Transcript Deadly Denial: Barriers to HIV/AIDS Treatment for People

Deadly Denial: Barriers to HIV/AIDS
Treatment for People Who Use Drugs in
Thailand
Paisan Suwannawong
Thai AIDS Treatment Action Group (TTAG)
August 5, 2008
IAC Mexico
HIV Prevalence in Thailand
National Sentinel Surveillance ‘89 – ‘04
Ministry of Public Health, Thailand
IDU in Thailand
• Only group experiencing no decrease in HIV
prevalence in 20 years
• 25% of all new infections
• No comprehensive harm reduction or policy
• Recent policy: “Drug users are patients, not
criminals” but in reality drug use still treated as
public security, not health problem
• Most drug users in prison or military-run
compulsory drug treatment centers (>50,000 in
2003)
• Ongoing, violent wars on drugs (2,500 EJEs in
2003)
Government Commitments and
Obligations
UNGASS 2006: “little has
been done,” “must act
quickly”
National AIDS Plan 2007 –
2011 recognizes
failures, commits to
harm reduction and
scale up
• Constitutional right to
equal access to health
care, including “quality
public health services”
and protection “against
dangerous infections
diseases “free of
charge” and in a “timely
fashion”
ARV access in Thailand
• People Living with HIV/AIDS including IDU and
allies fought for 10 years to achieve universal
access to locally-produced, generic ARV
• More than 80% of all who need it receive ARV
• Hundreds of comprehensive continuum of
care centers (CCCs) provide ARV
• Yet common for people who use drugs, including
methadone clients (!), to be denied HIV services
including ARV; CCCs do not meet the specific needs
of people who use drugs
TTAG Documenting Violations of IDU
since 2002
Partnership with HRW
• Invite HRW to
investigate violent war
on drugs in 2003,
including violations
against people who use
drugs
• Blacklists, 2,500
extrajudicial executions;
10s of thousands forced
into military-run drug
treatment
Barriers HIV/AIDS Treatment for
People Who Use Drugs in Thailand
• Partnership with HRW
HIV/AIDS Division
• Two field visits
• Interviews with 100
people, 50% people
who use drugs (many
HIV+ and IDU)
• 5 provinces in North,
South and Central
Thailand
Key Areas of Rights Violations
Investigated
•
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Right to health
Right to non-discrimination
Access to information
Failure to create conditions to promote health
Failure to protect confidentiality/Right to
privacy
IDU Experiences Accessing Care
• Don’t want to “risk my life” going to state hospital
where information is shared with police
• Police can and do ask for names of people in drug
treatment, and laws allow this
• Police interfere with drug users attending
methadone clinics, and use clean needles as
evidence of drug use despite legality of possession
• Outreach workers feel unsafe carrying clean injecting
equipment to distribute, fearing police
• Though ARV treatment guideline amendments
in 2004 no longer exclude IDU from accessing
tx, in practise, across the countries, providers
admit they expect active drug users, even
methadone clients, to stop drugs in order to
be eligible for drugs.
• Reasons given include not wanting to “waste”
ARV, fearing IDU will fail to adhere and spread
“drug-resistant” HIV, or simply do not deserve
it due to drug user status.
• Some providers were unaware the guidelines
had been updated
Services for IDU
• CCCs unequipped to serve people who use
drugs; harm reduction programs do not exist.
Drug and HIV services are not integrated, and
information such as ARV/Street
Drug/methadone interactions, viral hepatitis
coinfection, overdose and safer injecting
practises are NOT provided. There are zero
government programs providing clean
needles. Clients do NOT feel safe disclosing
drug use to providers.
“All my (IDU) friends are in prison
or heaven”
• IDU in custodial settings receive substandard
health and HIV care
• Most IDU in custodial settings repeatedly
throughout life
• Pre-trial detention = increased risk for HIV
• Estimated 4,800 HIV+ in prison (pop. 160,000)
• 99% HIV/HCV co-infection
• HCW shortage and lack of guidelines ensure
high morbidity, mortality rates in prison
Prison (cont’d.)
• Lack of harm reduction including opioid
substitution therapy in prison
• Denial of need, promotion of cold turkey
withdrawal
• Failure of referral system to ensure continuity
of care post-release
Recommendations
To government of Thailand:
• Increase harm reduction services for drug
users
• Take concrete steps to reduce drug users’ fear
of seeking health care, ensure rights to
information, address structural barriers to
care (develop clear national harm reduction
policy)
To US Government:
• Lift ban on needle exchange
• Recognize importance of harm reduction and
support int’l. efforts to implement h.r.
including sterile syringes
To United Nations and int’l. donors to Thailand:
• Take steps to ensure Thailand adopt harm
reduction, ART and other HIV/AIDS services
for DU and takes concrete steps to reduce
drug users’ fear of seeking health services
TTAG/HRW Advocacy
• Monitoring government policy
• Initiation of government-NGO prison and HIV
health network to ensure health and HIV
services including ARV
• Shadow report submission to UN health and
drug control agencies
• Participation in international advocacy to
address the health impacts of repressive drug
control policies (UNGASS on drugs, UNAIDS
PCB, etc.)
Acknowledgements
• Thanks to Rebecca Schleifer, HRW, Karyn
Kaplan, TTAG, and all the people who use
drugs in Thailand who experience oppression,
human rights violations, and sickness and
death unnecessarily every day and shared
their stories with us to help advocate for
change.
www.ttag.info
www.hrw.org