The Burmese Connection: Heroin and AIDS
Source : Ce'sar Chalela and Chris Beyrer,Earth Times News Service
(Dr. César Chelala is an international medical consultant and the author of "AIDS: A Modern Epidemic." Dr. Chris Beyrer is the Director of the Johns Hopkins Fogarty AIDS International Training Program and the author of "War in the Blood: Sex, Politics and AIDS in Southeast Asia.")
Burma continues to be among the largest sources of illicit opium and heroin in the world, with poppy cultivation almost doubled since 1988. To make matters worse, drug abuse—particularly intravenous drug use-is on the rise both in Burma and in neighboring countries, and is contributing to the alarming increase of HIV-infected people throughout the region. As a result, the combined impact of heroin and HIV/AIDS has been devastating in the health status and quality of life of people not only in Burma, but in neighboring countries as well.
According to Burmese official statistics, townships have rates of injecting drug use (IDU) behavior among 1.7 percent to 25 percent of adults. Government statistics estimate the drug-addicted population at 66,463. The UN Drug Control Program (UNDCP) and Non-Governmental Organizations (NGOs) working in the health sector, however, estimate their number in 400-500,000.
In 1994, the World Health Organization helped the National AIDS Program measure HIV infection among addicts. The results showed that HIV infection rates among Burma's addicts are the highest among addicts worldwide: 74% in Rangoon, 84 percent in Mandalay, and 91 percent in Myitkyina, capital of the distant Kachin State on the Chinese border. The lethal drugs-AIDS combination is particularly found in ethnic minority areas that are the source of the drugs. Because most addicts are men, this facilitates the fast spread of the infection to women. According to figures form the National AIDS Program, of all the HIV infections estimated to have occurred by 1995, 50 percent were among pregnant women attending antenatal clinics.
According to Dr. Peter Piot, UNAIDS's executive director, Burma has presently at least 440,000 people infected by HIV/AIDS, the second worst AIDS epidemic in Asia after Cambodia. The Southeast Asian Information Network (SAIN) and other non-governmental organizations have confirmed Dr. Piot's estimates. The Burmese junta, however, claims that there are in Burma only 21,503 confirmed HIV cases and 2,854 AIDS cases.
One of the reasons for the very high rates of HIV infection among drug users in Burma is needle sharing, practiced among addicts because of the extremely short supply of syringes in the country. Also, the "paraphernalia" laws in Burma make carrying needles without medical license a crime. Habitual injectors work in "tea stall" shooting galleries, where they reuse needles and transmit HIV through that mechanism.
Another reason for the combination of high rates of heroin use and HIV are the young Burmese internal migrants working in the jade and ruby mines in Shan or Kachin states. People come from all over the country to work in the mines, in numbers that in the dry season may reach the hundreds of thousands. Because many of the HIV positive young adults in central Burma have worked in the mines, they probably have played a key role in the wide dissemination of HIV across the country.
The HIV epidemic among drug users in Burma has led to HIV epidemics in other border countries, such as China and India. The heroin route through western Burma, across the Indo-Burma border, as well as in the northeast Indian State of Manipur, has led to an explosive parallel outbreak of injection drug use and HIV spread. Something similar has occurred along Burma's eastern border, particularly in China's Yunnan province.
The Chinese Ministry of Public Health states that 80.4 percent of all HIV infections in China have been detected in Yunnan, and 60.0 percent of all confirmed AIDS cases. The Chinese province of Guangxi, on the border with Yunnan and Vietnam, has recently experienced outbreaks of HIV and IDU associated with a third route from Burma and Laos, through northern Vietnam and into China. Drug users in the Indian state of Manipur have among the highest rates of HIV infection in India. In 1994, WHO estimated that the HIV infection rate among drug users in Manipur state was 56 percent, and is spreading rapidly into the general population.
Based on studies from a variety of fields, including molecular epidemiology studies of HIV, narcotics investigations, and behavioral studies of injecting drug users, one can assert that Burmese heroin export routes are playing a crucial role in the spread of both injecting drug use and HIV infection throughout South and Southeast Asia. The failure of the Burmese junta to deal effectively with the epidemic of injecting drug use bodes ill for their ability to cope also with the AIDS problem. By all practical measures, the Burmese junta has become a health threat not only to Burma's own citizens, but to those of neighboring countries as well.