The Thai authorities are working with UN agencies to not only improve the availability of services after changing the way people are sentenced for drug crimes, but also reduce the stigmatization of people who use drugs and ensure that they have access to services where they are comfortable.
UN news spoke with UNAIDS Country Director, Patchara Benjarattanaporn, and Karen Peters, Regional Drugs and Health Program Officer for the UN Office on Drugs and Crime (UNODC), about opportunities for people who use drugs to access care.
Patchara Benjarattanaporn: New HIV infections in Thailand are decreasing, compared to 2010. However, the decrease is not nearly enough to achieve the end of AIDS by 2030, which is a commitment made by all countries under Sustainable Development Goal three, SDG 3. Therefore, HIV is still a critical health concern.
There are about 57,000 people in Thailand who inject drugs. According to our latest survey in 2020, 7.8 percent of people are infected with HIV. Another infection that is very common among people who inject drugs is hepatitis C, which affects the liver. About 42 percent are infected, which is of great concern to UNAIDS.
Karen Peters: At UNODC, one of the issues we focus on is reducing the health and social consequences associated with drug use by supporting harm reduction interventions. People who inject drugs have a higher risk of contracting HIV because of sharing needles and other risky behaviors, for example, having sex without using a condom.
Patchara Benjarattanaporn: Research suggests that people who inject drugs are 35 times more likely to get HIV than people who don’t inject. Prevalence is high due to these risky behaviors, yet there are other significant structural barriers to accessing treatments. The highly punitive legal framework that existed in the past as well as stigma and discrimination became important factors preventing people from accessing care and services.
Karen Peters: UNODC supports the national response to harm reduction by bringing together a wide range of stakeholders, governments, civil society organizations, and UN agencies to discuss plans to implement harm reduction measures under the auspices of the new law. For example, the Ozone Foundation, headquartered in Thailand’s capital, Bangkok, is a peer-led community-based organization aimed at reducing the harm caused by drugs. It is founded and run by people with experience of using drugs, who provide advice and services in a non-judgmental, non-discriminatory environment. Clients who come to Ozone appreciate the advice of like-minded people.
Patchara Benjarattanaporn: Places like Ozone help reduce the stigmatization faced by people who use drugs and encourage them to seek treatment. A significant change in Thailand’s health system also played an important role. Universal health coverage (UHC) was introduced in Thailand in 2002 and paves the way for comprehensive care, including essential services such as HIV testing, pre-exposure prophylaxis, or PrEP, treatment referrals, and screening and treatment for sexually transmitted infections (STIs) and hepatitis C.
There is still much work to be done; only a small percentage of people who inject drugs are enrolled in antiretroviral therapy, or ART, which is used to treat HIV. In the general population, about 90 percent of people with HIV receive ART, but this is less than 50 percent of people who inject drugs.
Karen Peters: A new narcotics law introduced in December 2021 also shifts the narrative in a positive way around people who use drugs. Historically, Thailand has had very punitive laws criminalizing drug offenders. The new law provides different penalties for drug crimes and alternatives to prison for certain offenses. For the first time, it seems that the health and well-being of people who use drugs is being considered.
Patchara Benjarattanaporn: We work on HIV prevention with many UN agencies in Thailand, especially UNAIDS, UNODC, UN Development Program (UNDP) and the World Health Organization (WHO). We focus on these key groups, these hidden populations, by promoting community-led services, which must be delivered close to the people who need them in a situation where clients do not feel stigmatized. Combining hepatitis C and HIV testing as part of a treatment package under UHC encourages more people to get tested. This integrated approach may also include harm reduction services.
Karen Peters: We discuss strategies and frameworks for implementing community-based treatment. The Ministry of Public Health, Office of the Narcotics Control Board, various civil society organizations, and international donors and technical experts are all sitting around the table advising and suggesting ways in which it can continue in a more sustainable way to get better results for the Thai people.
Patchara Benjarattanaporn: We also focus on supporting the Thai authorities in a national strategy to support these underserved groups, using state-of-the-art research and evidence-based solutions to create high-impact interventions. A multisectoral approach and community engagement are essential to address the issue.
If the government shows a commitment to face the challenges, good things will happen in terms of creating equal access to services and integration of services, and, even more, if civil society and partners like the UN have a voice at the table. In this regard, Thailand can be considered a model for the region.