Emerging Drug Use Trends and Local HIV Transmission

Global Research Network on HIV Prevention in Drug Using Populations

Dr Nick Crofts presented information on the changing situation of drug use, the response to it, and its relationship to HIV in selected countries in Asia. The Centre for Harm Reduction performed a rapid situational analysis of drug use in several Asian countries and is presently repeating the process in a wider range of countries. The changes in the countries over time were noted. In China both injecting behaviour and HIV in injectors have expanded. Injecting is found along drug trafficking routes and is reaching new populations of people. In 2000 there were 860,000 registered narcotic users in the country. Estimates are as high as three million total IDUs. Heroin is the drug of choice though amphetamine use is increasing. HIV prevalence in injectors is high. There are only a few pilot needle and syringe programs and methadone programs. There are reports that some women sex workers are beginning to inject drugs but this has not been studied. The situation in Vietnam is similar. There has been increased heroin use in the last half decade, especially in the north of the country. Women sex workers, mostly street based ones, are beginning to shoot heroin. Sharing of injecting equipment largely fuels the HIV epidemic in the country. Harm reduction is understood well by many HIV professionals. There have been peer education, needles syringe programs, and methadone projects but there is a constraint of funding, a lack of clarity, and the campaign against social evils makes police harassment common. In Myanmar, there has been recent acknowledgement of the drug and HIV problem by the government. Myanmar is the world's second largest producer of opium. In the 1990s there was a shift from smoking opiates to injecting heroin and shooting galleries began to appear. Estimates suggest that there are between 150,000 and 250,000 injectors in the country. Prevalence of HIV in injectors admitted to drug rehabilitation centres may reach ninety per cent. There are scant resources for developing harm reduction, legal constraints, and a historical emphasis on abstinence. Indonesia is a newcomer to the drug scene. There was little information in 1996. Amphetamines are popular; there are production facilities in the country. The use of heroin is increasing. There are up to two million drug users, half of whom are thought to be injectors. The economic crisis has inflated the prices of needles/syringes five fold. The number of places for injectors in drug rehabilitation centres is increasing. There are methadone pilots but no needle syringe programs yet. Harm reduction is starting to be found in activity plans. In summary, there is a continuing spread of both injecting drug use, new methods of use, and increasing HIV prevalence among injectors in the countries studied. Harm reduction is rarely accepted by local authorities. When it is, harm reduction activities are too small to have an impact.