Replace myths with evidence–based policies on IV drug use

6 September 2004. Related: Conference reports, Treatment access, Injecting drug users, World AIDS 15 Bangkok 2004.

Paisan Suwannawong, Director of the Thai AIDS Treatment Action Group

Speech to the Opening Ceremony, XV International AIDS Conference, Bangkok.

I would like to tell you a little bit about myself. I grew up in one of Bangkok’s biggest slums, not far from here. I saw many people using drugs, but never imagined that I would become a drug user myself. The first time I smoked marijuana, it felt like a challenge because all the public campaigns said drugs were “bad” and “dangerous.” I found it wasn’t true, so I continued to smoke it. Then I started smoking heroin, and became addicted without realising it. I didn’t have any money, I was feeling withdrawal symptoms, and my friend offered to share his heroin and inject me. Yes, it was scary the first time.

I got arrested at least 20 times. Most of the time, I did not have any drugs on me. The police would plant drugs on me and force me to confess, and beat me if I did not sign their document. I could not carry a needle around, because if the police arrested me, the charge would be more serious. I heard about the risk of getting HIV from sharing needles, but when you are craving heroin, you don’t think about anything else. You just want to inject.

I was in prison twice. The conditions were terrible and we had to stay in our cells for more than 15 hours a day. For me, there is nothing worse than losing your rights and your freedom. I am not surprised that people use drugs and inject in prison, even if they never used or injected before. I believe that I got HIV in prison because I injected almost every day there.

Getting off drugs is not easy. Many times, I went into drug treatment just to please my family, to get away from the police, or to take a break because the amount of drugs I needed was getting expensive, not because I wanted to quit; and the attitudes of treatment staff only made me feel worse. Other times, I really did want to quit, but can you imagine how it feels to leave a treatment programme and go back home, with nothing to do? How difficult it is to find a job and explain where you’ve been? My own family would watch my every move; I could see in their eyes they did not trust me. I was too embarrassed to see my friends, whose lives seemed so successful. It was so lonely. I felt I had nothing at those times. The only thing I could think of was to go back to using drugs.

Finally, I got off drugs 13 years ago. I knew I really needed help. I decided to go to a “TC,” or “therapeutic community.” This is how I found out I had HIV. The test still is a requirement for entering the TC. There was no pre- or post-test counseling. In fact, my results were given to my sister, not me. Today, not much has changed. Drug users are still seen as morally weak and bad people. We face stigma and discrimination in society and in the health care setting. We experience constant police harassment and ineffective services. In Thailand, injecting drug users or “IDUs” are the only group whose 50% HIV prevalence has not changed in 15 years. One third of all new HIV infections are IDU-related, and this number is increasing. Yet there has been no effective response from the government.

In a recent war on drugs in Thailand, over 2,500 people were killed extra-judicially in the first three months of the campaign. More than 50,000 people were arrested, hundreds of thousands were forced into military-run rehabilitation centres, and drug users were forced underground and away from services that were already difficult to access. Last year, the Thai Drug Users’ Network developed a proposal for a peer-driven HIV prevention, care and support intervention for injectors, and submitted it to the Global Fund. We had to bypass the country coordinating mechanism and lobby with the help of international AIDS activists to get political support for our proposal. In October, we were awarded a $1.3m grant, but we still haven’t received the money. Even though the Thai government says its current policy is to treat drug users as “patients,” not “criminals,” it is still illegal to be a drug user. We continue to be arrested and offered the choice of prison or military-run rehabilitation centres. Is this harm reduction or harm production?

Every minute, a person is infected with HIV by using a dirty needle. Globally, 1 in 3 of all new HIV infections outside of Africa is IDU-related. In fact, contaminated needles account for the largest share of new infections in Eastern Europe and Asia. The WHO says drug users have an equal right to all levels of care, but in practice, we are denied access to ARV treatment, as well as basic prevention interventions like clean needles. Methadone is still illegal in many countries and should be on the WHO Essential Drug List. There are many harm reduction interventions, including clean needles and methadone, which have been proven to help IDUs stay free of HIV. We need these means of prevention in place now. And we need access to treatment now. Drug users, like other politically, socially, or economically marginalised groups, are easily abused by the government and others, who exploit them for money or services. We often do not enjoy even the most basic human rights. In Thailand, this is true for sex workers, MSM, migrant workers and undocumented citizens as well.

The world we live in today is not a world of sharing but of advantage-taking, profit-seeking, and competition to “get ahead.” It is a world motivated by greed and controlled by corporations, which do not recognise the value of a human being. While an elite few amass enormous wealth, basic needs are denied to many millions. Today, many of our governments are run by this elite, who are more interested in protecting their personal investments than promoting public welfare. They invest public resources in projects whose profits go into the pockets of their friends instead of providing for the welfare of society. Governments privatise our public utilities, as well as our education and health care systems. Social welfare programmes and other forms of assistance become issues of charity, not rights or entitlement. As a result, our public hospitals are overloaded and under-funded, severely compromising the availability and quality of treatment and care offered. Of course, tackling AIDS isn’t just about health care and ARV.

