YANGON, 9 March 2009 (IRIN) - Maung Maung (not his real name) never knew he could contract HIV by sharing needles.

"I was too late," the 37-year-old, who routinely exchanged needles with drug addicts over a 10-year period, told IRIN/PlusNews.

"When I took a blood test six months ago, I was told I was HIV-positive," he said. Maung Maung has yet to receive ART treatment, despite being registered at the Waibagi Hospital, one of the few in Myanmar with the capacity to treat people infected with HIV.

"Whenever I think of my plight, I blame myself for not knowing more at the time," Maung Maung said.

There are thousands of injecting drug users like Maung Maung, with little or no awareness of the risks.

Government figures suggest there are around 70,000 registered drug users in the country, with the vast majority of newly registered addicts using heroin.

But with most addicts reluctant to register with the authorities (a requirement when seeking treatment) out of fear of persecution, numbers are likely to be much higher. The UN Office on Drugs and Crime [http://www.unodc.org/] estimates up to 300,000 people may be addicts.

HIV prevalence stands at about 35 percent among injecting drug users, according to government figures, in some areas topping 80 percent.

"HIV prevalence among injecting drug users is pretty high in this country," Sun Gang, country coordinator with the Joint UN Programme on HIV/AIDS (UNAIDS), [see: http://www.unaids.org/en/] told IRIN/PlusNews in Yangon. "One in three injecting drug users is infected with HIV/AIDS," he said.

An estimated 240,000 people are thought to be living with HIV/AIDS in Myanmar, the agency says.

In Myanmar - the world's second-largest producer of illicit opium and one of the largest producers of amphetamine type stimulants (ATS) - injecting drug use is the main mode of transmission after heterosexual sex – accounting for approximately 30 percent of all new infections.

Behaviour change key

"You cannot get behaviour change unless you have the correct knowledge," Willy de Maere, country coordinator with Asian Harm Reduction Network (AHRN) http://www.ahrn.net/], told IRIN/PlusNews in Yangon, emphasising the importance of awareness among this high-risk group, although in some areas that is already happening.

Nelly Thein, project coordinator with the Myanmar Anti-Narcotics Association (MANA), a local NGO, said: "They [injecting drug users] should really understand how HIV could be transmitted to them, and how it can be prevented."

Other areas of additional help needed include the provision of clean needles. At present, given the prevalence of injecting drug use, existing treatment and rehabilitation services are inadequate, specialists said.

In an effort to reduce the risks of HIV among high drug using populations, UNODC and partners such as AHRN and MANA are providing HIV/AIDS knowledge, needles and syringes, and distributing condoms through drop-in-centres and outreach programmes.

The organisations also provide vital medical care for opportunistic infections, skin infections, general healthcare, and offer referral services for access to voluntary and confidential counselling and testing, prevention of mother to child transmission, treatment for HIV/TB, sexually transmitted infections and anti-retroviral treatment, detox and methadone (a heroin substitute) maintenance treatment.

Imprisonment "not a solution"

In Myanmar, drug use is illegal, and offenders face between one and three years' imprisonment.

However, according to one doctor, who wished to remain anonymous: "Imprisonment of drug users is not a solution. It can make the situation worse in terms of HIV/AIDS transmission."

He added that police crackdowns and arrest of drug users affected the continuation of outreach and prevention activities as well as interrupting symptomatic drug treatment and other necessary treatment interventions such as anti-TB, antiretroviral and methadone treatment.

"In prison, it's hard to access clean needles and syringes, which could fuel HIV/AIDS transmission [as drugs are readily available]," the expert warned.

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