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The World Bank initiated a review of HIV prevention among injection drug users in Thailand, with the objective of providing technical assistance to strengthen national capacity to develop state-of-the-art injecting drug use harm reduction interventions. Thailand has received international recognition for its successful interventions to reduce the transmission of HIV among female sex workers and military recruits. It is looked upon as a role model for HIV education and awareness campaigns that include the extensive promotion and wide acceptance of condoms as an HIV prevention strategy. Thailand has the most progressive and comprehensive antiretroviral program in the region with a reported coverage of over 80 percent of eligible individuals. In 2001, it embarked on a progressive universal health care program that provides free access to a wide array of health care diagnostics and therapeutics for the people of Thailand. With these impressive achievements, it is remarkable how poorly Thailand has responded to the HIV epidemic among injection drug users (IDUs). From available data, it appears that the HIV prevalence rates among IDUs have remained high and stagnant over the last decade. Failure to provide effective interventions to reduce HIV transmission among drug users has resulted in unnecessary suffering, and for many, HIV-related death. Continued inaction threatens to undermine successful HIV prevention efforts in the country through ongoing HIV transmission among injection drug users and their sexual partners. The current focus on enforcement and punishment, along with the reliance on compulsory drug treatment centers, has done little to control drug use in Thailand. The unintended consequence of this approach has been to push drug users into precarious and dangerous environments that have directly led to risky drug using patterns and persistently high rates of HIV transmission. Adopting a harm reduction approach to deal with injection drug use could have a major impact on reducing HIV transmission as well as engaging drug users into better health care and effective drug treatment. This will require strong leadership in key government Ministries and related agencies so that the central stakeholders can roll out harm reduction programs. Thailand has the potential to greatly reduce the transmission of HIV among injection drug users and become a regional leader in harm reduction.

Adolescent Health --- Adolescents --- Amphetamines --- Antibiotics --- Capacity Building --- Cohort Studies --- Disease Control & Prevention --- Epidemiology --- Health Monitoring & Evaluation --- Health Outcomes --- Health, Nutrition and Population --- Hepatitis --- Hiv/Aids --- Human Rights --- Information Campaigns --- Informed Consent --- Injecting Drug Users --- Long-Term Care --- Morbidity --- Mortality --- Pharmaceuticals --- Population Policies --- Public Health --- Rehabilitation --- Sanitation --- Sex Workers --- Substance Abuse --- Technical Assistance --- Tolerance --- Tuberculosis --- Unsafe Sex --- World Health Organization --- Youth

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This report synthesizes data from surveillance, behavioral surveys and published and unpublished research to better understand emerging patterns and trends in the HIV epidemic in Bangladesh. Taking stock of 20 years of experience with HIV in Bangladesh, this report summarizes what is known about the coverage and impact of HIV prevention services, including knowledge on risk and protective behaviors. The report is divided into nine chapters. Chapter one provides a brief introduction and an overview of the methodology used for this exercise. Chapter two discusses the risks and vulnerabilities of the high risk groups including female sex workers, injecting drug users, male who have sex with male, hijra and overlapping populations, while chapter three discusses the trend of the infection amongst partners of high risk groups. Bangladesh continues to report low condom use, which is analyzed and discussed in chapter four. Structural factors including macro level and intermediate level factors that affect HIV interventions in Bangladesh are addressed in chapter five. The national HIV response is discussed in chapter six. The report concludes with a discussion of the main findings, with recommendations for the future in chapter seven, and chapter eight and nine are annexes and references.

Adolescent Health --- Cohort Studies --- Discrimination --- Disease Control & Prevention --- Early Childhood --- Epidemics --- Epidemiology --- Family Health --- Females --- Gender --- Health Education --- Health Monitoring & Evaluation --- Health, Nutrition and Population --- Hepatitis --- Hiv/Aids --- Homelessness --- Human Development --- Infections --- Injecting Drug Users --- Life Skills Education --- Malaria --- Mental Health --- Migrant Workers --- Migration --- Municipal Governance and Institution Building --- Nutrition --- Pharmaceuticals --- Rehabilitation --- Schools --- Sexual Behaviors --- Sexually Transmitted Diseases --- Social Dev/Gender/Inclusion --- Social Networks --- Tuberculosis --- Unsafe Sex --- Urban Development --- Youth

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The Kamagayan Comprehensive Care Center (KC3) clients report being very satisfied with the comprehensive package of health services offered under the BCP and they feel welcome and accepted at the KC3. Community members in Kamagayan, including family members of the KC3 clients, also praise the service as an excellent intervention. Virtually all key stakeholders interviewed noted that the KC3 team had performed especially well in building trust between clients and their health service providers, families, and community. In that sense, community-based advocacy efforts were successful at generating an enabling environment for service delivery. The KC3 clients, family members, and community representatives also appreciated efforts from the KC3 team to promote demand reduction through counseling, Narcotics Anonymous (NA) sessions, and privileged access to the Argao Treatment and Rehabilitation Center (TRC). There is great demand and genuine interest among the KC3 clients and patients' clients to become peer educators and provide support to PWID. The professionalization of PWID through peer educator roles has also reportedly reduced stigma and discrimination and increased acceptance of PWID in the community. Should services for PWID be scaled up in Cebu and beyond, recruiting a workforce of peer educators should not be a critical challenge, an important lesson learned for future harm reduction projects in the Philippines.

Adolescent Health --- Aids --- Alcoholism --- Amphetamines --- Capacity Building --- Children --- Civil Society Organizations --- Communication Channels --- Crime --- Discrimination --- Drugs --- Epidemiology --- Good Governance --- Health --- Health Monitoring & Evaluation --- Health System Performance --- Health, Nutrition and Population --- Hiv/Aids --- Human Development --- Human Rights --- Hygiene --- Informed Consent --- Injecting Drug Users --- Malaria --- Marketing --- Needs Assessment --- Peer Groups --- Pharmacies --- Posters --- Prevention --- Prostitution --- Public Health --- Respect --- Sex Workers --- Sterilization --- Substance Abuse --- Technical Assistance --- Tuberculosis --- Women --- Workers --- World Health Organization