Using groundbreaking methods, a team of international researchers led by an investigator at the School of Public Health has found that outbreaks of injection drug use and HIV-1 in Burma, India, China and Vietnam are associated with overland heroin trafficking routes originating in Burma and Laos. Injection drug users are well-known to play important epidemiologic roles in the early spread of HIV through their needle-sharing and sexual behaviors; until now, however, the relationship between overland heroin trafficking routes and the spread of HIV in South and Southeast Asia has not been appreciated. The study appeared in a recent issue of AIDS.

According to lead author Chris Beyrer, associate scientist in the Division of Epidemiology, School of Public Health, "Our findings suggest there is a clear and urgent need for India, China, Vietnam, Burma and their neighbors to consider and, where appropriate, implement strategies to reduce HIV transmission risks." However, he cautioned, "single-country narcotics and HIV programs are unlikely to succeed unless the regional narcotic-based economy is also addressed." Beyrer also has written a book, War in the Blood: Sex, Politics and AIDS in Southeast Asia, which shows how the interplay of culture and politics within seven countries in the region influenced each nation's response to the AIDS epidemic.

Beyrer and his team developed a unique research approach using tools from widely varying disciplines. For the first time, the molecular epidemiology of HIV-1, field-based research with drug users and their communities, and existing information on narcotics production and control were all brought together. The results demonstrated how molecular epidemiology can be used for mapping the spread of HIV along heroin trafficking routes. Of equal importance was the use of this methodology in identifying and characterizing overland drug routes. The team also was able to assess the impact of heroin trafficking on local communities through a series of confidential key-informant interviews with injection drug users, drug traffickers, local and ethnic leaders, public health staff and narcotics control personnel in India, Burma, China and Thailand.

The study found that recent HIV outbreaks coincided closely with four main drug trafficking routes--eastern Burma to China's Yunnan Province; eastern Burma to northwestern China; Burma and Laos through northern Vietnam and into southern China; and western Burma to the Manipur State in northeastern India.

The Golden Triangle region of Southeast Asia, composed of northern and eastern Burma, western Laos and northern Thailand, has been a major center of opium poppy cultivation since the 19th century. Burma now produces about 60 percent of the world's heroin, and heroin use in Burma has been on the rise since 1988. Predictably, the country has one of Asia's most severe epidemics of HIV infection. Laos is the world's third-leading producer of opium. Thailand is no longer a significant producer, largely through government efforts aimed at reducing poppy cultivation.