Revisiting ‘The Hidden Epidemic’ 
– a situation assessment of drug use in Asia in the context of HIV/AIDS

Date of release 8 February 2002
Author: Gary Reid and Genvieve Costigan
Publisher: The Centre for Harm Reduction, The Burnet Institute, Australia


(Extract on Myanmar, pp 140-150)

The full report, covering several countries, is online at  http://www.chr.asn.au/Rapidassessment.pdf (PDF file, 912K)
on the website of the Centre for Harme Reduction: http://www.chr.asn.au/projects.html

Myanmar

Comparisons: 1997 Versus 2001

Myanmar is considered to have one of the most severe HIV epidemics in Asia due to the high prevalence of injecting drug use and HIV among drug users. Reports suggest there are approximately 150,000 to 250,000 IDUs in Myanmar. In 1997 HIV prevalence among IDUs was 54%, in 2000 this had risen to 63% and in some states was among the highest rate in the world, at up to 96%. National surveillance data shows that IDUs in Myanmar often become infected with HIV early in their injecting careers which is rarely seen elsewhere in the world.

Afghanistan has overtaken Myanmar as the world largest producer and supplier of opium and heroin but Myanmar is still in second place. Throughout the 1990s the drug of choice in Myanmar shifted from the traditional smoking of opium, sometimes through a water pipe, to the smoking and injecting of heroin. In 2001 there was increasing production of methamphetamines which are easy to get on the streets of Yangon and Mandalay. In 1997 injecting began to be seen, not only in the cities, but also in rural areas where shooting galleries were popular. In 2001 this was still the case and usually there was only one set of injecting equipment (often homemade) which was shared. Needles and syringes can be purchased without a prescription, although they are often in short supply, and they are illegal to carry: possession of a needle and syringe may result in a fine and/or six months in prison.

The penalties for drug use in Myanmar are strict as the government has criminalized addiction. An addict must register with the authorities and undertake inpatient drug treatment. Failure to register, or being unsuccessful in treatment, can result in a three to five year prison sentence. It is estimated that drug offenders make up 70% of the prison population where transmission of HIV contributes significantly to the epidemic. The government in Myanmar has been well aware of the link between HIV and IDU since the late 1980s. However, it is only recently that there have been significant changes in the government’s attitude. In 2001 the government announced that HIV was of national concern with discussion of a multi-sectoral task force to be established to implement a range of activities aimed at IDUs and their families. But scant resources, the legal constraints of narcotic laws and a focus on abstinence-based treatment options are constraining factors.

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History

The earliest recorded evidence of opium being transported and used in Burma is in the late 16th century. By the early 17th century the Dutch East India Company were documenting the profitability of opium in Burma. The cultivation of opium in the north-eastern part of the country is believed to have been introduced by Chinese traders from the Yunnan province where its own common cultivation of opium poppy was documented in 1736. Burmese kings discouraged the use of opium and before colonisation by the British in 1852 opium use was not widespread (Khant and Ne Win 1978; UNODCCP 2001). After the annexation of lower Burma, British administrators began importing large quantities of opium from India, establishing a government controlled opium monopoly. In 1878, the Opium Act made it illegal for any Burmese to smoke opium, which could only be sold to registered addicts, most of whom were Chinese. Before the ban, opium use was widespread and viewed as a scourge on the country. By 1906, the trading of opium was declared illegal but this had minimal impact (Spencer and Navaratnam 1981; McCoy 1991; UNODCCP 2001).

In 1921, the sale of prepared opium from government opium shops ceased, but at no stage was the cultivation of opium poppies eradicated; the Shan State territories, which included the Wa States in the northern part of the country, continued cultivation (Khant and Ne Win 1978). In 1930, there was still an estimated 100,000 opium addicts in the country. In 1948, after independence, the government planned to eradicate opium cultivation within five years but without success. In 1950, and for the next 10 years, the Chinese Nationalists settled into the Burmese Shan states and expanded opium production and trade. From the early 1960s until the mid 1970s U.S. troops in Vietnam, and a growing demand in the West, accelerated the heroin and opium trade. In 1973 it was estimated that 34% of all U.S. troops in Vietnam commonly used heroin. As a consequence of the prospering trade in illicit trade the local population became affected and epidemics of heroin use was found in the large cities of Burma (Khant and Ne Win 1978; McCoy 1991; Lintner 1993; UNODCCP 2001).

