Some expansion of drug use has been attributed to the promotion of drugs, particularly methamphetamines, by employers for occupational use. In other cases, expansion seems to be driven by a mix of local politics, economics, and social conditions. The location of some villages on drug trade routes has stimulated drug-based economies, often coupled with the decline of local community cohesion and leadership (Barrett & de Palo, 1999). The varied and conflicting approaches to dealing with drug use and trafficking may account for some of the lack of sustained progress in reducing HIV infection among IDU. Recent policies reflect both pragmatism (as has been evident in the response to sexual transmission), as well as more peremptory responses. The historical zig-zag between tolerance and suppression reflect similar currents over time.