borders so this epidemic then soon spread rapidly in neighboring countries among and from people who were injecting drugs.

In the early 1990s, I participated in a World Health Organisation meeting in Kuala Lumpur, Malaysia on the subject of HIV control among people who inject drugs in Asia. Every country in the region was represented. It was the first ever official meeting to be held on this subject in Asia, many countries in the region were still ruled by communist governments. One delegate after another got up to read carefully and word-for-word their prepared and approved speech.

It was clear that the national representatives had been ordered to only read their officially approved speech and make no other comments. The meeting ran way behind time. Whether communist or capitalist, Hindu, Buddhist, Muslim or officially atheist, the representative of every country argued that HIV would never be a problem in their country and even if it did become a problem, their country would never accept ‘harm reduction’. I was so depressed by this meeting that I briefly retreated to my room.

But a quarter of a century later, every major country in Asia has now accepted harm reduction and implemented and expanded needle syringe programsand community and/or prison opioid substitution programs (with methadone and/or buprenorphine). Coverage is still woeful but improves a little every year. What hasn’t changed is the relentless opposition of ASEAN (Association of Southeast Asian Nations) to harm reduction. ASEAN still aims to make all member states drug free by the end of 2015.

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