Needle and syringe programme faces challenges in Cambodia

The health of people who inject drugs in Cambodia is being put at risk due to opposition from police and local communities to needle and syringe programmes.

The health of people who inject drugs in Cambodia is being put at risk due to opposition from police and local communities to needle and syringe programmes.

These programmes help prevent the transmission of HIV and Hepatitis C through contaminated syringes and needles, but lack of community understanding makes it difficult to deliver programmes effectively.

In recent years, the number of people who use drugs in Cambodia has increased and the availability of drugs has also risen. In particular, HIV prevalence among people who inject drugs is high at 25 per cent. HIV prevalence among this group is even higher in the capital Phnom Penh, at 34 per cent.*

Needle and syringe programmes encourage people who inject drugs to use clean syringes, while educating them on safe injection, clean storage and management of the syringes. They also help people access health services such as methadone maintenance therapy (a treatment for people who are dependent on opioid drugs such as heroin) and psychological support.

Harm reduction

So Kimhai, manager and technical advisor for harm reduction in Mondol Meanchey in Phnom Penh, said: “The needle and syringe programme began as a pilot in Cambodia in 2005 with Friends International, an organisation which works with young people who live on the streets. In 2006, the National Authority for Combating Drugs developed guidelines for a national needle and syringe programme, allowing organisations which work in harm reduction to implement it.”

Non-governmental organisations such as Korsang and KHANA, which work with people who inject drugs, are now licensed to implement needle and syringe programmes. For example, KHANA established a drop-in centre in Mondol Meanchey where it delivers the programme. The licenses are valid for one year but there are still many challenges to implementing the programme – including laws and government policies.

Police officers often arrest people for petty offences under drug control laws and village safety policies – and detain them without proper questioning. This has pushed people who use drugs into hiding, while also causing discrimination within their communities and families, and further limits their access to relevant health services and information on harm reduction.

Mom, 36, a mother of six from Phnom Penh, has been using drugs for eight years and is also married to an injecting drug user. Recalling an encounter with the police, Mom said: “I was arrested at my house, taken to the police station and was asked to take off my clothes for drug search. I had to pay the officials 30,000 Riels (USD 7.5) for my release.”

Lack of understanding

Another challenge is a lack of understanding and awareness, not just among the police, but among local authorities and the community.

Rath Samath, an outreach worker from Korsang, said: “During our field visit, a lady was angry with us for providing syringes to people who inject drugs because of used and contaminated syringes scattered all over the place. She was concerned that her children could be hurt while playing outside because of the sharp needles of those syringes.

“Our team explained to the lady about the needle and syringe programme and what we were doing to reduce the harm caused by drugs. At the end, she suggested that we educate people who inject drugs on how to manage their syringes.”

Samath continued: “When my colleagues and I visited following this complaint, we did not find any needles and syringes scattered all over the place and an injecting drug user showed us the box where the syringes are kept after injecting.”

Ouk Tha, team leader of a peer support group, said: “Truly, people who use drugs face challenges from the police and community because of a lack of understanding about the needle and syringe programme. It is our first priority to educate the police and community about the programme, so they understand what we do and support us.”

*National Population Size Estimation, HIV Related Risk Behaviors and HIV Prevalence among People Who Use Drugs in Cambodia 2012.

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Image: Discarded syringe lying on the pavement
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