A new government drug-reduction strategy will rely on the efforts of local harm-reduction NGO Korsang to reach the Kingdom’s growing number of intravenous drug users

Photo by: TRACEY SHELTON

JB, one of the members of the Korsang medical crisis team, attends to the wound of a heroin user in Phnom Penh on Tuesday.

IN a dark corner of one of Phnom Penh's poorest communities, JB, a member of Korsang's medical crisis team, cleans and disinfects scratches on a young girl. When he's done, the girl runs off to play in the boggy trash heaps adjacent to her room.

Despite appearances, JB's efforts form part of the front line  in Cambodia's battle against the spread of HIV.

Peer educators from Korsang, a local harm-reduction NGO, visit Phnom Penh's most drug-riddled communities every day. Most staff members are former drug users themselves and gain the trust of Phnom Penh's at-risk communities by talking candidly about drug use and HIV risk, and by providing basic medical aid.

"We come to this spot every other day, so they know who we are and they'll be comfortable talking to us. Every time we make contact with someone, we ask if they know their HIV status. Sometimes they tell us, ‘No. I don't know, but I want to', and we can make sure they get tested," JB says. "Some of the people in poverty don't even know how HIV is transmitted, what drugs do to their bodies and what options they have."

YOU SEE PEOPLE COME ALIVE. DAY BY DAY, WHEN I SEE THEM GET BETTER, I FEEL GOOD.

Korsang was one of the pioneers in the politically sensitive harm-reduction approach, which emphasises engagement with users without insisting on abstention from drug use. In a country where cold-turkey, boot-camp-style treatment was once the norm and where drug addicts are still treated as social pariahs, Korsang became one of the few places where drug users in Phnom Penh were treated with respect.

Today, Korsang's connections to the drug-using community will allow it to play a crucial role in Cambodia's new strategy to thwart the growing threat of an HIV epidemic caused by an increase in unsafe intravenous drug use.

"Cambodia has a very distinct problem with injections. Though the numbers aren't large, the problem is growing, and it's growing month by month," says Gordon Mortimore, a technical adviser to the HIV/Aids Asia Regional Program (HAARP).

The National Strategic Plan for Illicit Drug Use, developed by the National AIDS Authority and National Authority for Combating Drugs, with input from NGOs, is a comprehensive plan that focuses on harm-reduction strategies. The plan has yet to receive the necessary funding for full implementation, but HAARP and AusAid have both pledged financial support.

The plan has been lauded by experts. Mortimore calls it "a good example for the region", noting that it ensures a coordinated approach so that international NGOs and civil society groups can avoid funding redundant programs and know where the funding gaps in the plan lie.

Cambodia's new, holistic approach focuses on drug education, treatment and law enforcement, and is supposed to ensure that NGOs, the Ministry of Health and police have the same goals of reducing HIV rates and eliminating the stigma of being a drug user.

Introducing methadone

One key aspect of the plan is the introduction of methadone maintenance therapy, which will be available to drug users in Cambodia for the first time early next year. Though the pilot methadone treatment program run by the Ministry of Health at the Cambodian-Russian Friendship Hospital is an important step, it represents only part of the solution.

The government is relying on Korsang to run support services and make referrals for the methadone program, and Korsang has the experience and the contacts to help.

"Methadone is requested all the time. They [drug users] tell us they want a medicine to help them quit. They've been waiting for it," JB says.

Even though Korsang has been requesting the right to run a methadone treatment program for more than three years, Holly Bradford, founder of Korsang, does not think Cambodia is far behind the curve.

"[The] timing is good. There's an emerging injection drug problem," Bradford says.

Korsang may have started off small, but the organisation quickly grew to fill the various needs of Phnom Penh's growing population of drug users.

"Each additional program we implemented came from the drug users themselves. They let us know what they needed," says Short, one of about 20 Cambodian returnees deported from the US who now work at Korsang, where they are known only by their street names.

In only four years, Korsang has grown to 50 staff members and 20 peer educators. They currently run an outreach program, a 24-hour drop-in centre, a women's health education program, an infirmary, a needle exchange and a music and dance program for at-risk youth. But they are about to expand even more.

With promises of financial support for seven years from HAARP, Korsang will be able to run support services for methadone maintenance therapy in Cambodia and continue running an overnight program for street-based users, Bradford says, making it a key player in ensuring the success of Cambodia's national drug plan.

Govt 'recognises'

In his presentation at the Rights Beyond Borders conference, a regional harm-reduction forum held in Phnom Penh last week, Senator Chhim Kim Yeat said that the government recognises the importance of a harm reduction plan to ensure the continued decline in the HIV rate.

He described Cambodia's fight against HIV as a fragile success story that could be derailed without a collaborative solution to the problem of injection drugs. The HIV rate in Cambodia has dropped sharply, from three percent in 1997 to 0.8 percent in 2006, according to government statistics.

"There is a window of opportunity to avoid a crisis.... The extent of drugs and poverty may set back our goals," Chhim Kim Yeat told the conference.

In order to avert an HIV epidemic, Korsang's grassroots efforts to educate drug users and to refer people to the government-run methadone treatment program will be key.

Every day, Korsang's staff members provide Phnom Penh's drug users with information about HIV transmission, but as Tang - one of the first five staff members at Korsang - pointed out, it's not just what you do that matters, it's how you do it.

"We make them [drug-users] feel better. They see us, we hug them and talk to them. Treating drug users as friends is what separates us," he says.

During this day's outreach, JB and his team met one bloodshot-eyed drug user and calmly explained the effects of drugs. They checked on another drug user's baby to make sure she was still healthy, while later a woman high on methamphetamine, or yaba, demanded medicine they did not have.

In a few hours they will visit more sites, and more the next day. "[On outreach] you see people come back alive. Day by day, when I see them get better, I feel good," JB says.

How many speed addicts are there?

Cambodia is taking new measures to reduce addiction to amphetamine-type stimulants (ATS) – also called yaba – officials at the National Authority for Combating Drugs (NACD) said at a conference on Monday. “We are currently searching for the exact figure of how many people use the addictive drug ATS [as this] will help us effectively stop the spread of drug addiction in the long-term,” Lour Ramin, secretary general of the NACD, said. The United Nations Office on Drugs and Crime has chosen Cambodia to implement a drug-reduction program in 2009. Dr Manjul Khanna, regional adviser at UNODC, said Cambodia is a strategic partner in the region and so must develop a clear plan to solve the ATS problem. Lour Ramin said that though Cambodia does produce ATS, the drugs pass through Cambodia to other countries and finding out how many ATS users are in Cambodia is a necessary first step to prevent drug trafficking. According to UNODC, Thailand has 150,000 people addicted to ATS, Laos has 40,000 and China has 180,000. CHUN SOPHAL