Bangkok AIDS Conference


Opening Ceremony      11 July 2004


Thai Government and International AIDS Conference Organizers
Squelch Thai Activist Leader's Opening Ceremony Speech by Placed LAST on Agenda

Organizers of the XV International AIDS Conference in Bangkok effectively denied the more than 15,000 delegates assembled for the Opening Ceremonies on Sunday night the opportunity to hear one of Southeast Asia's most important AIDS activist voices.

Paisan Suwannawong, director of the Thai Treatment Action Group (TTAG), who spoke from the perspective of a drug user living with HIV, was placed last on an agenda that included Thai Prime Minister Thaksin Shinawatra, United Nations Secretary-General Kofi Annan, and Miss Universe. As a result of the calculated decision to have Paisan speak last, after most delegates had left the ceremonies, most did not have an opportunity to hear this important address chronicling his life under the Thai crackdown on drug users.

    Paisan Suwannawong

Good evening, ladies, gentlemen and friends. Welcome to Bangkok.

Sorry if I am a little nervous, but I am not used to speaking on stage;
I am more experienced with speaking on the street.

First I would like to say thank you to the people who supported my invitation to speak,
and thank you to IAS, because it means a lot to me, to speak from the perspective of a drug user living with HIV.

I would like to tell you a little bit about myself.

I grew up in one of Bangkok’s biggest slums, not far from here. I saw many people using drugs, but never imagined that I would become a drug user myself.

The first time I smoked marijuana, it felt like a challenge because all the public campaigns said drugs were “bad” and “dangerous.” I found it wasn’t true, so I continued to smoke it.

Then I started smoking heroin, and became addicted without realizing it. I didn’t have any money, I was feeling withdrawal symptoms, and my friend offered to share his heroin and inject me. Yes, it was scary the first time.

I got arrested at least 20 times. Most of the time, I did not have any drugs on me. The police would plant drugs on me and force me to confess, and beat me if I did not sign their document. I could not carry a needle around, because if the police arrested me, the charge would be more serious.

I heard about the risk of getting HIV from sharing needles, but when you are craving heroin, you don’t think about anything else. You just want to inject.

I was in prison twice. The conditions were terrible and we had to stay in our cells for more than 15 hours a day. For me, there is nothing worse than losing your rights and your freedom. I am not surprised that people use drugs and inject in prison, even if they never used or injected before.

I believe that I got HIV in prison because I injected almost every day there.

Getting off drugs is not easy. Many times, I went into drug treatment just to please my family, get away from the police, or take a break because the amount of drugs I needed was getting expensive, not because I wanted to quit; and the attitudes of treatment staff only made me feel worse.

Other times, I really did want to quit. But can you imagine how it feels to leave a treatment program and go back home, with nothing to do? How difficult it is to find a job and explain where you’ve been? My own family would watch my every move; I could see in their eyes they did not trust me. I was too embarrassed to see my friends, whose lives seemed so successful.
It was so lonely. I felt I had nothing at those times. The only thing I could think of was to go back to using drugs.

Finally I got off drugs 13 years ago. I knew I really needed help. I decided to go to a “TC,” or “therapeutic community.” This is how I found out how I got HIV. The test still is a requirement for entering the TC. There was no pre- or post-test counseling. In fact, my results were given to my sister, not me.

Today, not much has changed. Drug users are still seen as morally weak and bad people. We face stigma and discrimination in society and in the health care setting. We experience constant police harassment and ineffective services.

In Thailand, injecting drug users or “IDU” are the only group whose 50% HIV prevalence has not changed in fifteen years. One third of all new HIV infections are IDU-related, and this number is increasing. Yet there has been no effective response from the government.

In a recent war on drugs in Thailand, over 2,500 people were killed extra-judicially in the first three months of the campaign.

More than 50,000 people were arrested, hundreds of thousands were forced into military-run rehabilitation centers, and drug users were forced underground and away from services that were already difficult to access.

Last year, the Thai Drug Users’ Network developed a proposal for a peer-driven HIV prevention, care and support intervention for injectors, and submitted it to the Global Fund.

We had to bypass the country coordinating mechanism and lobby with the help of international AIDS activists to get political support for our proposal. In October, we were awarded a 1.3 million dollar grant, but we still haven’t received the money.

Even though the Thai government says its current policy is to treat drug users as “patients,” not “criminals,” it is still illegal to be a drug user. We continue to be arrested and offered the choice of prison or military-run rehabilitation centers. Is this harm reduction or harm production?

Every minute, a person is infected with HIV by using a dirty needle. Globally, 1 in 3 of all new HIV infections outside of Africa is IDU-related. In fact, contaminated needles account for the largest share of new infections in Eastern Europe and Asia.

