AIDS OUTBREAKS FOLLOW ASIA'S HEROIN TRAFFIC

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 accompanies a rise in local drug
use that reflects the flooding of the market with Burmese heroin.

Burma, the world's second-largest producer of opium and heroin (behind
Afghanistan), 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 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 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 regime, 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 primary opium-growing region is in northeastern Burma, in areas
belonging to various ethnic groups that are often controlled by local
leaders with their own drug-trafficking armies.

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, 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. Most of the
earliest cases of HIV infection in China were discovered in three border
counties in Yunnan province, among male drug addicts and their wives.

Another route, into northeastern India, was discovered to be "one of the
major heroin routes out of Burma," Beyrer said. "It's also the key route
for the chemical reagents that need to go in" to supply refineries that
make the drug.

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."