Prevention, harm reduction, poverty reduction and decent living standards are all part of the process; but governments, like the United States, or international organisations, like the WTO, make the task much more difficult. Market-driven policies and the emphasis on “abstinence-only” have already proved to be harmful or, at best, totally useless. It is outrageous that today, conservative groups, especially in the US, are advancing a moralistic ideology that contradicts scientific evidence about HIV prevention. Though condoms and clean needles are the most effective tool we have to prevent the transmission of HIV, programmes that promote them are not funded, or are de-funded. Evidence shows that widespread access to ARV leads to huge improvements in health and quality of life, with significant reductions in health care and other costs, because of improved health and productivity among people living with HIV/AIDS and their families.

The most painful experience I can think of, after living with HIV for 13 years, is being poor and HIV-positive. Again and again, I watched many friends die in front of me, from terrible opportunistic infections, simply because they were poor and could not afford treatment. What kills us is not AIDS, but greed. Multi-national pharmaceutical companies inflate the prices of their drugs without thought for poor people. They use they wealth to influence US and European government policy to ensure that intellectual property rights are weighed in their favour. Other governments say they are too worried about adherence and drug resistance to offer treatment, when the truth is they don’t want to pay or suffer repercussions from their trading partners by breaking patents. Four years ago, Thai people with HIV/AIDS asked the government to use a compulsory licence for ddI, but the government was too afraid of trade and other sanctions from the US. Ultimately, we took Bristol Myers-Squibb to court and won the right to produce tablet-form ddI, locally. In the final judgment, the Thai court ruled that, because patents can lead to high prices and limit access to medicines, patients have the right to sue the patent holder. This was a very important battle that we won. But the war is not over.

Recently, the Thai government entered Free Trade Agreement negotiations with the United States. We know the US unilaterally pushes for intellectual property protection that is stricter than what is agreed internationally. This means that Thailand, now producing generic ARV for most who need it, will no longer be able to sustain this important programme. We are demanding the Thai government refuse to trade away the health of its people by negotiating intellectual property protections for medicines.

The US government and its policies affect the ability of people all over the world to enjoy their basic rights and needs. Many poor countries cannot provide basic services like health care because they have to pay back enormous debt to the US and Western Banks. While thousands die of AIDS everyday from lack of funds, there is unlimited funding for war. Billions of dollars are freely available for the killing and destruction in Iraq, while the Global Fund is out of money. This is because of the broken promises of rich donor countries that refuse to pay their fair share. I have no simple solutions for achieving world peace, but I do know that the US government, led by that criminal, George Bush, wages war and occupies countries like Iraq in the name of peace. The US is too arrogant to listen to the UN, and the Thai government shows its loyalty to the US by sending Thai troops to Iraq.

Four years ago, at UNGASS, after activists demanded an urgent response to the global AIDS treatment crisis, Kofi Annan called on all the world’s governments to develop what he described as a “war chest.” This became the Global Fund. At the last International AIDS Conference, WHO launched its ‘3 by 5’ initiative; yet, today, 6 million people are still waiting for their drugs. AIDS doesn’t wait and neither do we. Faced with the abuse of power and greed of corporations, we cannot wait for our governments to act.

Governments and corporations hate activists because we know what they are up to, and we are pulling the masks of fake concern from their face to reveal their true nature. But to me, activists are to be honoured. Activists are my true friends. They stand by my side when I face discrimination and injustice. They have the courage to stand up to those in power who use their positions for their own benefit. They are the ones who can help provide a way forward to fight AIDS and injustice in this world. Access for all is the theme of this conference and the dream of many of us here. Yes, it’s not easy to achieve in the world we live in today, but the world belongs to all of us to change.

Five years ago, doctors, nurses and many other people told me and my friends that ARV was an impossible dream. Recently, Thailand announced that it would provide ARV to all who need it, starting with 50,000 people by the end of this year. Today, I urge all of us to dream: of a day when our world will be filled with love, sharing and peace. And I believe that when we dream together, our dreams come true.

The webcast of this speech (which was also given at the closing ceremony) is available online:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1185

Human Right Watch on Thailand:
http://www.hrw.org/campaigns/aids/2004/thai.htm

Thailand: Not enough graves: the war on drugs, HIV/AIDS, and violations of human rights. Human Rights Watch Report. Vol 16 No 8, June 2004:
http://www.hrw.org/reports/2004/thailand0704/thailand0704.pdf

CNN report on brutality of Thailands anti-drug policy:
http://www.cnn.com/2003/WORLD/asiapcf/southeast/05/07/thailand.drugs

Links to reports, pictures and transcript of activist groups at the conference:
http://www.actupny.org/reports/Bangkok/