The roar of dirt bike engines and a cloud of dust announces the arrival of the Cambodian

Harm Reduction Collaborative (CHRC) team at their drop-in center.

Covered with tattoos, they may look like a Khmer version of the "Wild Ones,"

but in fact they are the well-trained frontline of an innovative outreach program

for drug users, sex workers and the urban poor.

Despite the high level of HIV infections in Cambodia and generous NGO attention to

AIDS education and the care of HIV-positive patients, until this year nobody was

hitting the streets and working directly with adult intravenous drug users to reduce

their risk of infection.

In January, a determined group of six people, under the guidance of a street-hardened

clinical psychologist, began a community outreach program and opened a drop-in center

in the dilapidated block of flats known as "The Building." In two daily

shifts, they visit key sites within Phnom Penh, talking to people about HIV prevention,

vein care, overdose treatment, and providing condoms.

"A lot of NGOs are scared to get in contact with drug users, and they don't

like to go to the places we go," said Chan Chrisna Buth, who goes by the name

"Dreamer" and volunteers with CHRC. "They're afraid the drug users

are gonna stab them with a dirty needle or something."

"But we come with our heart," said Vong Sarath, an outreach staff member

who everyone calls "Bony." "We've never had any trouble."

The NGO Friends/Mith Samlanh is the only other group working with drug users in Cambodia,

but their focus is on street children. CHRC works with drug users regardless of age,

occupation, HIV status or social background. As a result, people are coming in from

the provinces just to access CHRC services.

Project director and clinical psychologist Holly Bradford brought almost 20 years

of experience working with IV drug users - much of it "sidewalk psychotherapy"

with gang members - with her when she came to Cambodia in September of 2004.

"I've dedicated my whole life to working with IV drug users. A lot of people

don't like 'em, but I think they're great. They're intuitive, they're creative, they're

smart," said Bradford, who calls herself an "ex-dope fiend with a Master's

degree."

Seeing that such a high-risk community was not being adequately assisted, she began

organizing the only harm-reduction program in Cambodia.

Harm reduction, sometimes known as risk reduction, is an addiction-care philosophy

currently used in the Netherlands, Britain and Canada, and rapidly catching on in

other countries around the world. The philosophy is based on working with users in

a compassionate, respectful and non-judgmental way, thereby building solid relationships

that can become the basis of further treatment.

Harm reduction works to minimize the negative effects of risky behaviors, rather

than eliminate them, and recognizes the impacts of issues like poverty, racism, social

isolation and past trauma on people.

For example, rather than try to persuade users to stop injecting heroin, harm reduction

workers might help a person reduce their intake gradually, teach them about safe

injecting techniques and suggest services that might stabilize their lives.

To date, CHRC has opened a drop-in center, educated 3,500 people about HIV and drug

risks, handed out more than 33,000 condoms, and distributed almost 7,000 educational

fliers.

The outreach team has undergone a three-month training course in case management,

as well as basic first aid and HIV instruction.

With a total budget of less than $4,000 per month, it's a high-impact, value-for-money

initiative.

The two major umbrella organizations for HIV services in Cambodia - the International

HIV/AIDS Alliance and the Khmer HIV/AIDS NGO Alliance (KHANA) - agree that there

is a need for direct services to drug users.

"The Alliance and KHANA have recognized in the past year that we need to work

with drug users," said Joanna Dorricott, technical support officer for the Alliance.

"This is an area that has been under-prioritized."

"In general, in Cambodia, very few people are doing this work," said Oum

Sopheap, executive director of KHANA.

Both the International HIV/AIDS Alliance and KHANA said they have been impressed

with CHRC's outreach activities and have committed to working with the group in the

future.

Currently, CHRC has 11 paid staff and five volunteers. They started with a small

grant from USAID, administered through the Returnee Assistance Program, and are now

seeking support from KHANA, the International HIV/Aids Alliance and AusAID, and hope

to continue receiving support from USAID.

"USAID is committed to supporting risk-reduction activities in Cambodia and

would like to increase its support of HIV prevention and AIDS care as it relates

to substance abuse," said US embassy spokesperson David Gainer.

At the moment, CHRC resources are stretched to the limits, but with more money the

program could expand to better service its client group.

"We need more supplies and an office," Bradford said. "We'd like to

be able to do oral HIV testing, which I don't think is offered anywhere in Cambodia,

and get set up to do a needle exchange."

Currently the only HIV testing available in the country requires people to schedule

an appointment, make their way to the testing site, and then return at a later date

for their results. While CHRC provides assistance and support for every step of this

blood-based testing, they report low rates of testing. Often those at the highest-risk

of contracting the virus also find it difficult to fit the logistics of a test into

their chaotic lives.

Oral testing would allow CHRC to take swabs on-site, conduct pre- and post-test counseling,

and bring the results to the homes of clients.

A crucial part of the program's early success, and a key to the future, has been

the outreach staff. Most of them have been convicted of a felony in their adopted

homeland of the United States and deported back to Cambodia. Many of them have a

history of drug use and abuse and have served prison time.

Though former drug addicts might seem a strange choice to counsel drug users, Graham

Shaw of the United Nations Office on Drugs and Crime (UNODC) insists this is a unique

strength of the program.

"It's the perspective of UNODC that these people are a tremendous resource for

prevention and awareness services," Shaw said. "It's internationally recognized

that the best people to do drug-use prevention and awareness are those who have been

addicts themselves."

The guys agree.

"We use our own experience to reach these people," said Bony.

While these former bad-boys wear clean white t-shirts with the CHRC logo for the

outreach sessions, their tattoos and body piercings seem to help break down a few

social barriers.

"When people see us ride up with all our tattoos and stuff, it's easy for them

to interact with us, they trust us more than they would a professional in a suit

and tie," said Om Roeun, a volunteer who everyone knows as "Lucky."

"They look at us like we're doin' a job," said Dreamer. "But we're

rebels, too."