Harm reduction in Cambodia: a disconnect between policy and practice

Chheng, Kannarath; Leang, Supheap; Thomson, Nick; Moore, Timothy; Crofts, Nick

doi:10.1186/1477-7517-9-30

Cited by 19 publications

(41 citation statements)

References 5 publications

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“…Article 107 states that “forced treatment shall not be imposed unless there is a serious situation;” but it does not define the term “seriousness” or the level of “seriousness.” Articles 45 and 53 implicitly criminalize repeated use of drugs by PWID/PWUD by stating that “drug users who have already received forced treatment and rehabilitation and are caught using drugs again will face imprisonment from one to six months.” Further, Article 40 articulates that “a person in possession of drugs faces imprisonment from two to five years,” without specifying the amount of drugs carried. As a result, police officials have challenges in distinguishing between PWID/PWUD and drug dealers [11]. …”

Section: Introductionmentioning

confidence: 99%

“…Violation of human rights and physical abuses of PWID/PWUD take place regularly [10], making PWID/PWUD live in fear of being arrested and/or removed from communities [10]. In many cases, PWID/PWUD were isolated from health, education, legal support, and other harm reduction services [10, 11]. Another repercussion of the VCSP was that besides the police’s suppressing approach, communities could report illegal activities, such as drug use, to local authorities [11, 13].…”

Section: Introductionmentioning

confidence: 99%

“…In many cases, PWID/PWUD were isolated from health, education, legal support, and other harm reduction services [10, 11]. Another repercussion of the VCSP was that besides the police’s suppressing approach, communities could report illegal activities, such as drug use, to local authorities [11, 13]. Also, parents could report and turn in their children who used illicit drugs to the police for rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the concepts of harm reduction and its implementation have not been well understood and accepted by the general public and law enforcement officers. The general public, and law enforcement officers, sometimes refer to harm reduction as needle and syringe program (NSP), while harm reduction embraces more aspects of health and human rights-related issues among PWID/PWUD [11]. In addition, in Cambodia, due to the perception that the risk of the transmission of HIV through injecting drug use is not as high as through unsafe sex, many law enforcement officers are not convinced that NSP is an effective means to prevent HIV transmission among PWID in Cambodia [11].…”

Section: Introductionmentioning

confidence: 99%

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How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Tuot

Ngin

Pal³

et al. 2017

Harm Reduct J

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BackgroundHarm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders.MethodsThis qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns.ResultsThere was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD.ConclusionsThere is a lack of common understanding of the drug-related law and policy and their implications to harm reduction services among both law enforcement officers and PWID/PWUD. Thus, there is a need to mainstream and simplify the law and policy for better comprehension among these actors. To improve the quality and coverage of harm reduction interventions, the gap of understanding and enforcement of laws and policies should be narrowed, and coordination between the government and NGOs and other key stakeholders should be strengthened.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Tuot

Ngin

Pal³

et al. 2017

Harm Reduct J

View full text Add to dashboard Cite

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“…Research has also sought to understand the perspectives of police at the interface between policing and HIV programmes working with key populations and have variously described contributors to negative policing behaviour including the poor understanding of HIV and HIV programmes, the lack of appropriate police training, poor communication from HIV programmes to police [17] and structural drivers of poor police performance such as low salaries and the setting of arrest quotas that specifically require police to target people who use drugs [18]. In response to the ongoing tensions between police, HIV programmes and the people that need access to these programs, various multilateral agencies [19], researchers [20] and civil society organizations (CSOs) [21] have recommended the need for enhanced partnerships between police and HIV programmes.…”

Section: Introductionmentioning

confidence: 99%

From conflict to partnership: growing collaboration between police and NGOs in countries with concentrated epidemics among key populations

Thomson

Riley

Bergenström³

et al. 2016

Journal of the International AIDS Society

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IntroductionBetween September 2012 and December 2015, a series of national and regional consultations, aimed at resolving a persistent dynamic of conflict between law enforcement agencies (LEAs) and civil society organizations (CSOs) working on issues of access to HIV services in high-priority countries for people who use drugs have been organized by the HIV/AIDS Section of the United Nations Office on Drugs and Crime, the Joint United Nations Programme on HIV/AIDS, the Law Enforcement and HIV Network (LEAHN) and other international organizations. The aim of these consultations has been to understand, at a national and regional level, the key points of tension between police and CSOs and how to overcome these tensions to enhance access to and uptake of services by key populations, including people who inject drugs, sex workers, men who have sex with men and transgenders. This commentary briefly describes the methods, process, content and key outcomes of these consultations held across diverse number of countries and regions, including Africa, South East Asia, South Asia, Central Asia, Eastern Europe and Latin America.DiscussionWhile the context varies, this paper highlights that there are commonalities that drive a persistent dynamic of conflict and therefore also common methods for resolution of conflict and forging partnerships. Both policing and CSOs have key sectoral responsibilities and reform agendas to implement to ensure that as an individual agency they are able to meet their obligations as partners in the HIV response. Using the key outcomes of discussions and recommendations from these consultations and drawing on existing literature, the objective of this paper is to present a preliminary model that roadmaps the critical path from resolution of conflict to partnership between LEAs and CSOs.ConclusionsThis paper seeks to highlight that critical resources are required to support ongoing development and harnessing of partnerships between LEAs and CSOs and argues that these resources should not just come from global HIV funding mechanisms but should be part of a more mainstreamed security sector reform agenda that understands the mutual benefits that programming for human rights–based policing reform would have on HIV, development and security.

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High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

Izenberg¹,

Bachireddy²,

Soule³

et al. 2013

Drug and Alcohol Dependence

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Background Ukraine’s HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention not resulting in imprisonment, defined as police harassment, of PWID is common, but its prevalence and impact on health is not known. Method HIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression. Results Detention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031). Conclusions HIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.

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Harm reduction in Cambodia: a disconnect between policy and practice

Cited by 19 publications

References 5 publications

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

From conflict to partnership: growing collaboration between police and NGOs in countries with concentrated epidemics among key populations

High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

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