While Thailand has received global recognition for its prevention interventions such as the "100% Condom Use" brothel-based programme (a UNAIDS Best Practice) and for significantly reducing sexual transmission of HIV overall, averting millions of new infections, the needs of other highly-vulnerable groups such as injecting drug users have been virtually ignored at the national level. Though high prevalence (currently around 50%) among IDUs has been reported since the 1990s, no effective policy or intervention has led to a decline in HIV transmission in that group. In fact, IDUs make up the largest number of new HIV infections, and this percentage (33%) is growing. Researchers recently commented that if Thailand continues to ignore the epidemic among drug users, the country's AIDS epidemic may be maintained "for many years to come".¹

Pushing drug users underground

The Thai Drug Users' Network

Recently, a group of present and former drug users organised to address the deplorable health and human rights situation in their community. The Thai Drug Users' Network (TDN), formed in Bangkok in December 2002, comprises over 70 individuals representing every region of the country. One of its initial core demands was to withdraw the criteria in Thailand's national ARV implementation guidelines that excluded "high-risk behaviour" groups, specifically injecting drug users, from accessing ARV therapy. In addition to lobbying government health and drug control officials, TDN held several public demonstrations and delivered letters to the Minister of Public Health and the Prime Minister, to bring attention to the historic discrimination of this group in national AIDS policy and the lack of a multi-sectoral approach to resolving it.

At the most recent National AIDS Conference (July 2003), the government declared that only medical criteria, such as CD4 count, would be used to determine with the PLWHA whether they are ready for ARV therapy, and the guidelines were revised. Whether the motivation was from an ethical or practical standpoint (Thailand wants to meet its goal of treating 50,000 people by 2005, requiring a rapid expansion of the current programme), social exclusion criteria are no longer recommended. However, rampant discrimination in the health-care setting still needs to be addressed. Often drug users are denied health care or social services on the grounds that they "must quit" first, yet drug treatment effectiveness using currently available options is poor. Treatment is often compulsory and is not client-centred, and counselling often consists of advice to play sports instead. Public campaigns describe people involved with drugs as a threat to family stability and national security, and communities are encouraged to implement social sanctions such as denying drug users (even former drug users) access to village-based revolving-loan schemes.

Unhealthy policies

TDN focuses on building the capacity of drug users to access and share information and skills necessary for reducing the health and other harms associated with drug use, and for advocating against unhealthy policies that impede their realisation of the highest attainable standard of health care and treatment, and other human rights. They work with the government, NGOs and international allies toward the resolution of their six main demands:

1.Eliminate the policies that promote violence in addressing the drug problem. Investigate each case of murder or other negative consequence following the government's announcement of its War on Drugs.

2.Promote educational campaigns about drugs and drug use that provide comprehensive and factual information. This will result in a well-informed public and not cause drug users to be disliked and discriminated against by society.

3.Change any law or policy that violates or leads to the violation of drug users' human rights, such as mandatory HIV-antibody testing, exclusion from antiretroviral therapy access for HIV-positive drug users, etc.

4.Urgently implement harm reduction programmes that aim to reduce the dangers associated with drug use, and provide information to prevent the spread of HIV among drug users. Establish programmes to make clean needles and syringes available, which will reduce the spread of HIV and hepatitis among injectors.

5.Cover costs related to prevention, care and treatment for drug users, including rehabilitation, detoxification, and substitution therapy, under the national health-care plan.

6.Involve both active and former drug users at all levels to address drug-related problems in Thailand, including policy development.

Thailand's experience of government-civil society partnership will become increasingly significant as it is made more visible at the upcoming International AIDS Conference in Bangkok in July 2004. The very factor that can ensure its success is the full participation of the key human resource, PLWHA, as part of the treatment infrastructure. PLWHA, including drug users, must be empowered to understand and constructively confront the core issues affecting their lives.

The Thai Drug Users' Network works with its key allies in the government as well as NGOs such as the Thai Network of People Living with HIV/AIDS (TNP+), the Thai AIDS Treatment Action Group (TTAG), Médecins Sans Frontières (MSF) Belgium/Bangkok, and the Thai NGO Coalition on AIDS (TNCA), to make Thailand's treatment programme more inclusive and respectful of dignity and equal rights, through focusing on strengthening the capacity of people with HIV/AIDS to play a central role.