In 1977, there were 20, 269 drug users registered with the health department of Burma and 10 years later this figure had more than doubled (UN 1991). The ruling Burmese Socialist People’s Party collapsed in the second half of the 1980s. In 1988 the State Law and Order Restoration Council (SLORC) came to power and from that time heroin use became widespread among youth. In the late 1980s the number of heroin users was estimated at 30,000 and by the early 1990s this figure had increased to 160,000 (McCoy 1991; Lintner 1993).


Current Situation

Myanmar is the second largest producer of illicit opium and heroin, despite a sharp (40%) decline in production since 1996. In the past four years cultivation of opium has declined by nearly a third and in 2000 the potential yield was 1,085 compared to 1,750 in 1997 (Narcotics 1998; Narcotics 2001). In 2001 however, the United States opium yield survey reported that Myanmar currently represented 68% of the world’s opium production (80% is produced in South East Asia) and that Afghanistan only produced 6% (US Department of Agriculture 2001). This information contradicts other current literature where is it acknowledged that Afghanistan is the world’s largest opium producer accounting for 72% of the world’s illicit opium supply. (Narcotics 2001; UNODCCP 2001). Although the Taliban imposed a complete ban on opium cultivation in 2000, and the current conflict will no doubt destabilise opium production for some time, the UNDCP estimated recently that Afghanistan may have stockpiled as much as 60% of its opium production each year since 1996 (Bach 2001) and so is likely to remain the major supplier of opium for the world.

The decline in opium production in Myanmar is not solely the result of government efforts to eradicate the crops but is linked to recent adverse weather conditions affecting the areas during the planting season (UNDCP 2000; Beyrer et al. 2000; Narcotics 2001). The majority of opium poppy is found in the mountainous Shan plateau, which extends the entire length of the Shan State from the Chinese to the Thai border. It is frequently tended on a small scale by peasant farmers belonging to the various ethnic hill tribes (nearly half the population of Myanmar is believed to have an ethnic minority background). It is estimated that up to 300,000 of these people depend on opium poppy cultivation as a cash crop to supplement their subsistence existence (Department of Foreign Affairs 2001; UNODCCP 2001; Beyrer 2001). Recently western Myanmar has also become an important area for opium cultivation (Beyrer et al. 2000).

Armed groups are often found controlling the opium growing areas and what is not consumed by the locals is transported to various refineries located near the border of China and Thailand and transformed into heroin. For many indigenous people living in this area opium has been used for medicinal and ceremonial reasons and has become an integral part of the culture. Over time heroin use has become increasingly common in these areas. Most heroin is produced in small mobile laboratories, it is then largely trafficked through the porous Chinese and Thai borders. In 1999/2000 the Myanmar government destroyed 21 heroin refineries (Morineau and Prazuck 2000; UNDCP 2000; UNODCCP 2001).

The Central Committee for Drug Abuse Control (CCDAC) has found that heroin and opium are the main drugs of choice. It is reported that heroin tends to dominate in the Kachin State, in the Northern Shan State and in most of the large cities. For example in 1997, in the capital Yangon, 98% of those at the treatment centre used heroin. In the City of Myitkyina another study showed that in 1991 heroin use represented 0.7% of the total and by 1997, 95% were using heroin. Opium use is believed to dominate in the Eastern and Southern Shan State and in Kayah State. The pattern of drug use has tended to follow the drug trafficking routes and the availability, affordability and accessibility of the drugs (Porter 1994; UNAIDS and UNDCP 2000; Dorabjee 2001).

An increasing amount of methamphetamine production is taking place mainly in the Wa region and southern Shan State and most is trafficked to Thailand across the land border. There are also increasing discoveries of methamphetamine tablets being trafficked through to China, Laos, Cambodia, India and Vietnam. The current high rate of seizures show the use of methamphetamine may also become a serious problem and is spreading inland from the border areas; in 1999/2000 56 million methamphetamine tablets were seized by government authorities (UNAIDS and UNDCP 2000; UNDCP 2000; Narcotics 2001; UNODCCP 2001). Laboratories in the Wa territory are believed to be producing hundreds of thousands of these tablets each day. Each methamphetamine tablet costs about (U.S$ 0.08) to produce and sells in Bangkok for around U.S$3.00 (Cooke 2000). Stories are told of occupational amphetamine use among miners and seafarers, and of the easy availability of amphetamines on the streets of Yangon and Mandalay. With both heroin and methamphetamine precursors, chemicals are required and acetic anhydride and ephedrine respectively are sourced from China and India (Narcotics 2001). Other drugs used in Myanmar include, morphine, pethidine, cough mixtures containing codeine, marijuana, ephedrine, phensedyl, opium oil, stimulants and tranquillisers (UNAIDS and UNDCP 2000; UNODCCP 2001; Ministry of Home Affairs 2001).


