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Copyright: 2000 San Jose Mercury News
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Author: Susan Okie, Washington Post

AIDS CASES FOLLOW PATH OF HEROIN IN ASIA

Study: Trafficking Carries HIV To Uninfected Neighboring aAeas

Burma's booming heroin industry is helping to kindle the AIDS
epidemics in nearby countries, including China, India and Vietnam,
with outbreaks of the infection flaring like a fuse along routes used
by traffickers to transport the drug.

A new study by American, Chinese and Indian researchers tracks how
different strains of the AIDS virus have followed the path of heroin
in communities along four separate trafficking routes in the region.
The spread of the human immunodeficiency virus (HIV) accompanies a
rise in local drug use that reflects the flooding of the market with
Burmese heroin.

Burma, also called Myanmar, is the world's second-largest producer of
opium and heroin (behind Afghanistan). It also is suffering from its
own twin epidemics of drug addiction and AIDS. The findings of the
research team, led by Chris Beyrer of the Johns Hopkins School of
Hygiene and Public Health, underscore how quickly local drug
trafficking can carry HIV, the AIDS virus, into remote, previously
unaffected areas.

``In every market town along (a trafficking) route, there are new
outbreaks of drug use,'' said Beyrer, whose findings were published in
the January issue of the journal called AIDS. ``Overland routes
involve local people, highways, local traders and, sadly, have led to
this burgeoning AIDS epidemic for India, China and Vietnam.''

Opium production in Burma doubled in 1989, the year after that
country's authoritarian military government, known as the State Peace
and Development Council, assumed control. Although production has
declined in the past three years, Burma currently accounts for about
80 percent of the opium production in Southeast Asia, according to a
State Department report released last week.

The research project began about 18 months ago, when Beyrer was
invited by the Chinese government to help investigate an HIV outbreak
among heroin users in the southern province of Guangxi Zhuangzu,
bordering Vietnam. ``On both sides of the border, the amount of heroin
had been very rapidly increasing,'' Beyrer said. The upsurge ``appears
to be a phenomenon of the last decade. . . . It's very disturbing to
China.''

This border area is a mountainous rain forest, impossible to patrol,
Beyrer said. Heroin from Laos and Burma was being transported into
northern Vietnam. Chinese users and small-scale traffickers ``were
going across, meeting their Vietnamese counterparts on the other side,
and testing heroin'' by self-injection, often sharing needles.

The researchers used three separate techniques to track the spread of
HIV along the drug-trafficking routes. Using blood samples from
HIV-infected people, they analyzed the genetic differences among viral
strains circulating in the region. They interviewed users, dealers,
drug-treatment counselors and other ``key informants'' about local
drug availability, smuggling routes and injection practices. They also
used data on opium-poppy cultivation compiled by the State Department,
as well as information on heroin trafficking obtained from the CIA,
the Drug Enforcement Administration and foreign intelligence sources.

The researchers found clear evidence that specific viral subtypes
follow the heroin trade routes. For instance, in Guangxi province,
subtype E is common, mimicking the situation in most of Southeast
Asia. In Yunnan province, along China's border with Burma, subtype C
prevails.

When the team traced a new trafficking route all the way to Urumqi in
northwestern China, Beyrer said he pointed on the map to neighboring
Kazakhstan and asked health officials what was the next city on the
highway. ``This epidemic is going to happen there,'' he told them.

``Six months later,'' Beyrer recalled, ``I get an e-mail from the
World Health Organization (saying) that there's been an explosive
outbreak of HIV in Almaty, Kazakhstan, and somehow there end up being
5,000 drug injectors there.''