Human Rights Watch documented several cases of extortion and beating of injection drug users (IDUs) by the police and by mastans. Human Rights Watch was also told of several arrests of needle exchange outreach workers. As with sex workers and men who have sex with men, Bangladesh’s AIDS policy recognizes that drug users must be active partners in the fight against AIDS. Noting the efficiency of HIV transmission via shared needles, the policy states: “Prevention of HIV is however possible if . . . drug users or community organizations are involved in prevention . . . [and] means of behaviour change (access to needles, syringes, bleach, condoms, etc.) are made accessible, [and] options are offered to the IDUs as to how they will make a change in behavior rather than a single approach.”224 Again, as with sex workers and men who have sex with men, mistreatment by police and mastans of injection drug users breeds fear rather than collaboration. Injection drug users become further alienated from figures of authority and from society in general, and it becomes more difficult for them to be participants or beneficiaries of AIDS prevention and care programs. Nothing in the law on narcotics drug use in Bangladesh countenances the police extortion and violence documented here.
Injection drug use rose to a significant level in Bangladesh in the 1990s.225 The practice is most concentrated in Dhaka and Rajshahi, but present in many cities and towns in western, central, and southeastern Bangladesh. The primary drug used by injection drug users in Bangladesh is buprenorphine, which is sometimes mixed with diazepam and other less expensive drugs.226 The health ministry announced in June 2003 that its most recent surveillance had found a 4 percent prevalence of HIV among injection drug users in central Bangladesh, up from 1.7 percent in 2001.227 Human Rights Watch spoke to injection drug users in Dhaka and Rajshahi; some of those interviewed in Rajshahi had lived in Chapai Nawabganj and had come to Rajshahi for treatment.
Human Rights Watch gathered several reports of police extortion of injection drug users. Mumdani D., fifty-six, said he had used various kinds of drugs for thirty years. He told Human Rights Watch that police “find out who the addicts are” and then regularly “catch them and take whatever money is in their pockets.” Mumdani D. stated that police often threaten arrest when they extort in this way. He reported that police extorted money from him twice in 2002; both times the police took 100 Tk. [U.S.$1.72].228
Mustafa T., a thirty-six-year-old drug user in Rajshahi, was arrested in October 2002 and brought to a police substation. The police asked him for money; they wanted 8000 Tk. [U.S.$134]. He begged for forgiveness and said he had no money. Ultimately he paid a bribe of 750 Tk. [U.S.$12.93] for his release.229 Jail can be the consequence if a user fails to produce a bribe. Afroz F., a thirty-year-old former drug user, said that the police arrested him in 1998 and demanded a bribe of 500 Tk. [U.S.$8.62]. He only had 72 Tk. [U.S.$1.24] so the police jailed him under section 54 for seven days.230 There is no treatment for drug addiction available in jails in Bangladesh.231
Police arrests are sometimes accompanied by violence. Mujib J., thirty-seven, said that when the police saw him injecting heroin in September 2002, they beat him on his back, arrested him, and demanded a bribe of 5000 Tk. [U.S.$86.21] from him. He offered 500 Tk. [U.S.$8.62] but the police did not accept. Mujib J. then hit one of the officers. At the police station, he was hung from a tree by his handcuffed hands and beaten ten to twelve times with a police stick. He showed Human Rights Watch scars from the incident that covered half his back. He said he spent two and a half months in jail and paid a 6000 Tk. [U.S.$103.45] fine before being released. He pled guilty to drug use without complaining about being beaten.232
Farukh R., forty, also faced violence and jail after he was unable to pay a bribe. He was arrested in 1997 with five other friends. Three of them paid bribes and were released. Farukh R. had no money and was taken to the police station. He said that police threw him against the wall with his arms tied around his back, and that he bled as a result. He was jailed for six months and paid a 300 Tk. [U.S.$5.17] fine before being released.233
Thirty-year-old former user Musa B. said that he too was often subjected to extortion by police. He said that sometimes, however, police would simply beat him. In December 2002, the police came upon him using heroin at a volleyball stadium in Dhaka. Musa B. ran up the stairs and jumped out of the stadium. He said that the police followed him, caught him, and beat him on his shins, back, and legs. He showed Human Rights Watch researchers a one-inch-square gash on his shin from the incident.234
Some drug users also reported facing extortion and violence from mastans. Abbas H., thirty-seven, said that when he was a user mastans would take his needle ten to fifteen times a month and would beat him up because they knew him to be a user.235 Afroz F., thirty, said that about once a week mastans would come and steal from him and from other friends who were also users. “They took two watches from me; they took money, drugs, and they always took my pride.”236
