Even in countries with very high rates of HIV and AIDS, there may be very few AIDS Golden Triangle?
people publicly known as HIV+, and those suspected of HIV may be subject to extreme measures of rejection and persecution in their communities
Supportive self-organisations of people with HIV are well-established in Thailand and some countries of East Africa, but weak or absent in other Asian and African nations
Organisations of people with HIV in Asia and Africa, dedicated to exercising leadership in AIDS education, or to fighting for basic rights, are even more fragile, despite the efforts of the Global Network of People with HIV (GNP+), the International Council of AIDS Service Organisations, and the repeated manifestos of international conferences since 1983. [KD] *
The "War on Drugs" makes HIV spread faster, argues Ken Davis million inhabitants, most of them young, and presumably sexually active. Many regions of the country have a 10% HIV+ rate. As rural populations in the Mekong or drug using activities inside the
The only solution to the African AIDS crisis is to transform the factors which make the population particularly vulnerable to infection. The foreign debt should be written off. IMF-imposed Structural Adjustment Programmes should be abandoned. Health and Education budgets should be increased. Development policies based on social needs, food, water, education and women's rights should be adopted. The corrupt regimes which steal the AIDS treatment budget just like they steal from the rest of the state budget must be swept aside.
In narrow health terms, Africa needs a co-ordinated policy ensuring the widespread availability of the 200 basic drugs identified by the World Health Organisation, and serious disease prevention programmes, concentrating on tuberculosis and sexually transmitted diseases.
The price of anti-viral drugs to treat HIV must be brought down to a level where they are available to African patients. In other words, prices which will not include any profit margin, and generic (non-branded) production processes. Those who worry about extending costly tri-therapy to Africa might be encouraged to know that vaccines, once identified, cost only a few dollars for each dose. * delta are forced to cut opium production, scarcity causes local modes of consumption to switch from traditional smoking, to injection of the "valueadded" heroin, often with shared and contaminated injecting equipment. The most dynamic axis of the epidemic is a South-Éast Asian "corridor" stretching from North East India, across Burma (where 70% of drug injectors are HIV positive), Thailand, Cambodia, Laos Yunnan and Vietnam. This HIV axis thrives on two economies, the trafficking in opiates and in women.
International and domestic political pressures have led several countries to intensify repression of drug-using groups. In Vietnam, the "struggle against social evils" targets drug abuse, prostitution, pornography and gambling as the unwanted side-effects of the reintroduction of capitalism.
The strategy in Ho Chi Minh City, where most HIV in Vietnam in centred, has been to round up all drug users and sex workers, confining them to two large "rehabilitation" and detention centres. Inmates are HIV tested, and those found positive cannot be released Many are newly infected through sexual centres. For the majority of people detected with HIV in Vietnam, the future holds only incarceration until death.
Yet also in Vietnam there have been experiments in allowing the training and development of peer education programs for injection drug users, sex workers and gay men - though more recently these peer groups have become more controlled by local Party cadre. There are trial needle exchange schemes in three districts of Hanoi, and pilot projects in care of HIV positive drug injectors in their family homes.
Similar "harm minimisation" and peerorganising projects for drug injectors have been operating in Nepal, Manipur, Cape Town, Malaysia and Thailand Even in Yunnan, where China's HIV epidemic is centred, highly repressive responses alternate and co-exist with some more effective and pragmatic interventions.
Minimising HIV transmission through drug injection is largely incompatible with the application of repressive meas ures against drug users, because repression prevents the creation of a civil space in which users can organise and inform themselves. *
April 1997 #287 27
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AIDS