Drug taking practices and risk factors

Throughout the 1990s the drug preference has gradually shifted from the traditional smoking of opium sometimes through a water pipe to the smoking and injecting of heroin. This transition has occurred either as result of cost or the desire for an instant effect. Opium use still remains popular as shown from the national data of 1998; among the registered drug users; 60% used opium and 30% used heroin (UNAIDS and UNDCP 2000; UNODCCP 2001). However, in some areas of the country such as Kachin State, in northern Myanmar, figures from a detoxification centre show 96% used heroin. Among this group 40% inhaled, 47% injected and the rest used both methods. The study showed a tendency for drug users to smoke/inhale heroin for the first year and then move onto injecting. For those injecting, 14% used the blow pipe method in which a rubber hose is fitted to a needle, blood is then drawn into the hose, mixed with heroin and then blown back into the vein. The blowpipe is then systematically passed around to other drug users in attendance (Morineau and Prazuck 2000). Other methods have included using eyedroppers with an attached needle. Most of this equipment is impossible to sterilise and consequently the risk of HIV infection is great (UNAIDS and UNDCP 2000).

In the mid 1990s it was reported that many drug injectors had their first injection from a professional injector and that these injectors were used by drug users when they were away from their home area. Many professional injectors work in a drug injecting tea shop or ‘shooting gallery’ where for a fee, a drug user is administered with heroin. In some ‘shooting galleries’ heroin is only sold on the condition that it will be consumed on the premises, which presumably reduces the risk of police activity. The risk of HIV in such environments remains great as sterilisation of the various injecting paraphernalia items is rarely a consideration. Recent reports indicate that little has changed with high risk behaviours in ‘shooting galleries’ still widespread and access to such sites to implement HIV prevention activities still proving to be both sensitive and a challenge (Stimson 1994; Prazuck 1997; Morineau and Prazuck 2000; UNODCCP 2001).

The sharing of needles and syringes remains widespread and a recent study showed that 61% of IDUs using heroin shared their equipment. The same study showed that the rate of sharing could relate to occupation; among the farmers it was 91% compared to non-farmers, which was 46%. The results of the survey also showed that for those with experience of more than one detoxication treatment the rate of sharing was 69% and for those in treatment for the first time it was 55% (Morineau and Prazuck 2000). Earlier studies have shown similar sharing practices with many using the same needle for several weeks until it became blocked or blunt. For those cleaning their injecting equipment the results are nearly always inadequate to prevent HIV transmission (UNDCP 1994; Southeast Asian Information Network (SAIN) 1995; SAIN 1998). The modification of HIV risk taking among IDUs has, however, been achieved at the Yangon Drug Dependency Treatment and Research Unit. In 1992 it was found 95.7% had ever shared drugs and injecting equipment and by 1996 this level had been reduced to 70.6% (Doe 2001).

How freely available needle and syringes are to buy probably depends on the area of the country. Some reports show that in the markets of large towns needle and syringes are on open sale along with a variety of injectable preparations but some drug users considered them expensive (Stimson 1994; UNAIDS and UNDCP 2000). Other reports suggest an extreme shortage of such equipment (SAIN 1995; SAIN 1998) and in remote parts of the country this is likely to be the case. A major factor compounding the high rate of sharing is that it is illegal to possess a needle and syringe: it is punishable by six months in prison or a fine or both. Such regulations are likely to make it difficult to keep injecting equipment in the home for fear of discovery by family members (Stimson 1994; UNAIDS and UNDCP 2000). The current cost of a needle and syringe is around 25 Kyats for a 3cc and a 5cc and 65 kyats for a 20cc (US$ dollar = around 600 to 700 kyats: US$ 0.05 to 0.10 per units, retail price) (G. Le Hegarat, personal communication 2001).


Prevalence and profile

In 1998, the number of registered drug users was 66,076 and by 1999, it was officially 86,537 (UNAIDS and UNDCP 2000; Narcotics 2001). However, with an escalation of drug use throughout the country, the overall level of opiate use is likely to be significantly higher than reflected in the drug registry. UNDCP and various NGOs have estimated as many as 300,000 to 500,000 drug users are in the country (Chelala and Beyrer 1999; UNAIDS and UNDCP 2000; UNODCCP 2001). It has been difficult to determine how many of these are IDUs but in 1996 an estimate of around 300,000 nationwide out of total population of 40 million was made (Prazuck 1997). Recently it has been suggested by UNDCP that conservatively up to 50% of all drug users in the country are injecting (Department of Foreign Affairs 2001). Consequently a conservative figure of 150,000 to 250,000 are likely to be IDUs.