Kunal N., a twenty-five-year-old former user from Dhaka, was injecting heroin in a public toilet when some mastans snapped a photo of him. Kunal N. said the mastans took him out of the toilet and demanded 10,000 Tk. [U.S.$172.41] in exchange for the photograph. The mastans threatened to kill him if he did not pay. He paid.237
CARE-Bangladesh runs the major needle exchange programs available in Bangladesh, in Dhaka, Rajshahi, and Chapai Nawabganj. These programs provide injection drug users with a range of life-saving services: access to clean needles, access to condoms, referrals for drug treatment, and health care for abscesses, STDs, and other ailments. Several of the injection drug users interviewed by Human Rights Watch reported that before interacting with needle exchange outreach workers they had often shared needles—indeed, they had not been aware of the risks of sharing needles—but that afterwards they were able to stop sharing needles altogether.238
The National AIDS policy explicitly embraces needle exchange programs as an important tool in the nation’s HIV prevention strategy. The policy notes with concern that “[p]rogrammes are often abstinence oriented in spite of high HIV prevalence.” The policy encourages instead a strategy where “options are offered to the IDUs as to how they will make a change in behaviour rather than a single approach [and where] policy makers are sympathetic and supportive to such programmes even if they might appear to have controversial policies towards drug use in the beginning.” The policy goes further to recognize that “[t]here is overwhelming evidence of the high effectiveness of needle exchange programmes” and that “[s]trict paraphernalia laws restricting procurement of syringes and needles without prescription or misuse of the law (suspects are arrested for carrying injecting equipment) increases the risk of sharing needles and therefore of transmitting HIV.”239
Staff members of the CARE needle exchange program reported that some officials in the national Narcotics Control Department and some of the police superintendents in the districts where the programs are located recognize the value of the program, unofficially support the program, and agree not to interfere. However, CARE staff reported that in recent years, an outreach worker from one of the three programs was arrested roughly four to five times per year. CARE was generally able to bail out the outreach workers, and charges were usually dropped, but the arrests interrupted the critical activity of the needle exchanges. Farukh R., for example, told Human Rights Watch that prior to entering a rehabilitation program in December 2002, he regularly obtained clean needles from the CARE needle exchange program in Chapai Nawabganj. He said that after the arrest of a needle exchange outreach worker in July 2002, he and other users were fearful and had a hard time locating needle exchange outreach workers. As a result, he noted, he had to share needles with other users for a period of about two weeks before he was able to reestablish regular contact with a needle exchange outreach worker.240 In this way, the arrests of needle exchange workers may pose a direct threat to the health of injection drug users and undermine Bangladesh’s fight against HIV/AIDS.
224 Government of Bangladesh, “National Policy on HIV/AIDS and STD Related Issues,” p. 65. Cleaning needles and syringes with household bleach can reduce the risk of transmission of HIV associated with injecting with those needles, but not the risk of hepatitis C transmission. See, for example, Centers for Disease Control and Prevention, “Use of Bleach in Prevention of Transmission of HIV in Health Care Settings,” Biosafety Manual [online], http://www.cdc.gov/od/ohs/biosfty/bleachiv.htm (retrieved April 20, 2003).
225 National Assessment of Situation and Responses to Opioid/ Opiate use in Bangladesh (NASROB), “What Will Happen to Us?,” June 2002, p. 13.
226 AIDS and STD Control Programme, Bangladesh Ministry of Health and Welfare, “Report on the Second National Expanded HIV Surveillance,” September 2000, p. 20. Buprenorphine is a narcotic derived from thebaine, a minor constituent of opium, rather than from opium itself, but with opiate-like effects. Ibid. Buprenorphine, like methadone, is used medically as substitution therapy for heroin users. Diazepam is the generic name of the antianxiety drug sold under the trade name of Valium in many parts of the world; it is used medically for short-term relief of anxiety.
227 “HIV infection alarming among drug users,” Daily Star, June 30, 2003, vol. 4, no. 34, p. 1.
228 Human Rights Watch interview with Mumdani D., Rajshahi, December 21, 2002.
229 Human Rights Watch interview with Mustafa T., Rajshahi, December 21, 2002.
230 Human Rights Watch interview with Afroz F., Dhaka, December 23, 2002.
231 NASROB, “What Will Happen to Us,” p. 41.
232 Human Rights Watch interview with Mujib J., Rajshahi, December 21, 2002.
233 Human Rights Watch interview with Farukh R., Rajshahi, December 21, 2002.
234 Human Rights Watch interview with Musa B., Dhaka, December 23, 2002.
235 Human Rights Watch interview with Abbas H., Rajshahi, December 21, 2002.
236 Human Rights Watch interview with Afroz F., Dhaka, December 23, 2002.
237 Human Rights Watch interview with Kunal N., Dhaka, December 23, 2002.
238 Human Rights Watch interviews with drug users: Rajshahi, December 21; Dhaka, December 23, 2002.
239 Government of Bangladesh, “National Policy on HIV/AIDS and STD Related Issues,” p. 65.
240 Human Rights Watch interview with Farukh R., Rajshahi, December 21, 2003.