Kicking the Habit

Kicking the Habit
Drug use and harm reduction policies in Burma
Tom Kramer
Irrawaddy Vol. 13, No. 10, October 2005

Online version with photos

The struggle to combat the twin threats of HIV/AIDS and drug use in Burma is an uphill battle.

With an estimated 500,000 drug users, half of whom are categorized as injecting drug users, or IDUs, Burma has a serious drug problem. To compound matters, the HIV/AIDS epidemic has been spiraling simultaneously, and infection rates among drug users in Burma, especially in Shan and Kachin states, now rank among the highest in the world.

Burma, Thailand and Cambodia have been hit hardest by the HIV/AIDS epidemic in Asia. Burma, however, is the only one of the three where the infection rate is still rising. This is mainly due to the high-risk behavior of IDUs, who commonly share needles and syringes and rarely sterilize them. Such high-risk behavior is especially widespread in the teashops, known locally as shooting galleries, where heroin is sold.

Two of the major obstacles to combating the rise of HIV/AIDS and drug use are a general lack of resources and, maybe less predictably, the legal constraints of narcotics laws.

Drug addiction in Burma is illegal, and the penalties are strict. Treatment is orientated towards abstinence, substitution therapy only recently having been introduced on a tentative, pilot basis. Addicts are required to register with the authorities for compulsory in-patient drug treatment, and failure to register, or respond to treatment, can result in a three to five year prison sentence. Government crackdowns do more harm than good - it is not uncommon for drug users and shooting galleries to flee to the jungle, where they are hidden and out of reach of both the authorities and NGOs.

Heroin is widely and cheaply available and most prevalent in Kachin and northern Shan states and most of the larger cities, while opium - the national drug of choice until the late 1980s - is now mostly used in eastern and southern Shan State and in Kayah State.

Meanwhile, the production of methamphetamine in areas bordering Thailand and China has increased dramatically. Methamphetamine tablets are mainly consumed in neighboring countries, especially Thailand, where they are better known as ya ba, or "crazy medicine", but they are now also easily available in big cities like Rangoon and Mandalay.

While the governments of Thailand and Cambodia responded relatively quickly to the HIV/AIDS epidemic, in Burma this has not been the case. The military regime was slow to respond to the epidemic and long employed a policy of denial. However, in 2001 the government made a significant policy change and listed HIV/AIDS as one of the three priority diseases in the country (along with malaria and TB). Furthermore, the need to address HIV transmission through drug use has made it onto the agenda of the new National Aids Programme of the Ministry of Health.

In recent years, international funding for Burma to combat HIV/AIDS - always a political sticking point - has increased dramatically, and Burma is now one of the three priority countries for the UN Joint Programme for HIV/AIDS (UNAIDS). In 2002, the UN Expanded Theme Group on HIV/AIDS was set up to include the Burmese government, donors and international NGOs. Several objectives were identified, notably reducing the risk of HIV transmission among IDUs and their partners. Then, in 2003 the largely UK-backed Fund for HIV/AIDS in Myanmar (FHAM) was created to support UNAIDS.

However, in the face of such tangible progress, Global Fund’s recent decision to cancel its five-year, US $98 million program in Burma to fight HIV/AIDS, TB and malaria - blaming impractical new travel restrictions imposed on international NGOs - was a major blow. The move has angered many NGO workers in the country who feel US-based advocacy groups have, for political reasons, lobbied to impose restrictions on the Global Fund that would make implementation impossible.

"If this is seen as the impossibility of providing humanitarian aid to Burma [it] will be a major setback to wider humanitarian action in Burma", says Charles Pietri, the UN Resident Representative in Burma. "It is possible to implement humanitarian operations in Burma. It is complicated, necessitates tremendous efforts and time, and it is that level of flexibility that the Global Fund private-public partnership was not able to accommodate, and led to the decision to terminate".

Although the regime has acknowledged the important role NGOs can play in harm reduction activities, there are still many limitations. Among the legal obstacles is the Burma Excise Code of 1905, which prohibits the making, selling, possession or use of a hypodermic needle without a license. In 2001, an order was given not to enforce this regulation, though it remains unclear how efficiently the reversal has been implemented.

As in many other countries, law enforcement sectors in Burma seem to tackle drug policies before the health sectors get involved. Thankfully, there are indications that the Ministry of Health has recently become more open to harm reduction activities. Needle exchange programs run by international NGOs, though still controversial, have started to increase.

So, even though the trend in Burma is towards harm reduction - including needle exchange and substitution treatment - HIV/AIDS infection among drug users remains a sensitive issue for the government. The current capacity of drug treatment centers is woefully inadequate, and access to services provided by NGOs for addicts is restricted by law enforcement regulations, forcing drug users to go underground. The Global Fund could have played an important role in supporting and building up the pilot projects. Instead, international agencies are now desperately looking for means to compensate for their withdrawal.