WHO says drug users have an equal right to all levels of care, but in practice, we are denied access to ARV treatment, as well as basic prevention interventions like clean needles. Methadone is still illegal in many countries and should be on the WHO Essential Drug List.

There are many harm reduction interventions which have been proven to help IDU stay free of HIV, including clean needles and methadone. We need these means of prevention in place NOW! And we need access to treatment NOW!

Drug users, like other politically, socially, or economically marginalized groups, are easily abused by the government and others, who exploit them for money or services.
We often do not enjoy even the most basic human rights. In Thailand, this is true for sex workers, MSM, migrant workers and undocumented citizens as well.

The world we live in today is not a world of sharing but of advantage-taking, profit-seeking, and competition to “get ahead.” It is a world motivated by greed and controlled by corporations, which do not recognize the value of a human being. While an elite few amass enormous wealth, basic needs are denied to many millions.

Today, many of our governments are run by these elite, who are more interested in protecting their personal investments than promoting public welfare. They invest public resources in projects whose profits go into the pockets of their friends instead of providing for the welfare of society. Governments privatize our public utilities, as well as our education and health care systems.

Social welfare programs and other forms of assistance become issues of charity, not rights or entitlement. As a result, our public hospitals are overloaded and under-funded, severely compromising the availability and quality of treatment and care offered.

Of course, tackling AIDS isn’t just about health care and ARV. Prevention, harm reduction, poverty reduction and decent living standards are all part of the process; but governments, like the United States, or international organizations, like the W.T.O., make the task much more difficult.

Market-driven policies and the emphasis on “abstinence-only” have already proved to be harmful or, at best, totally useless.

It is outrageous that today, conservative groups, especially in the US, are advancing a moralistic ideology that contradicts scientific evidence about HIV prevention.

Though condoms and clean needles are the most effective tool we have to prevent the transmission HIV, programs that promote them are not funded, or are de-funded.

Evidence shows that widespread access to ARV leads to huge improvements in health and quality of life, with significant reductions in health care and other costs, because of improved health and productivity among people living with HIV/AIDS and their families.

The most painful experience I can think of, after living with HIV for 13 years, is being poor and HIV-positive. Again and again, I watched many friends die in front of me, from terrible opportunistic infections, simply because they were poor and could not afford treatment.

What kills us is not AIDS, but greed.

Multi-national Pharmaceutical companies inflate the prices of their drugs without thought for poor people. They use they wealth to influence US and European government policy to ensure that intellectual property rights are weighed in their favor.

Other governments say they are too worried about adherence and drug resistance to offer treatment, when the truth is they don’t want to pay or suffer repercussions from their trading partners by breaking patents.

Four years ago, Thai people with HIV/AIDS asked the government to use a compulsory license for ddI, but the government was too afraid of trade and other sanctions from the US. Ultimately, we took Bristol Myers-Squibb to court and won the right to produce tablet-form ddI, locally.

In the final judgment, the Thai Court ruled that, because patents can lead to high prices and limit access to medicines, patients have the right to sue the patent holder.

This was a very important battle that we won.

But the war is not over.

Recently, the Thai government entered Free Trade Agreement negotiations with the United States. We know the US unilaterally pushes for intellectual property protection that is stricter than what is agreed internationally.

This means that Thailand, now producing generic ARV for most who need it, will no longer be able to sustain this important program. We are demanding the Thai government refuse to trade away the health of its people by negotiating intellectual property protections for medicines.

The US government and its policies affect the ability of people all over the world to enjoy their basic rights and needs. Many poor countries cannot provide basic services like health care because they have to pay back enormous debt to the US and Western Banks.

While thousands die of AIDS everyday from lack of funds, there is unlimited funding for war. Billions of dollars are freely available for the killing and destruction in Iraq, while the Global Fund is out of money.

This is because of the broken promises of rich donor countries that refuse to pay their fair share.

I have no simple solutions for achieving world peace, but I do know that the US government, led by that criminal, George Bush, wages war and occupies countries like Iraq in the name of peace. The U.S. is too arrogant to listen to the UN, and the Thai government shows its loyalty to the U.S. by sending Thai troops to Iraq.

Four years ago, at UNGASS, after activists demanded an urgent response to the global AIDS treatment crisis, Kofi Annan called on all the world’s governments to develop what he described as a “war chest.”

This became the Global Fund.

At the last international AIDS conference, WHO launched its ‘3 by 5’ initiative; yet, today, 6 million people are still waiting for their drugs.

AIDS doesn’t wait and neither do we.

