HRW report on Thailand: barriers to HIV/AIDS treatment for people who use drugs
Human Rights Watch publicou hoxe un informe sobre os obstáculos que as autoridades tailandesas seguen a poñerlles ós usuarios de drogas para accederen ó tratamento antirretroviral contra o VIH/SIDA.
O informe leva por título “Deadly Denial: Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand”. Copio e pego un extracto da introducción (a negrita é miña):
Thailand is one of the few developing countries to have successfully curbed a runaway HIV/AIDS epidemic, cutting the number of new infections by almost 80 percent since 1991. Among injection drug users, however, prevalence has not dropped, and remains at nearly 50 percent—virtually unchanged over the past two decades.
Thailand is also a global leader among developing countries in providing antiretroviral therapy (ART), with more than 180,000 people living with HIV/AIDS on ART by mid-October 2007. More than 80 percent of people in need of ART in Thailand are receiving it, making it one of three developing countries worldwide–and the only one in Asia–to achieve this level of coverage. Thailand has also been hailed as a model with regard to its efforts to provide antiretroviral drugs to HIV-positive women to prevent mother-to-child transmission, reaching 89 percent of women who need it. Yet despite repeated proclamations to provide access to antiretroviral treatment to all who need it, the government of Thailand has failed to systematically extend treatment to drug users.
Thailand has refused to implement proven, evidence-based strategies to reduce HIV risk among drug users as promoted by the World Health Organization, UNAIDS, and the UN Office on Drugs and Crime. It has in the past systematically blocked access to HIV treatment for drug users. Most pointedly, in 2003 the Thai government launched a repressive and inhumane “war on drugs” that included thousands of extrajudicial killings of alleged drug users or dealers, and drove drug users further underground and away from effective HIV/AIDS prevention or treatment. The result of these policies is an HIV epidemic among drug users that mars Thailand’s reputation as a success story in the global fight against AIDS. Indeed, the Thai government has publicly acknowledged that the HIV infection rate among people who use drugs “has sustained itself at an unacceptably high level in Thailand.”
In response to advocacy by people who use drugs, the Thai government has taken steps to reduce some of the barriers to health services. In 2004, for example, the Thai government rescinded a national policy that explicitly permitted the exclusion of injection drug users from ART programs.
Thailand has repeatedly pledged to address its failures to prevent HIV infection or extend treatment to drug users. In its report to the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS in 2006, the Royal Thai Government acknowledged that “little has been done to address specific challenges” of providing HIV testing and counseling, care and support, and ART for injection drug users, and acknowledged that it should “act quickly” to scale up outreach, related harm reduction, ART, and other HIV/AIDS services for injection drug users. At the Special Session itself, the government pledged to promote and implement HIV prevention and harm reduction services for all those who need them, to increase access to methadone maintenance, and to enable and empower drug users to take measures to reduce unsafe injecting practices and to enter treatment programs. The government’s 2007-2011 National AIDS Plan, introduced in June 2007, again recognized its failures to address HIV and AIDS among drug users and renewed its commitments to ensure HIV and AIDS services to them.
Research by Human Rights Watch and the Thai AIDS Treatment Action Group (TTAG) found, however, that drug users still face serious obstacles to obtaining needed care. Many healthcare providers either do not know or do not follow the revised HIV/AIDS treatment guidelines and therefore continue to deny antiretroviral treatment to people who need it based on their status as drug users, even if they are in methadone treatment programs. HIV and drug treatment care providers are grossly under-informed and untrained in issues central to the appropriate care and treatment of people who use drugs, and they continue to let their negative attitudes toward people who use drugs inhibit drug users’ right to healthcare services. For example, some healthcare providers denied drug users access to ART because of an erroneous conviction that the treatment would be “wasted” on “unreliable” drug users who would fail to adhere to medication, develop resistance to it, or spread drug-resistant HIV strains.
HIV clinicians and drug treatment providers reported that they did not have the knowledge or training they needed concerning interactions between ART and methadone or illicit drugs and the associated consequences. Reflecting another dimension of the same problem, Human Rights Watch and TTAG also found that drug users who do receive ART are unlikely to tell their physicians about their drug use, or to seek information about drug dependence treatment from their ART provider, out of fear of reprisal. This fear is not unfounded: our research confirms that many public hospitals and clinics share information about drug use with law enforcement, both as a matter of policy and in practice. Some ART providers operated a “don’t ask, don’t tell” policy toward drug users, refusing to inquire about patients’ drug use or drug treatment history, in some cases despite knowledge or suspicion of current drug use or methadone treatment.
In this setting, information sharing between drug users and clinicians is a dangerous “catch-22”: in a context where police both formally and covertly gain access to hospitals’ information about individual drug users, drug users as well as sympathetic healthcare workers have good reason not to disclose any information about drug use. However, failure to ensure conditions in which safe exchange of information is possible can compromise drug users’ access to adequate HIV and other healthcare services, and can expose ART recipients to dangerous drug-drug interactions. [...]
