title: Overland heroin trafficking routes and HIV-1 spread in south and south-east Asia.
abstract: OBJECTIVE
  Burma produces approximately 60% of the world's heroin, Laos is the third leading producer. Recent outbreaks of injecting drug use and HIV-1 in Burma, India, China, and Vietnam have been associated with Burmese and Laotian overland heroin trafficking routes. We analyzed findings from narcotics investigations, molecular epidemiology studies of HIV-1, and epidemiologic and behavioral studies of injecting drug use, to evaluate the roles that the heroin export routes play in the spread of drug use and HIV-1 in south and south-east Asia.
  
  
  METHODS
  We reviewed the medical and narcotics literature, the molecular epidemiology of HIV, and did key informant interviews in India, China, and Burma with injecting drug users, drug traffickers, public health staff, and narcotics control personnel.
  
  
  RESULTS
  Four recent outbreaks of HIV-1 among injecting drug users appear linked to trafficking routes. Route 1: From Burma's eastern border to China's Yunnan Province, with initial spread of HIV-1 subtype B, and later C. Route 2: Eastern Burma to Yunnan, going north and west, to Xinjiang Province, with B, C, and a B/C recombinant subtype. Route 3: Burma and Laos, through northern Vietnam, to China's Guangxi Province, subtype E. Route 4: Western Burma, across the Burma-India border to Manipur, predominant subtype C, and B and E.
  
  
  CONCLUSIONS
  Overland heroin export routes have been associated with dual epidemics of injecting drug use and HIV infection in three Asian countries and along four routes. Molecular epidemiology is useful for mapping heroin routes. Single country narcotics and HIV programs are unlikely to succeed unless the regional narcotic-based economy is addressed.
authors.affiliation: Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA. cbeyrer@jhsph.edu
authors.forename: C
authors.initials: C
authors.lastname: Beyrer
authors.forename: M H
authors.initials: MH
authors.lastname: Razak
authors.forename: K
authors.initials: K
authors.lastname: Lisam
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: W
authors.initials: W
authors.lastname: Lui
authors.forename: X F
authors.initials: XF
authors.lastname: Yu
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000209:etiology / Q000635:transmission*; D001208:Asia / Q000453:epidemiology; D005260:Female; D005843:Geography; D006077:Government Agencies; D015497:HIV-1; D003932:Heroin; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009294:Narcotics; D009313:National Health Programs; D009938:Organizations; D015819:Substance Abuse, Intravenous / Q000150:complications
chemical_list: D009294:Narcotics; D003932:Heroin