The battle to reduce HIV/AIDS among injecting drug users

Communist-ruled Vietnam still has a "window of opportunity" to prevent a generalised HIV/AIDS epidemic among its 82 million people if it makes stronger efforts to prevent the spread of the virus among injecting drug users, a World Health Organization (WHO) expert has said. Located near the heart of the poppy-growing Golden Triangle, Vietnam has an estimated 170,000 injecting drug users and HIV/AIDS prevalence rates among them nationally are around 33 percent, according to joint government and UN estimates. However, the national HIV/AIDS prevalence rate – which reflects the spread of the disease in the wider population – is still just 0.5 percent, relatively low compared to other southeast Asian countries, like Thailand and Cambodia. "We have a window of opportunity to slow down the epidemic," said Dominique Ricard, a medical officer specialising in HIV/AIDS at the WHO office in the Vietnamese capital, Hanoi. "Harm reduction efforts should be increased. Even if you start today, turning the tide among injecting drug users will take years." Ricard hopes that HIV/AIDS prevention efforts may get a boost later this month when Vietnam's parliament is expected to adopt new legislation aimed at strengthening the hands of those advocating so-called 'harm reduction efforts', such as needle exchanges for drug users. Until now, efforts to prevent the spread of HIV among Vietnam's mostly male drug users - and then on to their sexual partners - has been hampered by the traditional view of drug use as a 'social evil' that should be stamped out, mainly through repressive measures against addicts. Vietnam's national HIV/AIDS strategy, which was adopted in 2004, does endorse the provision of clean needles to drug users and the treatment of heroin addiction with methadone substitution. But on the ground, needle exchange programmes and other prevention efforts targeting drug users have made little headway in the face of strict drug control laws. These laws prohibit possession of needles and allow authorities to incarcerate drug users in primitive state rehabilitation centres for up to two years. Grassroots activists working on needle exchange programmes say outreach efforts targeting drug users is hindered by addicts' fear of being identified by authorities and locked up. "There is a tension between the drug control law and HIV/AIDS prevention efforts," said Ricard. "You have a national strategy which allows needle exchange, but you have a very strong drug control law and it is forbidden to carry needles." Meanwhile, methadone substitution projects – which provide addicts with methadone to stop their craving for injected heroin – have yet to get off the ground, despite plenty of studies by Vietnamese authorities about the role methadone can play in curbing injected drug use "It has been a long battle," said Ricard. "Hundreds of Vietnamese have gone to observe methadone programs in other countries. But nobody wanted to take the risk." The proposed new HIV/AIDS law, however, would endorse both needle exchange and methadone programmes, though legislators could still modify the draft. The AIDS law and the drug control law may also then have to be brought into harmony. But Ricard remained optimistic that Vietnam would finally be poised to step up the battle against the virus among heroin users. "As soon as we have a law on HIV/AIDS, it will be easier," he said. "We need a good legal corridor."