Harm reduction and law enforcement in Vietnam: influences on street policing

Abstract

Background and rationaleThe HIV epidemic in Vietnam has from its start been concentrated among injecting drug users. Vietnam instituted the 2006 HIV/AIDS Law which includes comprehensive harm reduction measures, but these are unevenly accepted and inadequately implemented. Ward police are a major determinant of risk for IDUs, required to participate in drug control practices (especially meeting quotas for detention centres) which impede support for harm reduction. We studied influences on ward level police regarding harm reduction in Hanoi to learn how to better target education and structural change.MethodsAfter document review, we interviewed informants from government, NGOs, INGOs, multilateral agencies, and police, using semi-structured guides. Topics covered included perceptions of harm reduction and the police role in drug law enforcement, and harm reduction training and advocacy among police.ResultsPolice perceive conflicting responsibilities, but overwhelmingly see their responsibility as enforcing drug laws, identifying and knowing drug users, and selecting those for compulsory detention. Harm reduction training was very patchy, ward police not being seen as important to it; and understanding of harm reduction was limited, tending to reflect drug control priorities. Justification for methadone was as much crime prevention as HIV prevention.Competing pressures on ward police create much anxiety, with performance measures based around drug control; recourse to detention resolves competing pressures more safely. There is much recognition of the importance of discretion, and much use of it to maintain good social order. Policy dissemination approaches within the law enforcement sector were inconsistent, with little communication about harm reduction programs or approaches, and an unfounded assumption that training at senior levels would naturally reach to the street.DiscussionWard police have not been systematically included in harm reduction advocacy or training strategies to support or operationalise legalised harm reduction interventions. The practices of street police challenge harm reduction policies, entirely understandably given the competing pressures on them. For harm reduction to be effective in Vietnam, it is essential that the ambiguities and contradictions between laws to control HIV and to control drugs be resolved for the street-level police.

In their own voices: Breaking the vicious cycle of addiction, treatment and criminal justice among people who inject drugs in Ukraine

“…For those who have demonstrated stability on OAT, allowing “take-home” dosing or making OAT available by prescription combined with re-directing ‘anti-diversion’ police efforts towards breaking the supply chain by targeting drug dealers rather than PWIDs can also be effective (Sabet, 2014; UNODC, 2014). Third, there is evidence police education about addiction as a medically treatable condition and including them as a coordinated effort not only to engage them in treatment and harm reduction services is a crucial component to tacking both the drug addiction problem, but also to reduce HIV transmission (Beyrer, 2012; Jardine, Crofts, Monaghan, & Morrow, 2012; Thomson, Leang, et al, 2012; Thomson, Moore, & Crofts, 2012). Fourth, a multi-pronged approach to introducing and expanding OAT to tackling the drug problem, especially with OAT scale-up, must include the community and criminal justice system, from criminal sanctions, policing practices, adjudication from drug courts and detention in pre-trial detention centers and in prisons.…”

“…One of the feasible approaches in changing law enforcement's agenda with PWIDs is through incorporating narratives about drug injection as a public health emergency rather than a criminal justice problem with validity of OAT as an effective tool to tackle this emergency (Stevens & Ritter, 2013). Examples of interventions with the police to facilitate harm reduction strategies have been successful, but often require continued education and monitoring (Davis, Burris, Kraut-Becher, Lynch, & Metzger, 2005; Jardine et al, 2012; Sharma & Chatterjee, 2012; Thomson, Leang, et al, 2012; Thomson, Moore, et al, 2012). …”

“…There are at least two explanations for such practices that stemmed from our data. First, there is the assumption that there are a targeted number of convictions that have to be met by police without exception, which may be a distant consequence of the ‘war on drugs’(Jardine et al, 2012). On the way to meeting this ‘plan’ police often take the easiest route by harassing drug users whose contacts they have access to, presumably through registration, or by ‘pasturing’ near OAT sites and waiting for someone to match a suspect's description or by coercion to frame someone for a crime.…”

Security trumps drug control: How securitization explains drug policy paradoxes in Thailand and Vietnam

“…The prevalent police culture views forced detoxification as the only means of reducing the perceived threat drug users pose to society. Indeed, local police use harm reduction programs as mechanisms for identifying drug users and, the harassment and arrest of harm reduction workers is common (Hammett et al, 2008;Jardine et al, 2012;. Harm reduction approaches to HIV prevention among … drugs users have been scientifically proven by public health experts, but cannot be successful without the active participation of law enforcement … We used to think of these people as our targets, but now we see them as our partners.…”

“…As centres fail to address underlying psychological or social problems, relapse rates tend to be high (Tyndal, 2010; also Csete et al, 2011;UNODC, 2011UNODC, , 2012. Furthermore, the threat of arrest and, subsequent imprisonment and forced detoxification in centres inflate risky injecting behaviour and prevents access to health care; including HIV/AIDS treatment and prevention (Pankonin et al, 2008;also Hayashi, 2013;Jardine et al, 2012;Kerr et al, 2014).…”