In the mid 1990s, the areas identified as having a high prevalence of drug use were Yangon, Mandalay, the Sagaing Divisions, the Shan and Kachin States (all include the main urban centres), the mining areas and the north-eastern border areas. The use of drugs is mainly found among young men in the cities, seasonal workers in the mining sector and the youth in the north-eastern drug producing areas (UNODCCP 2001). In the mid 1990s an estimated 3,000 IDUs resided in the city of Myitkyeena and a further 5,000 IDUs could be found in the city of Lashio (Prazuck 1997). In the same area an estimated 20-25% of the truck drivers occasionally injected drugs in the mining towns such as Phakhant in Kachin State (UNDCP 2001). It has been suggested many youth are vulnerable to drug use as a result of either being unemployed or under-employed; many universities have been closed for three to four years obstructing their education (UNAIDS and UNDCP 2000).

A particularly vulnerable group is the rural seasonal migrant workers visiting the nearby jade and ruby mining areas of Lashio in the Northern Shan State. Many frequently travel between their homes and these sites of employment. Up to 500,000 may visit these areas each year where heroin use, attendance at the numerous ‘shooting galleries’ and a thriving commercial sex work scene is widespread (Prazuck 1997; UNAIDS and UNDCP 2000). Drug users arrested in recent years have included government servants, students, traders, and farmers. In 2000, of those arrested under the Narcotic Drugs Law, 18% were female, a figure that has changed little in recent years (Ministry of Home Affairs 2001).

HIV was first introduced to Myanmar in the mid 1980s and in 1988 the first HIV/AIDS case was recorded. Within a year an emerging epidemic of HIV among IDUs was identified; in 1989 a survey in Bhamo, Kachin State found that the HIV prevalence among IDUs was 96%. The appearance of HIV infection among IDUs in Yangon closely paralleled the ‘epidemic’ of intravenous heroin use which commenced in the late 1980s (Doe 2001). Since that time HIV prevalence among IDUs at drug dependence treatment units still remains among the highest in the world (Wrigley 2001; WHO 2001). Myanmar has one of the most severe HIV epidemics in Asia, largely as a result of the high risk behaviour among the nation’s IDUs. Myanmar has been conducting small scale HIV testing since 1985 but it was not until 1992 that the country commenced conducting bi-annual sentinel surveillance of HIV/AIDS (UNAIDS and UNDCP 2000). The HIV epidemic among IDUs is believed to have resulted from the removal of various barriers to drug use, these were as follows: the lack of restriction of trafficking, the sale and use of drugs; the widespread mixing of drug users from different townships; the cheap availability of drugs; and the difficulty of finding clean injecting equipment (Doe 2001).

In 1997, it was estimated 440,000 adults and children had HIV/AIDS and that 86,000 people had already died from AIDS; as a result an estimated 14,000 children had been orphaned (UNAIDS and UNDCP 2000). At the end of 1999, it was estimated 530,000 adults and children have HIV/AIDS and the cumulative number of orphans as a result of losing their mother or both parents to AIDS is 48,000 (UNAIDS and WHO 2000). The annual number of adult AIDS cases has been calculated by UNAIDS to be 46,000 in 2000 and is projected to reach 55,000 in 2005 (WHO 2001). During the period 1988 to March 2001 a cumulative total of 33,553 HIV infected cases and 4,598 AIDS cases were recorded. A total of 1,973 AIDS deaths were reported to various hospitals in different regions of the country. Most people were aged between 20 and 40 years and the male to female ratio was six to one (Ministry of Health 2001a).

