Time running out for Asian fight to avert HIV epidemic among IDUs

Photo by bobbyramakantHIV spreads fast once it enters a community of injecting drug users (IDUs). Despite the fact that this is well-documented, some attempts to contain the spread of the epidemic among IDUs have been delayed by up to 20 years.

In some Asian countries, such as Thailand, Myanmar, Cambodia and in four Indian states, there is evidence to suggest that HIV incidence is declining. But the number of HIV-positive IDUs in the same countries hasn’t dropped. In some places, it has increased.

After HIV was first found in IDUs in Thailand, the incidence of the disease went up from zero to 45 percent in less than a year. Once HIV was detected in IDUs in India’s Manipur state incidence rates shot up to 50 percent in six months.

Although it has been clear for some time that HIV spreads quickly among IDUs, responses to the growing epidemic have been too slow to avert the tide of IDU-related HIV, Dr Swarup Sarkar, from the Asian Development Bank, told delegates at the Asian Consultation on Prevention of HIV Related to Drug Use in Goa this week.

While the first case of HIV in Thailand was reported in 1987 there are still no comprehensive harm reduction programs in the country. In Myanmar, the first case of HIV was reported in 1988, but it took another 16 years for harm reduction projects to be implemented and most remain funded by external donor agencies. In Manipur, it took 20 years for a government-funded comprehensive harm reduction responses to the crisis to be developed.

Of the 10 Asian countries that have reported being home to IDUs, only six or seven have needle or syringe exchange programs, just three have opioid substitution therapy programs (OST) and only five or six have peer education programs in place.

“In China, because of the urban-rural divide, people who have access to OST don’t have access to needle syringe exchange programs,” said Dr Sarkar.

In Malaysia, comprehensive harm-reduction programs have been operating for the past two to three years but less than 10 percent of IDUs are being reached. OST coverage in Malaysia might be slightly higher but the reach of syringe exchange and peer education programs is very low.

“In Bangladesh, Pakistan, parts of Malaysia, China and India, and few other Asian countries there is a wonderful opportunity to keep HIV incidence in IDU low [using comprehensive harm reduction responses],” said Dr Sarkar.

The limited involvement of IDUs in program design and implementation is a big impediment to the fight against the spread of HIV. The rift between government policy and harm reduction activities aimed at HIV prevention, treatment and care is also hampering progress.

“At least the service provider and IDUs should be immune to the legal issues”, a delegate at the Goa conference said.

Studies have shown that vertical interventions such as needle and syringe exchange programs or OST result in fewer drops in HIV incidence than combined comprehensive harm reduction approaches.

“If we invest and focus on comprehensive harm reduction responses for IDUs, we can avert a large scale HIV epidemic,” said Dr Sarkar.

Needle and syringe exchange programs and OST could potentially prevent up to 80 percent of new HIV infections among IDUs - currently a mandatory national target for governments to achieve before 2010 as part of the Universal Access framework.

Bobby Ramakant-CNS

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