Faced with the abuse of power and greed of corporations, we cannot wait for our governments to act.

Governments and corporations hate activists because we know what they are up to, and we are pulling the masks of fake concern from their face to reveal their true nature.

But to me, activists are to be honored. Activists are my true friends. They stand by my side when I face discrimination and injustice. They have the courage to stand up to those in power who use their positions for their own benefit. They are the ones who can help provide a way forward to fight AIDS and injustice in this world.

Access for all is the theme of this conference and the dream of many of us here. Yes, it’s not easy to achieve in the world we live in today, but the world belongs to all of us to change.

Five years ago, doctors, nurses and many other people told me and my friends that ARV was an impossible dream. Recently, Thailand announced that it would provide ARV to all who need it, starting with 50,000 people by the end of this year. Today, I urge all of us to dream, of a day when our world will be filled with love, sharing and peace. And I believe that when we dream together, our dreams come true.

Bangkok, July 12, 2004  Next day rage:

Two hours into the opening ceremony, the arena was virtually empty when Paisan Swannawong of the Thai Drug Users Network took the stage. He spoke eloquently about his experience as a drug user and the human rights of people living with HIV.

Shame! Why are we here? We hold the conference organizers (International AIDS Society and the Thai Government) responsible for an appalling compromise of integrity, and violation of the dignity of people with HIV and drug users.  And we can't let the NGO co-sponsors off he hook either.

For some, attending AIDS conferences and running so-called "community" NGOs is a matter of advancing careers, profiteering, gaining political advantage and fulfilling professional obligations. For people living with HIV and those most vulnerable it is a matter of their lives.

What we witnessed yesterday evening at the opening ceremony of 15th International AIDS Conference was an act of offensive disrespect intended to strip a person of their dignity, universally recognised as the basis of all human rights. The fact that this happens 20 years into the HIV/AIDS epidemic should shame and enrage us all.

What we witnessed yesterday evening also flies in the face of protecting the rights of those most vulnerable and the greater involvement of people with HIV.

Do people who applauded the alleged successes of Prime Minister Thaksin Shinawatra and Royal Thai government realise that according to a recent report of Human Rights Watch, 2275 people suspected of being drug users have been murdered in a three month period in 2003.

We can learn from the experience of the Durban AIDS conference in improving access to ARV treatment and turn our moral outrage into definitively committing to treating injection drug users as human beings equal and deserving of human rights.

Paisan Swannawong has to give his speech at a plenary/the closing ceremony to a worthy and respectful audience. In addition, we can show our solidarity by showing respect to one person, one drug user, one person with HIV, one activist.

Closing Ceremony Speech        
16 July 2004 .

   Paisan Suwannawong

Good afternoon, ladies, gentlemen and friends.

I am a former Injecting Drug User or IDU. I injected for many years but finally gave up 13 years ago, at which time I found out that I was HIV positive. At that time there were no services for IDU and the police, the health services and the general public treated us all like criminals.

Today, not much has changed. Even though the Thai government says its current policy is to treat drug users as “patients,” not “criminals,” in a recent war on drugs in Thailand, over 2,500 people were killed extra-judicially in the first three months of the campaign. We continue to experience constant police harassment, and discrimination in society and the health care setting.

Injecting drug users in Thailand are the only group whose 50% HIV prevalence rate has not changed in fifteen years. Yet there has been no effective response from the government. Basically, we are offered the choice of prison or military-run rehabilitation centers.

Is this harm reduction or harm production?

During the opening of this conference our Prime Minister commited to introducing comprehensive treatment programmes for IDU, with the participation of Thai drug users, and to change the current repressive policies. We wait to see if these promises are going to be broken, and along with our international allies, we will hold him accountable. We are tired of broken promises.

Globally, 1 in 3 of all new HIV infections outside of Africa are IDU-related and without effective interventions and a massive change in attitude this situation will only get worse, with disastrous consequences for Eastern Europe and Asia.

UNAIDS and WHO need to take an aggressive leadership role in advocating for the introduction of proven prevention and treatment interventions, such as needle and syringe exchange and methadone programs. WHO made a strong commitment at this conference to support the inclusion of methadone and buprenorphine on the WHO Essential Drug List. They need to take emergency steps to ensure it happens.

It is painful to be poor and HIV-positive. Again and again, I watched many friends die in front of me, from terrible opportunistic infections, simply because they were poor and could not afford treatment.

But what kills us is not AIDS. It is greed, ignorance, and the deadly policies of powerful conservative governments and Pharmaceutical companies who put their political and economic interests ahead of our lives. It is outrageous that the US is undermining proven prevention efforts and access to generic drugs. It is outrageous that the US is trying to force Thailand to trade away our health in the US-Thai free trade agreement.