Reports suggest that IDUs in Myanmar often become infected early in their injecting career, as shown in the national surveillance data, a pattern that is rarely seen anywhere else in world (UNAIDS and UNDCP 2000). Data from the national surveillance over recent years show HIV prevalence among IDUs in 1997 at 54%, 56% in 1998 and in 1999 at 51%. In 2000, the HIV prevalence rate among IDUs had increased to 63% (Department of Health (DOH), 1997; DOH 1998; DOH 1999; DOH 2000; WHO 2001). Commercial sex workers (CSW) are another group increasingly at risk of HIV infection. In 1992, HIV among CSW was 4.3%, rising to 26% in 1997 and in 2000 the figure was 38%. Information about drug use among CSW is scant but has been documented and the link between IDUs visiting CSW and being involved in unsafe sexual practices is acknowledged (UNAIDS and UNDCP 2000; DOH 2000; Wrigley 2001). In 2000, at the sentinel sites (drug users are only routinely tested on average at 4 to 6 of the 21 selected sites) the HIV prevalence rate of IDUs in the various major urban centres were as follows: Yangon (37%), Mandalaly (58%), Lashio (76%) and Myitkyeena (90%). The figures in the various sites have fluctuated over the past five years but overall remain consistently high (DOH 2000).


Government responses to illicit drug problems

In 1974, the government enacted the Narcotic and Dangerous Law to provide a broad legal framework. In 1993 it was replaced by the Narcotic Drugs and Psychotropic Substance Law. This law not only provides for the destruction of narcotic crops and confiscation of equipment but also prescribes a series of penalties which can include the death penalty to be imposed upon drug violators under certain circumstances (MOH 2001b). Even so it has been suggested that both policy and judicial officials have been slow to implement the law, targeting few if any, major traffickers and their drug related assets (Narcotics 2001).

The law follows a series of guidelines for registered drug users whereby they attend a place designated by the Ministry of Health or a government recognised medical centre. Those that don’t register are punished with imprisonment for a minimum of three years to a maximum of five years. Drug users are obliged to appear with their parents when registering for treatment and are issued with a card which they must carry with them to confirm registration. Determining how long the drug user is registered has not been confirmed (UNAIDS and UNDCP 2000; MOH 2001b).

On first admission, drug users are kept within the drug treatment centre for five to six weeks, the first 2 weeks centres on detoxification using opium tincture followed by various prescribed medications (diazepam, analgesics). It has been estimated the relapse rate is 60 to 70%. Upon a second or third visit, drug treatment is usually for two to three months and the program is much the same as for the first visit. It has been reported that treatment is free but it has also been suggested the drug user or their family pay for the fees. A mixture of the types of methods used, and the many unqualified staff, or lack of staff available to deal with the complexities of drug users lives has probably had the effect of driving many drug users underground (UNAIDS and UNDCP 2000). The many drug users who have not sought treatment and are then caught, are sent to prison (UNAIDS and UNDCP 2000). It is difficult to assess how many prisoners are there as a result of drug use (data is not available) but it can be anticipated that the figure would be great. It is likely the transmission of HIV in prisons through injecting, both medical and non-medical, contributes disproportionably to the Myanmar HIV epidemic. In the mid 1990s prisoners were not allowed reading materials about HIV transmission (UNDCP 1994), but the current situation on this issue is uncertain.

Since 1997, 30 drug treatment centres have been established and the locations of six major drug treatment centres (DTC) are found in Yangon, Mandalay, Myitkyeena, Taungyi, Lashio and Kyaing Tung. There are also 22 subsidiary centres which are to be found in Kachin State (4), Sagaining Divisions (10), Shan State (5), Mandala Division (2) and Mon State (1). There are also what are called two comprehensive centres. The township hospitals are also to provide drug treatment services in those townships without DTC. Currently the six major DTC have 250 beds in total and the yearly capacity has been estimated at 2000. (Ministry of Health 2001b). While attempts will be made to increase the number of beds and facilities to serve this population it is clear the current capacity to assist drug users is totally inadequate. The Ministry of Social Welfare is responsible for providing rehabilitation and after care for those leaving the DTC. Currently there is only one rehabilitation centre in the country offering social and practical skills training (UNAIDS and UNDCP 2000).


Government response to drug use and HIV

The government, and its polices, have been responsive towards the HIV epidemic but the sustained activities over the years have been more orientated towards the biomedical sphere. At the senior policy level there has been a real reticence or ambivalence towards dealing with the underlying issues of HIV/AIDS. In 2001 however, there were significant changes in the government’s attitudes towards the HIV epidemic. At the recent United Nations General Assembly Session on HIV/AIDS in New York, the Deputy Minister of Health stated: ‘we are fully aware of the tremendous toll it could exact, not only on the victim alone but also to society as a whole. Consequently, HIV/AIDS has been designated as a disease of national concern and Myanmar is committed to fighting this disease by all its available resources’ (The Myanmar Times 2001). How this will manifest in dealing with the high HIV prevalence among IDUs remains unknown.

