Dressed in black with a pony tail and gold earring, Paisan Suwannawong looks more like a Thai rock singer than an HIV activist.
Paisan, who grew up in Bangkok's slums, is the founder of Mit Sampan, a centre providing services for injecting drug users which also aims to prevent the spread of HIV.
But 17 years ago Paisan's life was very different. He was an addict himself and wound up doing two stints in prison where ironically he was able to inject almost every day. It was during his time in jail that he believes he got HIV.
"Addiction is not just about drugs. It's about human behaviour," said Paisan. "You need support systems like economic and social support. If you cannot provide them, how can you expect users to quit drugs?"
Mit Sampan is one of three harm reduction centres for injecting drug users (IDUs) in Bangkok and the only one in the country run by current and reformed drug users.
Located in one of Bangkok's labyrinthine back alleys, the modest centre welcomes over 400 people a month, for whom the place is a haven free from harassment and stigma. Around half the visitors are HIV positive.
The centre focuses on ways to reduce the harm associated with drug use and injection. Services include providing clean needles, condoms, meals, counselling and primary care.
In the late 1980s, one in two IDUs in Thailand was found to be HIV positive and this number has not changed much in almost 20 years, according to activists.
One particularly worrying factor is the level of unprotected sex among injecting drug users in Thailand. Only 35 percent use condoms, according to a 2008 report by U.N. agency UNAIDS.
"The prevalence rate for IDUs over the past 20 years has varied between approximately 30 and 50 percent," said Patrick Denny, UNAIDS coordinator for Thailand.
"The latest government report gets the rate down to 27 percent but this is based on people who actually attend government-sponsored drug treatment centres."
Activists and aid workers blame social stigma and government policy. They say addicts with HIV/AIDS who want to get off drugs face further discrimination from health care officers at the government-backed centres.
A heavy-handed "war on drugs" in 2003 has also helped push injecting users further underground, keeping many away from services that could help them. And those sent to prison get little help inside.
"Prison offers very little rehabilitation," said Karyn Kaplan, director of Thai AIDS Treatment Action Group (TTAG), which helps run Mit Sampan. "Everyone at our centre who has been in prison, almost every one of them has used drugs in prison."
Compounding the problem is the lack of agreement on the number of injecting users in Thailand. An article in the Lancet medical journal in September 2008 puts the figure at over 160,000 but other estimates range from 50,000 to 300,000.
Public Safety v. Public Health
Thailand has 610,000 people living with HIV/AIDS, of whom 60 percent receive antiretroviral drug treatment. But Paisan says it is common for IDUs to be denied treatment until they quit drugs.
Activists say Thailand's drug policy focuses too much on criminalising users. They want to see a more comprehensive approach that includes providing clean needles, condoms, substance substitute therapy and public education.
"Thailand really needs to see drug use as a health issue, not just a criminal issue," Kaplan said.
Paisan added that government campaigns on drug use were too simplistic, telling people to 'Say no to drugs' without teaching them the life skills needed to do so.
In a country often held up as a shining example of how to turn back the tide of HIV/AIDS, the lack of supportive services for injecting drug users is a sore point for Paisan.
For example, harm reduction is not part of the government's policy in Thailand, meaning there is no government-sponsored needle exchange programme - activists say the equivalent of a condom for IDUs is a clean needle.
In addition, methadone, a synthetic narcotic used to wean addicts off heroin, is only available in limited drug treatment centres.
Funding remains a big issue for centres like Mit Sampan which tries to support IDUs without forcing them to give up drugs. Kaplan estimated it cost around $40,000 a year to run the centre, which has received support from The Global Fund and Open Society.
"It's not a popular investment," Kaplan said. "It has to be a progressive, open-minded donor who understands the issues of drug use."
There is progress, however. A few months ago, methadone was finally added to the essential medicines list in Thailand's universal healthcare policy. In the coming months, methadone treatment will be rolled out across the country.
Next year will also see IDU programmes scaled up with the help of the Global Fund and Bangkok will host the International Harm Reduction Association 2009 conference.
"It's getting better but it is very slow, because we are trying to empower drug users," Paisan said.
There is at least a happy ending for Paisan himself. Kaplan is also his partner in life - they met at the UNAIDS conference in 2001 in New York and haven't looked back.
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