Pubdate: Sun, 12 Nov 2000
Source: Washington Post (DC)
Copyright: 2000 The Washington Post Company
Contact:  1150 15th Street Northwest, Washington, DC 20071
Feedback: http://washingtonpost.com/wp-srv/edit/letters/letterform.htm
Website: http://www.washingtonpost.com/
Author: Pamela Constable, Washington Post Foreign Service

THREAT OF THE NEEDLE

LAHORE, Pakistan - They crouch on sidewalks in the brief camaraderie of 
drug users, small clusters of men in filthy pajamas fumbling with syringes 
and plastic packets and tin foil. In a few moments they disperse, one 
staggering off while another keels over in solitary oblivion.

Sometimes, the men stumble to the door of the Nai Zindagi (New Life) 
drop-in and needle-exchange center. Inside, they are offered a shower and a 
nap, a clean syringe and first aid for abscesses and stomach cramps. The 
doctor, S.M. Sayeed, shows clients how to avoid injecting drugs into 
arteries, which causes swelling and pain.

He also tells them about HIV and AIDS. It is a disease few Pakistani 
addicts have heard of, although an increasing number risk exposure to it as 
they switch from the traditional culture of smoking and inhaling heroin to 
the fast-growing trend of injecting tranquilizers and painkillers.

"I always chased [inhaled heroin] before, but I've been injecting 
[sedatives] for about 18 months now. It's cheaper, it works faster, and 
everyone was pushing me to try it," said Sanaullah, 32, a bleary-eyed man 
slumped on a straw mat in the shelter's nap room.

Sanaullah said he did not know about AIDS, but he and several other clients 
said they had been told by counselors at Nai Zindagi (pronounced "nigh 
ZIN-da-gee") that there was a serious "syringe sickness" and that they had 
to stop sharing needles to avoid getting it.

"We don't preach, we just make them aware," said Jawad Akhtar, a staff 
member. "We tell them, if they want to shoot drugs, don't take the extra 
risk. If they start keeping needles for their own use, that's a big change 
in itself."

Pakistan is a major outlet for heroin from next-door Afghanistan, the 
world's largest producer of opium poppies from which heroin is made, and it 
has developed a large population of addicts in the past 20 years. An 
estimated 3 million people are habitual drug users, and about half are 
addicted to heroin.

Until recently, most Pakistani addicts smoked heroin or heated it on tin 
foil and inhaled the fumes, a method known as "chasing the dragon." Now, 
according to a 1999 study by the U.N. Drug Control Program in Pakistan, 
injecting pharmaceutical drugs is fast becoming the preferred method of 
substance abuse.

The most popular drugs to inject are opiate painkillers, antihistamines and 
tranquilizers. They cost about half the price of heroin, they are legal and 
widely available because pharmacies do not require prescriptions, and 
injecting them delivers a faster high.

But needles are also a major source of transmitting AIDS. The disease is 
relatively unknown here, with less than 200,000 cases of HIV reported to 
date. But the skyrocketing use of intravenous drugs, according to the 
United Nations, is a "warning sign of the potential for an epidemic of HIV 
infection" among Pakistani addicts.

One recent study of 200 injecting addicts by Nai Zindagi found that none 
were HIV positive and most had been injecting for only a year. But an 
alarming 89 percent were infected with hepatitis C, another illness spread 
through needles.

"We still have a window of opportunity to reach people, but we have to act 
fast before Pakistan becomes like Burma, Vietnam, India and other countries 
where AIDS is growing rapidly," said Tariq Zafar, the director of Nai Zindagi.

The government is becoming alarmed, too, and officials acknowledged that 
while Pakistan has worked hard to eliminate opium poppy cultivation and 
drug smuggling, it has done far too little to treat addicts and educate the 
public about the interlinked dangers of drugs and AIDS.

"Frankly, we know very little about it," said Mohammed Aziz Khan, an 
anti-narcotics official at the Interior Ministry. "Rehabilitation and 
reducing demand have been our areas of tremendous weakness. Now we see AIDS 
coming, and we know we won't be immune if we have a lot of intravenous users."

There are 73 drug treatment centers in Pakistan, but most offer only 
detoxification and serve only a tiny fraction of the country's addicts. 
Pakistani jails are crammed with drug addicts - about 30 percent of all 
inmates - who rarely receive treatment and report that drugs are widely 
available behind bars.

Nai Zindagi, a private program founded 10 years ago, is one of the few 
places that offer treatment, education and vocational training for addicts 
in recovery. The 1999 U.N. study showed that half of Pakistani addicts are 
unemployed and 73 percent have had no formal education.

In Angoori, a village in the hills above Islamabad, 30 recovering addicts 
live in the Nai Zindagi retreat, crafting wood and metal art objects for 
sale. For many, it is the first time they have breathed fresh air or known 
life beyond the grimy, drug-infested streets of Lahore or Karachi.

Muzamil Hussain, a cheerful man of 37, spent three decades as a homeless 
beggar and laborer, turning to drugs for solace. Injured in an accident and 
never treated, he contracted gangrene and his legs were amputated. Now, 
after several years of treatment at Nai Zindagi, he said he has finally 
found a family and a purpose.

"I never got love from anyone, and I thought I was no good," he said as he 
padded about the Angoori workshop on his knees, making coffee. "I miss the 
streets, but I know I was in a bad society there. Now I hope it is not too 
late to make some use of my life."

But Hussain is still a rarity in Pakistan, where most street drug users 
live by their wits and many die of their addiction, bouncing in and out of 
jail but never getting serious help. In Lahore, hundreds doze in a public 
park where the Nai Zindagi drop-in center opened in August.

Each day, about 75 addicts stop by the shelter. Most are interested only in 
a shower, a nap and a new syringe. Some hurry out to meet their suppliers 
and hit the foil or the needle; others stay until closing time, swapping 
street stories and vowing to stay clear of drugs for good.

"I lost everything because of drugs - my wife, my children, my house. I 
weep for them, but I cannot stop," said Nasir Tirmazi, 32, a longtime 
heroin addict who recently switched to injectable painkillers. Four days 
ago he vowed to quit, but ever since he has been shaky and unable to sleep. 
The chances of his remaining drug-free, said Nai Zindagi counselors, are slim.

But Tirmazi and other Nai Zindagi clients have one advantage over their 
friends on the streets. They have access to medical treatment and advice 
about the importance of not sharing needles, using condoms and maintaining 
personal hygiene.

Sometimes, the advice comes too late. One day recently, three Nai Zindagi 
employees carried in a severely emaciated teenager on their backs. He was 
too weak to walk and his feet were grossly swollen, probably from injecting 
drugs into his femoral artery.

As he slumped in a chair, the other addicts crowded around, clucking in 
sympathy. It was almost closing time, and a dozen grimy men lined up for 
their new syringes. Some had saved their old needles but others admitted 
they had given theirs away.

One man drew a filthy needle from his pocket, and Sayeed gently took it 
from him. He plunged it into a bottle of red dye, filled it up and then 
squirted it out. The needle was still full of blood-red droplets. Each one, 
the doctor explained, could kill.
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