HARM REDUCTION IN THE HILLS OF NORTHERN THAILAND

The human immunodeficiency virus (HIV) pandemic has swept through inje cting drug user (IDU) communities around the world, Once HIV is presen t in an IDU community, seroprevalence rates escalate rapidly unless im mediate and comprehensive prevention methods are put in place. Such me asures often include providing IDUs with sterile injecting equipment a nd dispensing methadone or other opiate substitution formulas. These m easures fall under the rubric of harm reduction-an attempt to reduce t he harm to drug users, their families, and communities, including prev enting or limiting the transmission of HIV and other blood-borne virus es. In Thailand, HIV-1 spread rapidly among IDUs with seroprevalence r ates jumping from 1 to 40% in the space of a year. Current incidence r ates are estimated at 11 per 100 person years. This paper describes th e establishment and implementation of needle and syringe exchanges amo ng injecting drug users in nine Hilltribe communities in Northern Thai land. The exchanges have been operating for between 1 and 3 years and have been effective in limiting the transmission of HIV within these s mall communities. The needle and syringe exchanges are run by indigeno us staff with the cooperation of the community and provide a good exam ple of the feasibility of establishing locally-run, community-based ha rm reduction programs.