Safe from harm: reducing HIV among people who use drugs in Cambodia

As the 20th International AIDS Conference gets underway, three leading HIV and drugs organisations are warning that global funding for HIV prevention for people who inject drugs is in crisis.

As the 20th International AIDS Conference gets underway, three leading HIV and drugs organisations are warning that global funding for HIV prevention for people who inject drugs is in crisis.

Today (21 July), at the conference in Melbourne, Australia, Harm Reduction International, the International Drug Policy Consortium and the International HIV/AIDS Alliance have released a report which indicates HIV prevention services for people who inject drugs are not being prioritised due to changing donor policies and national government neglect.

This failure to invest will bring an exponential rise in HIV transmission which in turn will cause additional costs to government health sectors.

Injecting drug users in Cambodia

Reaching injecting drug users in Cambodia with harm reduction programmes – such as needle exchange services, education and HIV testing – is vital to achieving the UN vision of getting to zero new HIV infections.

According to the National AIDS Authority’s Strategic Plan: “The prevalence of HIV infection among injecting drug users can increase rapidly, since sharing needles and syringes is a very effective mode of transmission.”

Since drug use is often associated with an increase in unprotected sex, the partners of non-injecting drug users also face a high risk of HIV infection and should be included in harm reduction programmes.

According to the National Center for HIV/AIDS Dermatology and STDs (NCHADS): “Based on a person’s risk behaviors, service delivery should include: condom provision; testing for HIV, sexually transmitted infections and tuberculosis (TB); antiretroviral therapy; needle and syringe programmes; methadone maintenance therapy and psychosocial support.”

Preventing blood borne diseases

So Kimhai, manager and technical advisor for harm reduction in Mondol Meanchey, Phnom Penh, said: “Harm reduction programmes are really important for Cambodia because they can prevent HIV, hepatitis B and C and other infectious diseases among people who inject drugs.

“We are very concerned about the risk of co-infection with HIV, hepatitis and tuberculosis among this group, as well as mental health problems, a lack of nutrition and drugs overdoses.”

Dr Hy Someth, a government HIV/AIDS programme manager, said: “In order to run harm reduction programmes effectively, we need strong cooperation and involvement from the police, and community, as well as people who use drugs themselves.”

Afraid to access services

However, according to Kimhai, a lack of understanding and support from communities, local authorities and the police creates barriers to delivering the programmes.

He said: “It is hard to implement programmes to enable people who use drugs to access health services, due to drug control laws, existing village policies and safe commune schemes. This makes them afraid to access services, which means they lack information and do not receive health education. This increases unsafe injecting practices, as well as stigma and discrimination from the community. The fear of punishment from the police makes it hard to reach people who inject drugs and their partners as well.”

Ouk Tha, leader of a peer support group, said: “People who inject drugs face many problems, including health issues and social problems, because they lack understanding about risky behaviours such as sharing needles and unprotected sex. But those who have taken part in a harm reduction programme are more likely to change their behaviour and access health services, such as methadone maintenance therapy and antiretroviral therapy.

“Stigma, discrimination and violence against people who use drugs, from police and communities in Cambodia, is a big challenge. This means they often hide their status and have limited access to health services.”

Missing data

A lack of reliable data also makes it difficult to gauge the size of Cambodia’s drugs problem and plan an effective response. The most recent figures, from 2007, show an HIV prevalence among people who inject drugs of about 25 per cent. Government figures also reported there were 5,797 people who used drugs in 2007 and 6,500 in 2008.

On 11 June, the National Authority for Combating Drugs (NACD) released its latest estimates for the number of people who use drugs in Cambodia. Based on the 2007 population size, it estimates the current number between 9,000 and 20,000 – of whom around 2,000 are injecting drug users.

Establishing and documenting national estimates of people who use drugs is critically important for better advocacy, resource mobilisation and planning and managing targeted health programmes.

Download a copy of The funding crisis for HIV-related harm reduction: Donor retreat, government neglect and the way forward

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