The Burma Excise Act of 1905 which prohibits the making, selling, possessing or use of a hypodermic needle without a licence is still being implemented and as a consequence high risk behaviour among IDUs remains (UNAIDS and UNDCP 2000). However, in April 2001 the Myanmar Police Force commander issued instructions not to enforce these stipulations, but it is not yet clear how this new instruction will be followed (G. Le Hegarat, personal communication 2001). Disseminating these new instructions may take time and therefore the law as it stands is likely to remains a major obstacle for early prevention and effective peer education approaches for reaching out to active drug users. This is reflected in areas where high risk injecting behaviour inside ‘shooting galleries’ remains obvious. Access to these establishments by NGOs willing to offer HIV preventative measures (such as supplying bleach to clean needles) is still regarded as highly sensitive by government authorities (Morineau and Prazuck 2000; UNAIDS and UNDCP 2000). Drug treatment is orientated completely towards total abstinence and substitution therapy has only recently been considered on a pilot basis (G. Le Hegarat, personal communication 2001). Information and HIV preventative programs using a peer education approach inside DTC have been operating on a low scale but it has been difficult to gauge how specific and explicit the information is.


National AIDS Policy

The National AIDS Program (NAP) is within the Ministry of Health and its policy was established by the National AIDS Committee. The issue of HIV/AIDS in Myanmar is of national concern and has been recognised by the Ministry of Health (MOH) as one of the three priority communicable diseases. The National Health Plan ranks drug abuse as priority numbers seven. Among the various specific objectives to address the HIV epidemic the NAP has stated the need to prevent HIV transmission among IDUs. Recently the response of the UN Theme Group for HIV/AIDS in Myanmar, in coordination with the MOH, has been to focus on seven priority areas including reducing the harmful consequences of IDU.

Appropriate information, education, counselling, care and support will need to be made available to IDUs and their families and communities affected by HIV/AIDS. A multi-sectoral task force will be established to implement a range of activities. Currently, various activities have yet to be implemented and it not known how they will work considering the various constraining factors for preventative interventions to occur. These include; scant resources to deal with the many social and health issues, the legal constraints of narcotics laws and the regulations focusing on abstinence oriented treatment objectives (UNAIDS and UNDCP 2000; UNAIDS 2001; MOH 2001a).


Non-government responses to drug use and HIV

In 2001 there are 16 National NGOs working in Myanmar on issues related to HIV/AIDS including six international NGOs. Several of these have very small programs and have restricted themselves to single issues or geographic locations. Those that work specifically on drug use and HIV vulnerability are more limited. World Concern has a peer education program for IDUs in Kachin State with the aim of preventative education and raising awareness of the risk associated with injecting while also discouraging IDU among high risk groups. Medecin du Monde has been working in Kachin State with IDU since 1996. Much of their work is closely linkedRevisiting ‘The Hidden Epidemic’ – a situation assessment of drug use in Asia in the context of HIV/AIDS 148 with local treatment centres, providing preventative education about HIV/AIDS and the safe use of injecting equipment. Currently they are attempting to link up with a small number of shooting galleries, to provide preventative education and a bleach program for IDUs. Population Services International has been operating since 1997 and running successful programs in the social marketing of condoms. They have not worked with drug users but it is likely they will soon adopt a policy of applying social marketing to drug use and HIV vulnerability (UNAIDS and UNDCP 2000; World Concern 2000; Morineau and Prazuck 2000; UNAIDS 2001).

Of all the national NGOs the most prominent is the Myanmar Anti-Narcotics Association. Their main role is to assist the national program in suppressing the use of drugs, to educate the community about drugs and improve rehabilitation services which they believe prevent the spread of HIV among IDUs. They attempt to address behaviour change in the community and at school and are also involved in conducting surveys on drug use attitudes, knowledge and behaviours. Essentially their role is to promote a demand reduction approach and to encourage abstinence from drugs. All the NGOs are extremely aware of the political sensitivities of their activities in this area and consequently do not openly acknowledge the exact nature of their work or their activities (UNAIDS and UNDCP 2000).


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Estimated number of drug users: 300,000 to 500,000

Estimated number of IDU: 150,000 to 250,000

Drugs that are used: heroin, opium, methamphetamines, morphine, pethidine, codeine, marijuana, ephedrine, phenseydl, opium oil, stimulants, tranquillizers

Drugs that are injected: heroin

Estimated number of HIV infections among IDUs: HIV prevalence among IDUs is 63%, in some states as high as 90%

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