Advocacy on Drug Treatment: Thailand

1. Advocacy on Drug Treatment: Thailand Karyn Kaplan, Thai AIDS Treatment Action Group (TTAG) Paisan Suwannawong, TTAG and Thai Drug Users’ Network (TDN) IHRD Partners Meeting Amsterdam, November 13-15, 2006

3. For “Oom” – JunsudaFirst and fiercest Thai woman PLWHA IDU activistDied 2006

4. Thailand

5. Situation: Drugs 2002 • Est.2.2 m. “addicts”; 100,000/yr. in drug tx • 56% Heroin, 60% injectors, >90% male • Methadone detox (forced taper), herbal detox, TC, Matrix, forced cold turkey (prison, detention) 2003 • Major ATS consumption – incl. male and female youth – a political opportunity • Thaksin’s “War on Drugs” – marked by egregious rights violations and switching to alcohol/benzo and other over-the-counter drug use and abuse • MOPH et al. reclassify drugs, increasing legal penalties (Amphetamines, Midozolam, etc.)

6. Situation: HIV • 570,000 HIV+ • 1.5% adult prevalence rate • 50% prevalence among IDU • IDU exclusion from ARV (2002 national guidelines) • >90% Hepatitis C • >MDR-TB in prison • OD fatality ?? • Extreme social exclusion and stigma • “If you died from amphetamine abuse, don’t even think of being cremated here” – sign, Buddhist temple, Trat Province

7. Thai Drug Users’ Network (TDN) • Est. 10 December 2002 - To promote the basic human rights of people who use drugs, in order to be able to live equally and with dignity in society

8. 2003 – 2006 War on Drugs 2,500 killed in first three months -forced military boot camp “rehab” -quotas, reward/punishment -uninvestigated extra-judicial executions -blacklists and unsubstantiated accusations leading to mass arrest - Driven underground, away from services; persistent fear of disclosure to provider - Switched drugs, ways of using: more alcohol, methamphetamine, over-the-counter drugs and injecting methadone, midozolam, etc. • 2003 law “drug users patients, not criminals” - ARV scale up not meeting needs of users - # accessing unknown (tx guidelines excluded IDU in 2003)

9. “Patients, not criminals” law • Legal environment/law enforcement mandate and public health contexts at odds • Methadone/drug tx not covered under universal health care scheme • Insufficient coverage • Provider attitudes and treatment of clients (“they treat us like dogs”) • Police harassment on-site • Providing client names to law enforcement officials • Lack of linkages or effective referrals between drug treatment and HIV services, prison and HIV services • Lack of information or guidelines for providers (ex., ARV/methadone interactions) • Limited tx options (no buprenorphine, etc.) • Lack of harm reduction services (no NSP) or comprehensive, targeted services (even less so for drug-using women or gay/transgendered)

11. Severe rights abuses: forced cold turkey, shackling, differential tx, disproportionate overincarceration, profiling, planting, forced confession, arbitrary arrest and detention, etc. AI excerpt: • On 7 December 2001, two Akha tribesmen, Ateh Amoh, aged 34, and Ajuuh Cheh Cuuh Gooh, aged 42, were forcibly taken by soldiers from their village of Ban Mae Moh, Mae Fah Luang district, Chiang Rai Province, to the 11th Cavalry military camp in order to be treated in a opium detoxification program. According to Ateh Amoh, they were pushed into a small hole in the ground where three other Akha men were already detained. Soldiers then poured water, coal and ashes on the five men and left them there until the evening when they were blindfolded and taken separately for questioning. Mr. Ateh said: • ''The soldiers never talked about the opium detoxification programme. They tried to force me to admit the drug charges by electric shocks to my ears, kicking my face and body, punching me hard in the body and hitting me with a gun handle on my head and chest several times...When they felt that I could no longer stand it because my body was soaked with blood, they took me back to the hole and left me there for a night and a day.''(4) • One man escaped, and as a punishment Ateh Amoh and Ajuuh Cheh Cuuh Gooh were severely beaten again. Ajuuh Che Cuuh Gooh died from the beatings on 9 December and Ateh Amoh spent six days in the hospital being treated for a ruptured lung and other injuries. Army Commander-in-Chief General Sarayud Chulanont acknowledged that some soldiers used ''violent means'', including detaining drug addicts in pits, in treating tribal people alleged to be drug users or traffickers in the Thai-Myanmar border area. He said that investigations would be conducted and those found guilty would be transferred and punished.(5) Other army officers claimed that Ajuuh Cheh Cuuh Gooh died from the effects of opium addiction.

12. Drug Treatment Advocacy • TDN/TTAG/AH GFATM project • Promotion of user involvement in policy solutions • Educating and training users to advocate and document abuses • Harmonization of public health and drug control approaches toward rights-based framework • Advocate for harm reduction policy and legal reform (ex., explicit ordinance supporting legality of NSP) • Demand integration of HIV and Drug Treatment services • Demand drug treatment/MMT guidelines that reflect best international practise • Lobby for government budget allocation to user groups, NGOs and harm reduction work • National and intergovernmental advocacy – use international rights frameworks to demand accountability to obligations (ex., UNCHR); Initiated National Harm Reduction Task Force; held first national Harm Reduction meeting on International Day Against Drugs (2006) • Methadone + Bup. On EDL (int’l. coalition)