Thailand ignores HIV epidemic in drug users
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《英国医生杂志》
The opening of the 2004 international AIDS meeting in Bangkok, with its elephants, Thai dancers, and loud drumming, was intended to be a fanfare for Thailand's new commitment to treat 100% of its citizens who had AIDS with regionally produced generic antiretroviral drugs. Prime Minister Thaksin Shinawatra even announced that Thailand would help neighbouring countries to treat their own cases.
But, although his promise delighted some, not everyone shared his optimism. Thailand has dramatically reduced the levels of HIV infection among sex workers and reduced men's use of brothels (where some fathers would initiate their sons to sex), but it has neglected substantial HIV transmission among and from injecting drug users.
Also, Mr Shinawatra did not announce any provision to increase the number of doctors trained to monitor and treat HIV/AIDS. Thailand has only one trained doctor for every 6700 people infected with HIV, says Treat Asia, a programme of the American Foundation for AIDS Research.
Paisan Swannawong, director of the Thai Drug Users Network, was in tears during his speech, the last of the ceremony, for which most delegates did not stay.
"In a recent war on drugs in Thailand, over 2500 people were killed extra-judicially in the first three months of the campaign... are the only group in Thailand whose 50% prevalence has not changed in 15 years," claimed Mr Swannawong.
Harm reduction—the provision of clean needles and other support—is the approach by UNAIDS to HIV transmission among injecting drug users, but that has not been Mr Shinawatra's method until now.
Mr Shinawatra announced the creation of a harm reduction programme, with help from the United Nations and nongovernmental organisations. But, said Mr Swannawong, "although the government says its current policy is to treat drug users as patients, not criminals... we continue to be arrested and offered the choice of prison or military-run rehabilitation centres. Is this harm reduction or harm production?"
Kevin Frost, director of Treat Asia, told the BMJ that his concern was proper care for HIV patients who are taking antiretroviral drugs.
It would be hard to make a dent in a figure of 6700 HIV positive people per trained doctor, he admitted, but "even family members can be trained as `buddies' in treatment programmes to help ensure compliance and making sure patients take their drugs regularly and on time."(Robert Walgate)
But, although his promise delighted some, not everyone shared his optimism. Thailand has dramatically reduced the levels of HIV infection among sex workers and reduced men's use of brothels (where some fathers would initiate their sons to sex), but it has neglected substantial HIV transmission among and from injecting drug users.
Also, Mr Shinawatra did not announce any provision to increase the number of doctors trained to monitor and treat HIV/AIDS. Thailand has only one trained doctor for every 6700 people infected with HIV, says Treat Asia, a programme of the American Foundation for AIDS Research.
Paisan Swannawong, director of the Thai Drug Users Network, was in tears during his speech, the last of the ceremony, for which most delegates did not stay.
"In a recent war on drugs in Thailand, over 2500 people were killed extra-judicially in the first three months of the campaign... are the only group in Thailand whose 50% prevalence has not changed in 15 years," claimed Mr Swannawong.
Harm reduction—the provision of clean needles and other support—is the approach by UNAIDS to HIV transmission among injecting drug users, but that has not been Mr Shinawatra's method until now.
Mr Shinawatra announced the creation of a harm reduction programme, with help from the United Nations and nongovernmental organisations. But, said Mr Swannawong, "although the government says its current policy is to treat drug users as patients, not criminals... we continue to be arrested and offered the choice of prison or military-run rehabilitation centres. Is this harm reduction or harm production?"
Kevin Frost, director of Treat Asia, told the BMJ that his concern was proper care for HIV patients who are taking antiretroviral drugs.
It would be hard to make a dent in a figure of 6700 HIV positive people per trained doctor, he admitted, but "even family members can be trained as `buddies' in treatment programmes to help ensure compliance and making sure patients take their drugs regularly and on time."(Robert Walgate)