AIDS EXPERT URGES FOCUS ON DRUG ABUSE

BANGKOK, March 19 (Reuters) - Asian governments must overcome resistance to
AIDS prevention programmes for drug users if they are to prevent explosive
epidemics among addicts spiralling out of control in the rest of the
community, a leading expert warns.

Nick Crofts, deputy director of the Macfarlane Burnet Centre in Melbourne,
Australia's largest virology and communicable disease research institute,
told Reuters drug abuse had been critically important in development of
Asia's AIDS epidemics.

``But it's been so hard to get governments in Asia to respond to the
problem of HIV and AIDS among injecting drug users.

``There's been a terrific response in other areas -- sexual transmission
and so one -- but injecting drug users are usually at the bottom of
everyone's list and usually not on anyone's list,'' he said in a weekend
interview.

Crofts, also director of the Centre for Harm Reduction, which aims to
reduce damage caused by illegal drugs, was in Bangkok to launch the
``Manual for Reducing Drug-Related Harm in Asia.''

The free 350-page manual is the culmination of more than 10 years' research
and offers advice to policy makers and others in the fight against AIDS in
Asia. Details are available from the Asian Harm Reduction Network at
www.ahrn.net

Crofts said the key problem in Asia was many governments -- and U.N.
agencies -- were opposed to programmes adopted successfully in some Western
countries, like needle exchanges, on the grounds they appeared to condone
or encourage drug abuse.

``We need to look at culturally appropriate and politically acceptable ways
of ensuring that if people do inject illicit drugs, they do it with clean
needles,'' he said.

Other approaches included providing methadone as a heroin substitute,
community education and joint programmes with police.

Crofts said programmes intended to wean addicts from drugs were generally
ineffective. ``They're not much better in the rest of the world, but
terribly ineffective in Asia.''

Amphetamine Abuse To Worsen Problem

Adding to the problem was a surge in Asian amphetamine abuse.

``No one has a clue how to deal with amphetamines. More people using
amphetamines means more unsafe sex and HIV reaching groups which would not
otherwise have been at risk.''

The alternatives to concerted action were horror stories like those seen in
military ruled Myanmar, where up to 80 percent of injecting drug users have
tested HIV positive.

``Generally you find the more the repressive the approach the more the HIV
problem and Burma is at the top of the league on the repressive approach
and therefore top of the league with HIV.''

Crofts said the major response of most Asian countries -- jailing drug
users -- only made matters worse.

``They still inject drugs, but with less equipment. They share more and
when they're released they go back to home with HIV and form the nucleus of
explosively rapid outbursts of the virus.

``Approaches to drug problems should recognise AIDS is the worst harm
associated with it. You have to have a balanced approach of reducing
supply, reducing demand and reducing harm.''

This had been shown by the fact that while there had been some success say
in reducing the traffic of drugs from Myanmar through Thailand this has
simply led to a shift in trafficking routes and new HIV epidemics to China
and India.

The pressing need for free needles was seen in the frightful phenomenon of
``shooting galleries'' in countries like Vietnam and Myanmar.

``In Vietnam you have professional injectors who fill a big syringe with a
drug and you go along and buy so much and they'll inject you with that much
then move on to the next person with the same needle and syringe. That
might involve up to hundreds of people being injected with the same
equipment.

``In example after example, country by country, you go from having almost
no HIV among users to having 40, 50, 60, 70 to 90 percent of drug users
infected within a few months.''

The tragedy was this was so easily avoidable.

``We know how to do it. It's not a technical matter but a frame of mind --
a matter of political will. One of the big barriers to getting political
will is that they say well they're only drug users so it doesn't matter.

``It can be even more extreme, as I've heard in Malaysia -- that addicts
and drug use will solve each other.

``But they don't realise the economic effects -- that drug users form a
nucleus for the spread of HIV to other sectors of the community and in most
countries in Asia are the start of the national epidemic.''