Access for all has been the theme of this conference and the dream of many of us here but what have we learned from this conference?

We have learned that discrimination still exists even within the conference venue.

The opening ceremony was designed to ensure that the leaders and the majority of the audience did not hear the only voice of people with AIDS on the programme.

Throughout this week, Thai people with AIDS attending this conference have been stopped and questioned because they are tattooed and perceived to be drug users. People with AIDS have been invited to speak at some events because they are living with AIDS, but have not been given time to speak. This "tokenism" is offensive to all of us.

On Wednesday, the Thai Drug Users’ Network received the 2004 International Award for Action on AIDS and Human Rights from Human Rights Watch the Canadian HIV/AIDS Legal Network. I would like to share this award with all activists that have been fighting for many years in Thailand and internationally, and I would like to thank all my true friends who support me in the vision of access for all.

In particular I would like to recognize Paul and David of MSF, Dr Richard Bunch from Alden House, Mr Pomboon Panichapak from CARE International, and Karyn Kaplan, who has believed in me and helped to make my work possible.

Thank you to Joanne Csete, Kasia Malinowska, and Ralf Jurgens, all the Health GAP and ACT UP friends and all the Thai and International protesters for their fantastic work and support. And last but not least, TNP+, TDN and the Global community of people with AIDS who are fighting for their lives every day.

Thank you.

“The capitalist world doesn’t care
about marginalised groups – especially drug users…”

“I’d like to see politicians involving civil society more –
you can’t let governments do things alone.”

Interview with Paisan Suwannawong of the Thai Drug Users Network

“Fifty percent of drug users in Thailand are HIV-positive,” says Paisan Suwannawong, director of the Thai Drug Users Network. “It’s been at that level for the past ten years, maybe more. This has a huge effect on the population and the bigger picture – all these people have families who are affected.”

Mr Suwannawong helped set up the network in December 2002 in response to this situation. The group comprises both former and current injection drug users, and has a mission to ensure and promote the rights of drug users in Thailand.

Advocacy is one of the Network’s main focuses, and they actively fight for drug policy that offers support for drug users, their families and communities. They also demand that the government stops killing drug dealers and drug users as part of its “war on drugs”, and stops endorsing violence by law enforcement agencies.

Another key area of activism is directed towards rescinding laws or policies that violate drug users' human rights. In Thailand, these include such directives as mandatory HIV testing and exclusion from antiretroviral therapy.

Drug use and HIV have a huge impact on public health and security in Thailand. In Mr Suwannawong’s view, these issues have not yet received the government attention they deserve.

“Drugs are everywhere,” he says. “But drugs is just another political issue. Government policies are ineffective.”

Mr Suwannawong believes the reason is that there is no real political leadership. “There have been changes in funding, but the amount invested in health care hasn’t changed.” In fact, as he points out, the cash crisis is so acute that many NGOs won’t work with drug users, “because they know they won’t get government funding.”

“The Prime Minister and government need to take the lead,” he says, mentioning that to force the issue the network had recently met with Prime Minister Thaksin Shinawatra for the first time in the run up to the XV International AIDS Conference.

Hopes are high for the Conference, and Mr Suwannawong wants it to be a real turning point in focusing the right kind of attention on drug use and HIV/AIDS issues for the country and the region.

In Thailand in particular, he feels, the Conference can encourage reflection on realistic means of tackling drug-use related HIV. “I hope things won’t be just the same after everyone leaves,” he says. “I hope it is not just talk.”

The shift in Thailand’s HIV epidemic towards high incidence among injection drug users has been recognised and emphasised in many forums, including the 2004 UNAIDS report. The global overview of the disease identifies transmission among injection drug users as responsible for the world’s fastest spread of HIV in recent years.

But it also points to proven prevention activities, including “making treatment available to users, providing appropriate substitution therapies and making sure clean needles and condoms are available”.

Mr Suwannawong points out that there is no real commitment to needle exchange programmes in his country, and that methodone access is not national. Even in Bangkok there are probably only “five hospitals that would supply free methodone; in the rest of Thailand you pay.”

Governments traditionally shy away from needle exchange programmes because they fear appearing to condone drug use, or worse, appearing to encourage it.

This is one reason why the network also delivers services, implementing programmes that aim to reduce the dangers associated with drug use, and providing information to prevent the spread of HIV among drug users. In the absence of state provision, they have established programmes to make clean needles and syringes available, and covered costs related to prevention, care and treatment for drug users under the national health care plan.

