UN Integrated Regional Information Networks - October 25, 2007

Many local police still saw drug users as engaged in "social evils" and deserving of harsh punishment, said public health expert Daniel Wolfe, deputy director of the Open Society Institute's International Harm Reduction Development Programme.

Police abuses often "drive drug users away from life-saving care, and fuel the spread of HIV," he noted. "No HIV prevention measure can be effective if people are afraid to use it; it only takes a few times of somebody being arrested in front of a clinic before drug users don't want to go there anymore."

All Southeast Asian countries have committed to eradicating drug use by 2015, and Asian governments have increasingly endorsed methadone treatment and needle exchanges to reduce HIV transmission among injecting drug users, who are at high risk of contracting the virus by sharing needles.

But many countries have mass round-ups of drug users and other marginalised groups prior to national holidays or big public events. Wolfe, speaking in Bangkok on the sidelines of the conference, said regional health officials and regional law enforcement authorities often worked at cross-purposes.

"There is a tension between what ministries of health plan for and what law enforcement agencies actually do, so you have one hand doing, and another hand undoing effective programmes for HIV/AIDS among injecting drug users," he said. "Until one hand works with the other, the result will be increased HIV infections, missed treatment opportunities and lost lives."

Incoherence

Some of this apparent "schizophrenia" stemmed from a lack of coherence at the highest level of policy-making. But even when high-level law enforcement policies were formally aligned with harm reduction programmes, beat cops on Asian streets did not always pay much heed. "There is this disconnect between law enforcement goals and health needs," Wolfe commented.

Communist-ruled Vietnam, for example, has committed to harm reduction programmes as part of its national AIDS strategy and has allowed needle exchange programmes in several areas with relatively large populations of injecting drug users. Yet many Vietnamese drug users were still reluctant to use these services, as carrying a syringe could leave them liable to arrest and imprisonment.

While Vietnam is due to begin its first methadone programme soon, the country also has over 50,000 people in 'forced treatment centres', where programmes consist of heavy labour, military-style drills and chanting slogans.

China has seen a rapid scale-up of harm reduction projects, with nearly 30,000 people put on methadone treatment, up from virtually nil three years ago. But at the same time, Wolfe said, an estimated 100,000 Chinese were in compulsory detoxification centres for as long as a year.

The Indonesian government has five public clinics in Jakarta that supply methadone as part of their overall strategy to promote harm reduction, and police and the National AIDS Commission signed a memorandum of understanding in 2002, agreeing to work together.

But Aditya Anurag Putra, a human rights research with the Indonesian Drug Users Network, complained at the conference that police extortion and harassment of drug users outside HIV testing facilities and methadone clinics was rampant. "It's very difficult for us to engage [with] drug users for [them to use] services in Indonesia," he said. "The situation is not a conducive atmosphere for drug users to access treatment."

Wolfe suggested that raising police salaries, which were low across Asia, could also help end the rampant petty extortion of money from drug users, a major disincentive to accessing services.

"Police wages are often extremely low, and police frequently use drug users as a kind of supplemental income because they can say to drug users, 'either you give me some money or you go to these very punitive treatment centres, or you go to jail for a long time.'"

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