HIV Infection Rates Still High Among Injecting Drug Users

In the three years that he was an injecting drug user, Phoe Htoo (not his real name) shared a needle with just one person—a close friend he grew up with.

The 23-year-old said he and his friend always went to the same house in Hlaing Tharyar Township, on the outskirts of Rangoon, to shoot up, because they considered it safe.

Then, a couple of weeks ago, his friend told him he was HIV-positive and urged him to have a test, too.

“I couldn’t believe my ears when I heard,” said Phoe Htoo, who put off taking the test for a week because he dreaded hearing the possible result.

As he feared, he soon learned that he was HIV-positive like his friend.

Due to a lack of adequate knowledge about the dangers of sharing needles, thousands of injecting drug users like Phoe Htoo and his friend are being infected with HIV in Burma.

According to UNAIDS, one in three injecting drug users is infected with HIV/AIDS in Burma, where an estimated 240,000 people are thought to be living with the deadly disease.

Government figures also show that HIV prevalence is at about 35 percent among injecting drug users; in some areas, the rate is as high as 80 percent.

Intravenous drug use accounts for 30 percent of all new HIV infections in this country, which is the world’s second-largest producer of illicit opium and one of the largest producers of amphetamine type stimulants (ATS).

In Rangoon and Myitkyina, the capital of Kachin State, HIV prevalence among drug users, including injecting drug users, reportedly tripled in 2008 compared with the previous year.

In Myitkyina, HIV prevalence among drug users stood at around 54.5 percent last year, while in Rangoon it was 19 percent, according to figures released by the Ministry of Health.

Experts say that the number of drug users has also increased at a surprising rate in recent years, and that many users are moving away from smoking opium to injecting heroin and taking ATS tablets.

The UN Office on Drugs and Crime (UNODC) estimates that there are around 300,000 drug users in Burma, while some NGOs believe there could be as many as 500,000.

An estimated 50 percent of all drug users are reportedly injecting drug users, according to experts.

In an effort to reduce HIV infection caused by needle-sharing, international and local agencies have been trying to raise HIV awareness among injecting drug users.

Through their outreach programs and drop-in centers, agencies don't just educate injecting drug users about the dangers of sharing needles—they also operate needle exchange programs, collecting used needles and syringes and giving back new ones.

However, challenges remain in terms of the effectiveness of these programs and the government’s collaboration.

“We’re still facing challenges not only in raising HIV awareness among the injecting drug users but also in persuading them to fully apply their knowledge,” said an expert from one international organization that is working on the reduction of HIV risks among injecting drug users.

There are many remote places that have yet to be reached by the agencies, the expert added.

Through awareness-raising campaigns, some injecting drug users know that they should not share a needle with other users in order to avoid becoming infected with HIV.

“Though they might not share a needle when they have enough needles and syringes, they might not apply their knowledge when they do not have access to clean and safe needles,” the expert said.

Some drug users say that one reason they tend to reuse needles is that they fear being arrested by the police when they buy new needles from drug stores.

“Drug users, including injecting drug users, are forced to live in a hidden community,” an official from the Asian Harm Reduction Network (AHRN) said.

While drug users are stigmatized by their communities, they are also arrested and imprisoned by the authorities for using illicit drugs.

Police crackdowns don't just negatively impact on the agencies’ access to injecting drug users—they also drive the users into hiding.

“This kind of law enforcement poses a high risk of increasing HIV infection among injecting drug users since they dare not come out to buy clean and safe needles,” the official from AHRN said.

The 1993 Narcotics Drugs and Psychotropic Substances Law requires drug users to register with government medical facilities to have treatment and rehabilitation. If they fail to register, they could be imprisoned for three to five years.

Since government health facilities are insufficient and poorly equipped, many drug users fail to register even if they want to undergo treatment or rehabilitation. Instead, they continue to live in their hidden communities and facing arrest. If one leaves the health facility without success, one can be arrested and put in jail.