‘ Experiences of working in harm reduction in South East Asia’

1. ‘Experiences of working in harm reduction in South East Asia’ Greg Denham Yarra Drug and Health Forum November 2010

2. Background Over recent years international donor activity in HIV prevention has aimed to strengthen the capacity of countries in South East Asia to take a more strategic and evidence-based approach to policy making, planning and programming in order to prevent the transmission of HIV through injecting drug use.

3. Background The epicentre of the global HIV pandemic is moving from Africa to Asia where approximately half of new infections are attributed to the sharing of non-sterile injecting equipment . A

4. Background . OF THE 16 MILLION INJECTING DRUG USERS WORLDWIDE, JUST UNDER 3 MILLION ARE LIVING WITH HIV, AND ONLY 4% OF THOSE ARE ON HIV TREATMENT. GLOBALLY, INJECTING DRUG USERSHAVE FEWER THAN TWO CLEAN NEEDLESPER MONTH. Annual Report 2009 | UNAIDS

5. Context: South East Asia • Illicit drug use, particularly heroin injecting, is seen as a ‘social evil’ • HIV infected people, along with their families, are subjected to high levels of stigma and discrimination • A focus on mostly law enforcement approaches has traditionally been at the forefront of government efforts to eradicate drug use . A

6. Context: South East Asia • A burgeoning sex ‘industry’ is evident with low rates of condom use amongst sex workers • Illicit drug users are frequently ‘rounded up’ by police and placed in compulsory detoxification centres for extended periods to undergo ‘rehabilitation’ • Legal frameworks that provide a supportive policy environment for non-enforcement approaches (harm reduction) either do not exist or conflict with other legislation (drug control laws). . A

7. Law Enforcement Issues: ‘Harm reduction is not an obstacle in reaching the goal of a drug-free world. Drug control authorities need not fear a rise in drug use simply because people are taking steps to protect themselves from HIV and reduce their drug dependency.’ Michel Sidibé .

8. Law Enforcement Issues: Police actions can be one of the strongest determinants of whether a person uses harm reduction services or not. Policing actions can be counter productive to harm reduction programs and increase the HIV risks to individuals and the general community. Police support for harm reduction approaches is critical in facilitating ‘enabling environments’. .

9. To develop and maintain a supportive and enabling environment for harm reduction approaches. Goal of Law Enforcement and Harm Reduction:

10. ‘Police can be the best friend - or the worst enemy - of harm reduction’ ‘Harm reduction cannot - and will not - work without the active participation and support from police’. .

11. Due to a number of factors, progress has been made recently in addressing the issues that have inhibited the progress of harm reduction programs and have contributed to increased support from law enforcement agencies.

12. A legal and policy environment is developing with some countries enacting laws that either support harm reduction or remove inhibiting laws (Vietnam and Indonesia) Methadone introduction and scaling-up is taking place with some funding from central level (China, Cambodia, Vietnam) Police academies are delivering pre-service training programs on HIV awareness and harm reduction (China, Vietnam, Cambodia, Indonesia) Police are undertaking in-service training on harm reduction (Malaysia, Vietnam, Indonesia, China, Burma) Law enforcement agencies are taking a lead role in HIV program development and support at central level (Burma) Policy guidelines for police have been promulgated in several countries (Malaysia)