Pubdate: Sat, 12 Mar 2005
Source: Financial Times (UK)
Copyright: The Financial Times Limited 2005
Contact:  http://www.ft.com/
Details: http://www.mapinc.org/media/154
Authors: Andrew Jack and Amy Kazmin
Cited: Centers for Disease Control http://www.cdc.gov/
Cited: Medecins San Frontieres http://www.msf.org/
Bookmark: http://www.mapinc.org/areas/Thailand
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

THAI AIDS CAMPAIGNERS QUESTION NEW CLINICAL TRIALS

US and Thai researchers gearing up to launch ground-breaking clinical 
trials on Aids prevention in Bangkok have found themselves torn between US 
administration restrictions and Thai activist hostility.

Thai authorities this week approved a trial co-ordinated by the US-based 
Centers for Disease Control (CDC) on 1,600 intravenous drug users designed 
to see whether tenofovir, an anti-retroviral medicine already used 
successfully in treating HIV positive patients, could also be applied as a 
prophylactic.

But Thai Aids campaigners have raised questions about researchers' decision 
to study drug users in Thailand, where in 2003 the government waged a 
bloody "war against drugs" during which several thousand suspected drug 
peddlers were gunned down. No one has been held accountable.

Aids campaigners have also accused researchers of breaching international 
ethical guidelines by failing to provide those participating in the study 
the full gamut of other confirmed HIV prevention tools.

Thailand has been lauded for dramatically reducing HIV infection among sex 
workers by promoting condoms. But it has so far failed to make similar 
progress for reducing infection among injecting drug users.

"Yet again, we drug users are treated as less than human, not worth the 
same basic dignity and rights as others," said Paisan Suwannawong, director 
of the Thai Aids Treatment Action Group.

Critics have objected that those taking part in the trial will not have 
access to free, clean syringes through needle exchange programmes, of the 
type that has sharply reduced infection among drug-users in many other 
parts of the world. Such exchange schemes allow drug users to swap used 
syringes for new needles.

But US government policy bans federally funded organisations - including 
the CDC - from supporting needle exchanges, fearing that it will encourage 
drug use. This is in spite of the fact that Lynne Paxton, a CDC team 
leader, says official studies have shown that these programmes both help 
reduce infection and do not increase drug abuse.

Thai policymakers are still ambivalent about needle exchange programmes. 
However, two pilot initiatives - studying the effectiveness of needle 
exchange in reducing HIV transmission among Thai drug users - may get under 
way later this year.

United Nations Aids experts say many Thai public health officials have 
"converted" to the idea of needle exchange as a useful tool in reducing HIV 
in drug users. But Thai police, who have wide discretionary powers, still 
occasionally use needles as evidence to arrest, and prosecute, addicts.

Given the clear restrictions from Washington - and the more ambiguous 
situation in Thailand - where policies are still in flux, Ms Paxton insists 
the CDC is doing what it can: introducing extensive counselling and 
providing bleach to clean existing needles.

Medecins San Frontieres, the charity, informally offered to pay for clean 
needles for study subjects, but CDC declined the offer.

Participants for the tenofovir study will be recruited at 17 Bangkok 
government health clinics that now offer methadone programmes to some drug 
users, a relatively new development in Bangkok's battle against drugs.

But critics say many of those approached will feel they have no choice but 
to join the study to ensure continued access to methadone.

Another criticism is that the cost of tenofovir means Thais are being used 
to trial a drug that will largely be used in the developed world; and those 
taking part will not use the treatment.

However, Ms Paxton rejects the claim. "The world is not using Thailand as a 
testing ground. The trials are designed to be used by Thais in Thailand."

She adds that Gilead, the manufacturer of tenofovir, has agreed to provide 
its treatment at cost - if it proves effective as a prophylactic - in the 
developing world; and Thai authorities have agreed offer treatment to any 
participant who does become infected.
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MAP posted-by: Richard Lake