HIV/AIDS and Human Rights

Not Enough Graves:

The War on Drugs, HIV/AIDS, and Violations of Human Rights in Thailand

Why do you have to kill people? . . . It’s better to help drug users find ways to change their behavior instead of killing them. There are not enough graves to bury us all.
—Odd Thanunchai, twenty-six, a recovering heroin user in Chiang Mai

A violent state-sponsored “war on drugs” is jeopardizing Thailand's long struggle to become one of Southeast Asia's leading rights-respecting democracies. Officially launched in February 2003, the government crackdown has resulted in the unexplained killing of more than 2,000 persons, the arbitrary arrest or blacklisting of several thousand more, and the endorsement of extreme violence by government officials at the highest levels. In the process, Thailand’s fight against human immunodefiency virus/acquired immune deficiency syndrome (HIV/AIDS), for which it has received international praise, has been severely undermined by a climate of fear that has driven injection drug users, in particular, underground.

Upon taking office in February 2001, Prime Minister Thaksin Shinawatra declared the “prevention and suppression” of narcotic drugs as one of his top priorities. He pledged that the government would strictly enforce drug trafficking laws and remove legal and other barriers to drug treatment and rehabilitation. Despite his rhetorical commitment to humane responses to Thailand’s drug problem, Thaksin’s anti-drug campaign quickly evolved into a violent and murderous “war on drugs.” Beginning in February 2003, the Thaksin government instructed police and local officials that persons charged with drug offenses should be considered “security threats” and dealt with in a “ruthless” and “severe” manner. The result of the initial three-month phase of this campaign was some 2,275 extrajudicial killings, which the government blamed largely on gangs involved in the drug trade; arbitrary inclusion of drug suspects on poorly prepared government “blacklists” or “watchlists;” intimidation of human rights defenders;violence, arbitrary arrest, and other breaches of due process by Thai police; and coerced or mandatory drug treatment.

This report gives special attention to unlawful state practices in the war on drugs against suspected drug users and their effect on drug users’ ability to seek and gain access to HIV/AIDS services. Human Rights Watch found that one consequence of the war on drugs was to drive countless drug users into hiding and away from what few services existed to help protect them from HIV. Interviews with peer educators and outreach workers revealed that drug users who had previously sought services were living in hiding, sometimes in the mountains in northern Thailand, where even their peers could not find them. A researcher who had helped to recruit hundreds of drug users for a study of HIV prevention said that over three quarters of them disappeared when the drug war began. Of those who were surveyed during the drug war, some reported increased syringe sharing (and associated HIV risk) due to reduced availability of sterile syringes.

The climate of fear created by extrajudicial killings and “blacklisting,” which caused many drug users to go into hiding, was reinforced by arbitrary arrests and other human rights violations by Thai police. Numerous persons who were arrested told Human Rights Watch that police had planted drugs in their pockets, forced them to sign false confessions, or threatened to arrest them simply for not being enrolled in drug treatment. In an effort to fill arrest quotas, police frequently—and sometimes violently—pinned drug trafficking charges on people they knew to have a history of drug use.

Arrested drug users frequently spent time in pre-trial detention or prison, where heroin was available and syringe sharing was rampant, but where drug rehabilitation and HIV prevention programs were wholly inadequate. Drug users reported sharing makeshift syringes in Thai prisons with dozens offellow inmates. Prison officials did not provide inmates with information about HIV and other blood-borne infections or access to HIV prevention services. A 2002 survey of 1,865 Thai drug users found that HIV prevalence rates were almost twice as high among males who had been incarcerated as among males who had not.

Despite a widespread perception that injected heroin is no longer a drug of choice in Thailand, injection drug users number anywhere from 100,000 to 250,000 in the country according to available estimates. The sharing of blood-contaminated syringes is a remarkably efficient way to spread HIV and other blood-borne viruses. An estimated 40 percent of injection drug users in Thailand are living with HIV/AIDS, the same figure as in 1988 when an explosive HIV epidemic first appeared among heroin users in Bangkok. Drug users are projected to account for 30 percent of new HIV infections in Thailand by 2005, a higher percentage than any other group.

Thailand enjoys an international reputation as a “best practice” model in the fight against AIDS, principally because of its successful “100 percent condom” campaign in the 1990s. With respect to drug users, however, the Thai government has rejected similarly effective HIV prevention programs in favor of policies of arbitrary arrest, mass incarceration, and forced drug treatment. Syringe exchange, a strategy recommended by the World Health Organization (WHO) that allows drug users to exchange blood-contaminated syringes for sterile ones, is opposed by the Thai government despite its proven track record in reducing HIV transmission without increasing drug use. Methadone, a prescription drug that reduces heroin craving and its associated risks, is severely limited in Thai drug treatment centers. An estimated 1 percent of Thai drug users were receiving HIV prevention services as of February 2004, including those who obtained condoms through the 100 percent condom program.

Throughout the war on drugs, the Thai government at the highest levels encouraged violence and discrimination against anyone suspected of using or trafficking narcotic drugs. At the outset of the war on drugs, Prime Minister Thaksin sought to distinguish between drug users, who he said should be treated as “victims” and “patients,” and drug traffickers, who were to be harshly punished. In practice, drug users along with drug traffickers became the targets of state-sponsored killings and ill-treatment. Many drug users were coerced into treatment during the drug war under fear of arrest. Those who enrolled were given substandard treatment, often consisting of military-style drills in hastily established treatment “boot camps.” Outside of treatment, drug users shared accounts of discrimination in hospitals and other public institutions, and exclusion from government-sponsored HIV/AIDS treatment programs.

The clearest outcome of the war on drugs was not to curb Thailand’s illegal drug trade, but simply to make it more dangerous. Most drug users interviewed by Human Rights Watch reported continuing to use heroin or methamphetamines during the drug war, albeit at a higher cost and less frequently. Treatment experts noted that many of those who reported to drug treatment in early 2003 were not drug users at all, but rather people who feared for their lives because they were suspected of drug involvement. Many of those named on government “blacklists” and “watchlists” had been mistakenly included or reported by personal rivals. For this futile exercise in drug control, thousands of Thais have paid a high price. While Thailand’s human rights record may yet improve, those who lost their lives as a result of the war on drugs—whether from a bullet or a shared syringe—will never recover.



*.pdf version


  To the government of Thailand
  To the United Nations and all
  international donors to Thailand


Human Rights Abuses in the War on Drugs

  Promotion of violence by   government officials

  Extrajudicial Killings

  Case Studies

  Blacklisting of drug suspects   without due process

  Government investigation of   human rights abuses

  Violence and breaches of due   process by Thai police

HIV/AIDS and Other Health Impacts of the War on Drugs

  Background on HIV/AIDS and   injection drug use in Thailand

  Coerced drug treatment and   rehabilitation

  Driving drug users “underground”

  Penalties for syringe possession

  Dangerous practices fostered in   detention facilities

  State and international response   to health impact of the war on   drugs

  Injection drug use and the human   right to health


Appendix A: Prime Minister’s orders establishing the war on drugs

Appendix B: Sample of summons order for drug suspects (Translation)