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Thursday, 15 June, 2000, 16:40 GMT 17:40 UK
Aids explodes on trafficking routes

Aids is following heroin routes into remote areas
By BBC News Online's Mangai Balasegaram

About a year ago, researcher Chris Beyrer predicted a new outbreak of the Aids epidemic in a remote and seemingly unlikely area - Almaty, in Kazakhstan, Central Asia.

He did it simply by looking at a map.

Dr Beyrer led a study looking at the link between drug trafficking routes in Asia and outbreaks of infection of HIV, the virus that leads to Aids.

"On the map, the most logical place where one of the routes would continue was Almaty," explained the director of the John Hopkins Fogarty International Aids training and research programme in the United States.

The risk of HIV being transmitted among dug injectors sharing needles is very high
"I said, 'Give it a year'.

"Six months later, I got an e-mail from a colleague in the UN saying there was a big outbreak there."

Dr Beyrer's study found "about a 100%" likelihood that an uptake of heroin use, followed by explosive outbreaks of HIV infection, would occur in communities living along drug smuggling routes.

Many of the communities are poor and unprepared to cope with an epidemic.

"The sad news is that it looks like when heroin is widely available and cheap, people start using it," he said.

"People would like to say it's a social problem, that it's personal, but we've found no community immune."

Rapid infection

Dr Beyrer said the new epidemics spread rapidly, with HIV infection rates among drug injectors leaping from 1% to 40% in just one year.

Two remote towns on drug trafficking routes recently hit by HIV outbreaks include Irkutsk, in southern Siberia, and Urumchi, the capital of China's Xinjiang province.

Remote towns in China now face an HIV epidemic
"Urumchi is a remote place, not considered to be at risk for any reason. Yet it has the second highest HIV prevalence rate in China after Yunnan," said Dr Beyrer.

Irkutsk also has the second highest prevalence rate in Russia.

Drug use lies behind the majority of HIV infections in China, Vietnam and Malaysia, accounting for well over 60 per cent of infections, official figures report.

And in many areas in Asia, including Thailand which has over 800,000 people with HIV, the epidemics began among drug injectors before spreading to the general population.

Fingerprinting the virus

The researchers tracked different strains of HIV in infected people living on four drug trafficking routes out of Burma.

"We looked at genetic sequencing, which is rather like fingerprinting.

Drug addicts
Burma's drug trade is fuelling addiction as well as an HIV epidemic in Asia
"Then when we overlaid the map of HIV sub-types and heroin routes, we got the same map," Dr Beyrer said.

"In Urumchi, everyone studied had a virus extremely closely-related. We identified it from the outbreak in Yunnan."

Trafficking routes lead from Burma into Yunnan - the neighbouring province of China - then go either east to Nanning or Hong Kong, or north to Urumchi.

The US State Department says Burma produces about 80% of south-east Asia's heroin.

Potential disaster

Dr Beyrer warned of a "potential public health disaster" as HIV infection spreads from drug injectors to the wider community through sexual contact.

He said most countries affected "didn't care about drug users" and simply incarcerated them.

Methadone has had a dramatic effect in bringing down HIV rates
Treatment programmes were extremely rare.

"So much so that methadone - the bedrock of heroin treatment, detox and management in the West - is illegal in China, Vietnam and Burma," he said.

Vietnam is the only Asian country with a needle exchange programme, which has been shown to prevent HIV infection.

"There are very few effective interventions in Asia," said Ton Smits, of the Asian Harm Reduction Network, which works on HIV prevention among drug injectors.

"We're facing a major challenge here. There's real cause for concern."

Dr Nick Crofts, deputy director of Mcfarlane Burnet Centre for Medical Research in Melbourne, said effective HIV prevention programmes in Australia had resulted in very low infection rates among drug users.

"People haven't learnt they can stop this epidemic," he said.

"The evidence is that if you give drug users the means and opportunity to change their behaviour, they will. Getting people to change their sexual behaviour is much harder."

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30 May 00 | Asia-Pacific
Vietnam set for record drugs trial
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