Half of all injection drug users in Thailand are thought to be HIV-positive. However, AIDS activists say the country's war on illegal drug use and discrimination against drug users make it harder for many to get lifesaving treatment. Aaron Goodman reports from Bangkok.
Thailand has been hailed as a global leader for cutting HIV infection rates by nearly 80 percent since 1991.
In addition to an aggressive program to encourage condom use and discourage risky behavior that can expose people to the virus that causes AIDS, the government also provides free antiretroviral therapy, or ART. More than 180,000 people with HIV receive the therapy.
But half of Thailand's 100,000 to 250,000 injection drug users are believed to be HIV-positive, and some AIDS activists say the government does little to help them.
Human rights groups say that in 2003, nearly 3,000 suspected drug users and dealers died in extrajudicial killings in the Thai government's war on illegal drug use. Some addicts went into hiding, and without clean needles or services, many contracted HIV.
Human Rights Watch and the Thai Aids Treatment Action Group say that HIV-positive drug users regularly are denied ART at public hospitals.
Karyn Kaplan is director of policy and development with the Thai Aids Treatment Action Group.
"The people we work with who are drug users, many of them injecting drug users, almost all of them are HIV-positive, yet none of them have access to the services they need," she said. "And this is because the government has neglected the issue of injecting drug users and HIV even though there's been a 20-year epidemic raging amongst this community."
Rights activists also say healthcare providers often share medical records with police, which makes drug users reluctant to seek treatment. And heroin addicts seeking methadone treatment to break their addiction say they are often harassed or arrested by police.
One HIV patient at Mit Sampan, a support center for addicts in Bangkok, says it was challenge for him to get antiretroviral treatment.
He says that when he told a nurse he was infected by using dirty needles to inject drugs, he was refused ART. He says the medical workers said he had to stop using methadone. It took five attempts to get treatment before he found a doctor who said it was not a problem for him to take methadone along with ART.
Dr. Petchsri Sirinirund is senior expert in preventive medicine at Thailand's Department of Disease Control.
She says HIV-positive drug users receive treatment under the country's universal ART program. She also notes the National Health Security Office will begin publicly funded methadone treatment for addicts next year.
She does not deny that some healthcare providers may still turn away HIV-positive drug users. But she says the government has adopted programs to train workers to treat such patients.
"We have worked closely with the people with HIV network trying to look at the perspective of the people with HIV, what kind of things do they need us to improve," said Dr. Petchsri. "Our staff have to understand, and also have the positive attitude towards them."
Paisan Suwannawong is director of the Thai AIDS Treatment Action Group. He says the government needs to do more, because many people still are not getting treatment.
He says he feels angry to have to see his friends everyday getting sick and weak, and lacking the services that they deserve. He says the government claims it treats drug users as patients and not criminals, but at the same time it wages war against addicts, using drug war policies as political popularity stunts.
Rights groups say that to help all HIV patients, the government must end human rights violations against people who use drugs. They also say the government must work to eliminate prejudice toward drug users.