Drugs Demand Reduction & HIV/AIDS

  • Established ATS and opiate abuse, emergence of new drugs, poly-drug use and growing complexity of treatment

  • Drug abuse, Injecting Drug Users and increased risk of HIV infection

In recent years, ATS abuse has overcome opium as the greatest threat to public health in Laos. Laos is situated at the hub of major drug trafficking routes in South East Asia. Crystal methamphetamine (Ice), heroin, ketamine and cocaine are seized in increasingly larger volumes than previously. ATS abuse continues to increase in the country, concentrating in but not limited to urban areas. The 'spill-over' effect mainly along transit trafficking routes has created conditions for a potential abuse epidemic. More than 50% of the Lao population is below the age of 20 years. Surveys in educational institutions in three major urban areas revealed that ATS was commonly abused, with 15-19 year olds being the most susceptible age group. According to the latest population census of 2006 this would imply that about 1.4 million youth are within the at risk age group. A UNODC study conducted in 2008 revealed that that the mean age for drug use is 16 years and poly-drug use is common with 98,6% of respondents combining ATS & alcohol, 86,7% combining ATS & tobacco, 41,3% combining ATS & marijuana and 19,9% combining ATS & Glue. This generalisation of ATS consumption associated with the emergence of poly-drug abuse patterns among youth is leading to increased health and mental problems as well as growing complexity in the treatment of addiction. However the drug treatment infrastructure in the Lao PDR, based heavily on treatment in residential drug treatment centres and community based detoxification camps for opium users is showing its limits, as relapse rates tend to be high, especially among ATS users.

The key drug demand reduction gaps in Laos are reflective of the situation in the East Asia and the Pacific region and they include:

1. Prevention:
a. Insufficient prevention efforts to deter experimentation or at least delay onset primarily among at-risk youth.

2. Treatment:
a. Inadequate care and support for drug users.
b. Inadequate trained manpower to deliver services (especially in the case of ATS) and ill-equipped training centers.
c. Insufficient community/voluntary treatment centres as an alternative to compulsory treatment centres/imprisonment.
d. Inadequate minimum standards of care and support.

3. Reintegration:
a. Insufficient community-based reintegration and aftercare programmes.
b. Ineffective drugs laws and policies geared to respond to drug use offences.
c. Insufficient legal "coverage" for vulnerable groups within the criminal justice system.
d. Inadequate capacity-building for police officers.

While the adopted strategies to eliminate opium production and consumption have achieved some considerable success, among the remaining population of opium dependent people there is likely to be a high proportion of older people who may be more resistant to the strategies so far embraced. It is likely that they will require additional approaches, to reduce their dependence on illegal opium and to avoid the risk that they will be attracted to other forms of drug use, such as amphetamine-type stimulant (ATS) use and injecting drug use, particularly heroin injecting.

There are also emerging pockets of heroin and black water use in some border regions as well as in Luangprabang and Vientiane capital. Also, the patterns of drug use among some tourists may contribute to risks of drug use among the population of Lao PDR.
Accessibility of evidence-based drug dependence treatment and care services is very limited in Lao PDR.

The ATS threat:

Amphetamine Type Stimulants (ATS) use can contribute to risky sexual behaviours and increased HIV/AIDS infection rates. With ATS abuse increasing in urban as well as some rural areas, it is possible that HIV/AIDS infection rates could increase from its low levels of 0.2% in 2008. The risk of IDU emergence also remains very serious and its link to an HIV/AIDS epidemic raises many concerns especially as Laos is located at the hub of countries that have some of the highest rates of HIV/AIDS prevalence among IDUs, with up to 74,3% in Myanmar and around 70% in China. In Laos, out of the 2,858 HIV positive people found between 1990 and June 2008, it is estimated that 0,2 % were infected through needle use. In 2008, according to Government statistics some 5,222 cases of HIV had been confirmed. Of these, 157 developed AIDS and 49 died. Without effective efforts to address drug abuse and increase HIV/AIDS awareness, Laos faces a very serious HIV/AIDS epidemic in the near future.