BANGKOK -- Bored and despairing in a Bangkok slum, Paisan Suwannawong made a slow but steady transition from smoking marijuana to smoking heroin 20 years ago. He was soon addicted, and one day when he was in withdrawal and could not afford to buy more to smoke, a friend offered to share a needle.
Through the next few years of addiction, he started to hear talk that there was some risk of contracting HIV from a shared needle. But Mr. Paisan, now 38, was in and out of police custody.
"I could not carry a needle around because if the police arrested me, the charge would be more serious," he told delegates to the International AIDS Conference in Bangkok last week. And so he continued to share.
"When you are craving heroin, you don't think about anything else," he said. "You just want to inject." It took 13 years for him to kick the habit.
In a rehabilitation centre, he learned he had contracted HIV. He believes he got it during one of his two stints in prison, where he injected "almost every day" amid conditions so oppressive that even non-users were driven to start taking drugs.
But Mr. Paisan quickly found that there was little help for an HIV-positive drug addict.
Although international AIDS experts have heaped praise on Thailand because of the country's remarkable success in lowering its infection rate -- the number of new infections declined by 80 per cent from 1990 to 2000, possibly the best turnaround in the world -- help for intravenous drug users has not been part of Thailand's response plan. In fact, it has been quite the opposite.
In early 2003, the government launched a harsh "war on drugs" that drove injection users underground and helped to keep infection levels among addicts at more than 40 per cent. (Research suggests there are anywhere between 100,000 and 250,000 injection-drug users in Thailand today.)
Human Rights Watch says that there have been more than 2,000 unexplained extrajudicial killings since the campaign against drugs began, and that thousands more people have been arbitrarily arrested.
Thai Prime Minister Thaksin Shinawatra said when he kicked off the crackdown that drug users would be considered "a security threat" and ordered his police to deal with them in a "ruthless" manner, according to a recent Human Rights Watch report on the issue.
Mr. Thaksin has since said that Bangkok's mind set has changed. "We now see drug users as patients who require our support and treatment," he said, promising to start harm-reduction efforts.
But it is unclear whether those efforts will include the provision of methadone or clean needles, key elements of a harm-reduction plan.
There is still no needle exchange in Thailand, and drug use remains illegal. Those who are arrested are given a choice of prison or military-run "rehabilitation" centres.
Consequently, addicts hide and share needles, avoid being tested for HIV and are unable to get treatment when they develop full-blown AIDS. Just 1 per cent of Thai drug users receive any HIV prevention services, according to rights groups.
"It's amazing to me that you could do something so damaging as fast as they did it," said Susan Sherman, a professor at Johns Hopkins University who works with Thai drug users.
Thailand's combative position on drugs puts the country at odds with the top international bodies working to check the spread of AIDS, all of which have recognized that injection-drug users have to be specifically engaged since they are such a huge source of infection.
"The government talks about prevention -- sure, with men who go to sex workers. But it's not more than that. And if we weren't having an AIDS conference here, they wouldn't be scaling up treatment," said Mr. Paisan, who helped found the Thai Drug Users' Network in 2002. The plan was to document abuse and mistreatment of drug users by police, but has grown into a lobby effort for HIV-prevention services.
Mr. Paisan believes that the government's response illustrates a larger failure to understand the importance of needle-and-blood-borne HIV transmission.
The addict-turned-activist said it is emblematic of Thailand's treatment of other marginalized groups, such as migrant labourers and sex workers, none of whom are perceived to be politically important.
"We live in a country dominated by corporate people . . . the public perception is that drug users, or men who have sex with men, or migrant workers, they are not important or influential," he said.
Earlier this year, Mr. Paisan's organization became one of only two non-governmental organizations in the world to be awarded a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria: $1.3-million (U.S.) that will be used for services such as needle exchange. His group took the step of applying on its own, the activist said, after the Thai government refused to consider services for drug users in its own application to the fund.
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