AIDS Outbreaks Follow Asia’s Heroin Traffic

By Susan Okie

March 6 (Washington Post )

Burma’s booming heroin industry is helping to kindle the AIDS epidemics in nearby countries, including China, India and Vietnam, with outbreaks of the infection flaring like a fuse along routes used by traffickers to transport the drug.

A new study by American, Chinese and Indian researchers tracks how different strains of the AIDS virus have followed the path of heroin in communities along four separate trafficking routes in the region. The spread of the human immunodeficiency virus accompanies a rise in local drug use that reflects the flooding of the market with Burmese heroin.

Burma, the world’s second-largest producer of opium and heroin (behind Afghanistan), is suffering from its own twin epidemics of drug addiction and AIDS. The findings of the research team, led by Chris Beyrer of the Johns Hopkins School of Hygiene and Public Health, underscore how quickly local drug trafficking can carry HIV into remote, previously unaffected areas.

“In every market town along [a trafficking] route, there are new outbreaks of drug use,” said Beyrer, whose findings were published in the January issue of the journal AIDS. “Overland routes involve local people, highways, local traders and, sadly, have led to this burgeoning AIDS epidemic for India, China and Vietnam.”

Opium production in Burma doubled in 1989, the year after that country’s authoritarian military regime, known as the State Peace and Development Council, assumed control. Although production has declined in the past three years, Burma currently accounts for about 80 percent of the opium production in Southeast Asia, according to a State Department report released last week.

The primary opium-growing region is in northeastern Burma, in areas belonging to various ethnic groups that are often controlled by local leaders with their own drug-trafficking armies.

The research project began about 18 months ago, when Beyrer was invited by the Chinese government to help investigate an HIV outbreak among heroin users in the southern province of Guangxi, bordering Vietnam. “On both sides of the border, the amount of heroin had been very rapidly increasing,” Beyrer said. The upsurge “appears to be a phenomenon of the last decade. . . . It’s very disturbing to China.”

This border area is a mountainous rain forest, impossible to patrol, Beyrer said. Heroin from Laos and Burma was being transported into northern Vietnam. Chinese users and small-scale traffickers “were going across, meeting their Vietnamese counterparts on the other side, and testing heroin” by self-injection, often sharing needles.

The researchers used three separate techniques to track the spread of HIV along the drug-trafficking routes. Using blood samples from HIV-infected people, they analyzed the genetic differences among viral strains circulating in the region. They interviewed users, dealers, drug treatment counselors and other “key informants” about local drug availability, smuggling routes and injection practices. They also used data on opium poppy cultivation compiled by the State Department, as well as information on heroin trafficking obtained from the CIA, the Drug Enforcement Administration and foreign intelligence sources.

The researchers found clear evidence that specific viral subtypes follow the heroin trade routes. For instance, in Guangxi province, subtype E is common, mimicking the situation in most of Southeast Asia. In Yunnan province, along China’s border with Burma, subtype C prevails. Most of the earliest cases of HIV infection in China were discovered in three border counties in Yunnan province, among male drug addicts and their wives.

Another route, into northeastern India, was discovered to be “one of the major heroin routes out of Burma,” Beyrer said. “It’s also the key route for the chemical reagents that need to go in” to supply refineries that make the drug.

When the team traced a new trafficking route all the way to Urumqi in northwestern China, Beyrer said he pointed on the map to neighboring Kazakhstan and asked health officials what was the next city on the highway. “This epidemic is going to happen there,” he told them.

“Six months later,” Beyrer recalled, “I get an e-mail from the World Health Organization [saying] that there’s been an explosive outbreak of HIV in Almaty, Kazakhstan, and somehow there end up being 5,000 drug injectors there.”

Heroin flows from northeast Burma into China through Kunming, and then ast to Hong Kong through Nanning. Researchers have discovered that, along this route, HIV strains called subtype C and a hybrid strain dubbed B/C dominate.

From Mandalay in central Burma, heroin from the northeastern part of the country is trucked to Manipur, an isolated border state in northeastern India. Despite being an insurgent area that the Indian government has closed, Manipur has India’s highest HIV rates. Viral strains detected in the area include subtype C — the dominant strain in India — and subtypes B and E, Southeast Asia’s major strains.

Burmese heroin reaches the Chinese border town of Pingxiang via a route that traverses Burma, Laos and northern Vietnam. HIV subtype E dominates this route.

A fourth, previously unrecognized route, runs hundreds of miles — north from Kunming into Urumqi in China, then west across the Chinese border into Kazakhstan. This helps explain a recent sudden outbreak of heroin use and HIV infection with subtype B/C in Urumqi.

All Over the Globe is published by IPA House.
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