Reconceptualizing Needles

It is estimated that in Southeast Asia there are 4.9 million people living with HIV, and the number of new infections is rising every day. More AIDS deaths occur in this region than any other region except for Sub-Saharan Africa. At the same time, millions are spent every year waging the war on drugs in Southeast Asia. This policy, however, is working to increase the threat of HIV in the area. By treating drug use as a crime instead of a public health issue, drug users are pushed into precarious positions.
While governments in Southeast Asia espouse many of their drug prevention programs, the war on drugs has inadvertently increased the prevalence of HIV/AIDS amongst drug users. Aggressive drug law enforcement practices aimed at reducing the prevalence of drugs in Southeast Asia drive addicted individuals away from public health services and into environments that promote the spread of diseases. Because the criminalization of the distribution of clean syringes has become integral to the efficacy of the drug war in the region, drug users are pushed to the very margins of society to find the needles they desire for their drug use. As a result, addicts are forced to share used and contaminated needles and syringes, promoting the spread of HIV/AIDS. By waging a war on drugs and treating drug use as a crime, governments have driven people towards riskier drug practices.
Southeast Asian governments’ criminalization of drugs also drives heavy drug users away from health institutions, further reinforcing the issue of HIV/AIDS. By treating drug use as a crime, the public health field becomes imbued with stigmas against drug users, shaming drug addicts away from hospitals. In numerous Southeast Asian countries, health providers are often entitled to refuse patients service based on their drug use, breach promises of confidentiality, requiring patients to be drug-free in order to be eligible for treatment, and use official government registries to list people as current or past drug users, thereby inhibiting their abilities to find jobs. Consequently, drug users have lower rates of antiretroviral therapy use and higher AIDS death rates, showing that by conditioning medical care on drug use as per the war on drugs, people at risk of infection are left out in the cold.
Measures to fight against these issues in the status quo are hardly sufficient. At a 1998 UN special session of the General Assembly, the Association of Southeast Asian Nations established a goal to make the region “drug-free” by 2015; unfortunately, opium production in the Golden Triangle “has doubled over the last ten years”, and in places where opium eradication has been effective, users have simply moved on to using other drugs, mainly methamphetamines. Many studies cite the drastic regional transition from smoking opium to injecting heroin, which has presented a new demand for needles and syringes.
The UN’s Global Synthetic Drug Assessment states that there are increasingly large quantities of amphetamine-like synthetic drugs manufactured in East and Southeast Asia, which have driven overall drug prices down. For example, from 2002 to 2011, lower drug prices increased demand in Thailand, contributing to a rapid rise in the number of HIV-positive people receiving antiretroviral treatment. In Malaysia, two-thirds of the entire HIV-positive population contracted the virus from injecting drugs. The unfortunate failings of the war on drugs have created a scenario where there is a clear correlation between drug use and HIV.
Threading the Needle
The issue is that in many of these Southeast Asian countries, public health and drug policy are on the same legislative chopping block. As a result, with every escalation in the drug war, there is a decrease in funding for public health resources. In numerous countries, such as Myanmar and Thailand, legislative officials have merely paid lip service to public health. In fact, in the vast majority of countries in the area, most of the funding for protecting people from HIV comes from NGOs, rather than the government. In the future, a reduction in funding for the drug war and a reallocation of those funds towards public health may yield tangible benefits.
For the meantime, however, two of the most effective ways of combating the effects of the war on drugs on public health are syringe exchange programs and supervised injection centers. Indeed, even in an early 1997 study, researchers found that HIV prevalence increased by approximately six percent per year in 52 cities around the globe that lacked syringe exchange programs. Countries in the region that already have syringe exchange programs include Vietnam, Thailand, Malaysia, Myanmar, and Taiwan, but such locations require buyers to present certification, a legal status that functionally excludes current drug addicts. The effectiveness of syringe exchange programs has already been established in many countries, such as Estonia, where the number of injectors who came in contact with HIV halved after the introduction of the syringe exchange program. Similarly, supervised injection facilities, where drug users can inject their illicit drugs under the supervision of medical staff and with clean needles and syringes, have proven to increase the number of people pursuing addiction treatment, reduce the percent of people injecting drugs, and decrease the spread of HIV. Through these simple policies, Southeast Asian countries can at least begin to tackle the issue of the spread of HIV via drug use.
By fundamentally changing the way drugs are viewed in Southeast Asia and treating drug use as a health concern as opposed to a crime, it becomes evident that the spread of HIV can at least be slowed. People in the region have had to put up with far too much violence and casualties to bear an ineffective and, in many regards, detrimental war on drugs.
Image source: BBC/Malaysian AIDS Council/International HIV/AIDS Alliance