Unsurprisingly, Mr Suwannawong’s group is also active addressing stigma and discrimination against drug users.

But the sad truth is that whatever the official line on needle exchange, cultural stigma means that most drug users are so afraid to make their HIV positive status public that in the end the much-needed rehabilitation centres end up closing due to lack of demand. This irony isn’t lost on Mr Suwannawong, whose personal disclosure and public visibility are particularly significant.

“I’m not afraid any more,” he says. “I have nothing to lose. A long time ago when I used drugs I was afraid. I think about it but what can I do.” And his personal inspiration? “My friends died without treatment and help, that inspired me,” he says.

Despite all his different efforts to help HIV positive drug users, Mr Suwannawong ultimately still sees a change in the way his fellow Thais view drug users as the only long-term solution. “The public image of the typical drug user is someone who is selfish and doesn’t care, but they can contribute to society.”

-- HDN Key Correspondent Team

Schedule of Opening Ceremonies       see webcast on  KAISERNETWORK

    * Elephants Show  (outside Arena)
       The importance of elephants for Thais is that they are recognised as a symbol of the nation. To symbolise that Thailand
       is honoured to host such an import event, the elephants have been chosen as a visible symbol of the XV International
       AIDS Conference.              
Click here to see killer elephant story

    * Traditional Thai performances and video
    * Introductory Remarks
      Dr. Joep Lange, IAS president, co-chair of Conference Organising Committee

    * Welcome and Opening Speeche
      Thaksin Shinawatra, Prime Minister of Thailand

    * Special Address
      Kofi A. Annan, secretary-general, United Nations

    * Candlelight Memorial Ceremony
      Jennifer Hawkins, Miss Universe 2004, takes part in the ceremony alongside Prime Minister Thaksin

    * Young Voices Sing "Stardust from Thailand and Shangilia from Kenya"
      Children from one of the largest orphanages in East Africa and one of the earliest homes for children affected
      by HIV/AIDS in Thailand, sing.

    * Film: "Global Youth in a World with HIV/AIDS"
      This film promotes the importance of involving young people in any successful fight against HIV/AIDS globally.
      It is directed by film producer Staffan Hildebrand from the Swedish-based Face of AIDS Foundation.

    * Global HIV/AIDS epidemiology
      Dr. Karen Stanecki, UNAIDS/MAP  
 [she graciously deferred speaking for Paisan Suwannawong!]

    * Modeling the HIV/AIDS epidemic in Asia
      Dr. Tim Brown, East West Center  
 [also cancelled speech]

    * "Access for People Living with HIV/AIDS"
       Paisan Suwannawong, Thai Drug User's Network

Schedule of Closing Ceremonies  [revised]     see webcast on  KAISERNETWORK

    * The Young Investigator Award
      The Young Investigator Award goes to the highest scoring presenting author submitted by young investigators
      in each track. The IAS President presents the award.

    * Video of various Conference events this week

    * Performance from children affected by HIV/AIDS
      Children affected by HIV/AIDS from Mitratom Home will perform jointly with other children to bring attention
      to the pain of HIV/AIDS positive children, and to raise awareness of their rights, which should be equal to those
      of other children

    * Closing Speech
      Sudarat Keyuraphan, Thailand's minister of Public Health and chair of Local Host Steering Committee

    * Speech from Incoming IAS President
      Helene Gayle, M.D., M.P.H., director, HIV, TB and Reproductive Health program, Bill & Melinda Gates Foundation

    * "Facing the Future"
      Gracia Violeta Ross, International Community of Women Living with HIV/AIDS

    * Community Statement
      Don de Gagne, co-chair, Community Program Committee -- with community voices speaking for themselves

    * IDU Community Statement  
      Paisan Suwannawong, Thai Drug User's Network

    * "Towards Universal Access to Treatment and Care - Thinking Beyond 2005"
      Jong-wook Lee, M.D., director-general, World Health Organization

    * "Getting Ahead of the Epidemic"
      Peter Piot, M.D., executive director, UNAIDS

    * Leadership Statement
      Graca Machel, patron, Leadership Program

    * Sonia Gandhi, MP and president, Indian National Congress Party

    * Nelson Mandela, former president, South Africa

    * Ceremony to Hand Over a Candle and Symbol of the Conference
      Dr. Mark Wainberg, director McGill AIDS Centre, representative of the next host country, Canada
      and host of the XVI International AIDS Conference, gives a speech and presentation to all delegates.
      After the speech, the chair of the Local Host Steering Committee hands over a candle and symbol
      of the Conference.

    * Thai Blessing Dance of Angels
      This Thai cultural dance aims to give blessing to all participants and delegates for travelling safely.

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