Observers warn of ‘developing’ health crisis with needle programme stalled.
A LOCAL NGO says some intravenous drug users have resorted to the dangerous practice of sharing needles since its licence to distribute clean needles ended at the beginning of the year, sparking fears that HIV transmission rates among drug users could soar if the situation is left unchecked.
Anecdotal evidence collected by Korsang, a harm-reduction NGO that works with drug users, suggests that some of its clients are again sharing needles after authorities failed to renew its needle and syringe programme (NSP) licence January 1, the organisation said.
“There has been no consistent access to sterile injection equipment since our licence was not renewed,” said Holly Bradford, the group’s founder and technical adviser.
In interviews with 20 drug users earlier this month, 17 reported that they had started sharing needles since the licence expired, Bradford said. One drug user said he had injected with a needle that six other people had used before him.
“They had access to needles and had learned not to share,” said Bradford, calling the situation a “public health crisis”.
“Blood-borne viruses are definitely being transmitted,” she said. “The only way to stop that is to get back in there and make everybody use a new syringe for each injection.”
Tension with authorities
Korsang’s needle and syringe licence expired two weeks after tension mounted over a controversial detoxification drug programme that authorities wanted to administer to drug-using clients from Korsang and Mith Samlanh, an NGO that works with street children.
Officials with the government’s anti-drugs bureau, the National Authority for Combating Drugs (NACD), had approached the groups looking for participants, which alarmed rights groups and UN agencies because the drug trial involved a little-known Vietnamese medication, Bong Sen. Both organisations declined, and NACD officials appeared to take offence when Korsang asked its international donors to intervene.
“They complained to [international groups], claiming that authorities were forcing them into the trial,” Neak Yuthea, the NACD’s director for legislation, education and rehabilitation, said in an interview last month.
“We did not force anyone. There is no reason for us to bring people to die or joke with people’s lives.”
Since then, Korsang has had little communication with authorities. A letter sent this month requesting a meeting with the NACD, which oversees licence approval, has gone unanswered, Bradford said.
NACD officials declined to comment when reached by the Post on Sunday, citing the Chinese New Year holiday.
In early January, NACD Secretary General Moek Dara told the Post there were no plans to stop Korsang from distributing needles. However, authorities did not issue a new licence when the old one expired on December 31.
Korsang was one of only two organisations permitted to distribute clean needles in Phnom Penh. The other, Mith Samlanh, planned to temporarily cover the gap left by Korsang’s absence.
But the problem has been compounded by a jump in near daily street sweeps that have sent many drug users into hiding, said David Harding, the international coordinator for drugs programmes with Friends International, which is affiliated with Mith Samlanh.
Now, Mith Samlanh’s outreach workers are finding it harder to reach drug users, despite a surge in the number of people they must cover.
Outreach workers used to see an average of 150 drug users each day before December, Harding said, and now they see an average of 60.
“They’re finding smaller groups of people, with people coming out of their hiding places less frequently,” said Harding, who called the situation “deeply concerning”.
“This is the first time I’ve felt that harm-reduction services for [injection drug users] have been seriously undermined,” he said. “We’ve had blips before and issues with police actions, but we’ve always had a gradual progression in the depth and the scope of services being provided.
“This is the first time I’m deeply concerned that harm reduction is not serving its population.”
Harding warned that health concerns could broaden beyond drug users. Through unprotected sex, people infected with HIV or Hepatitis C acquired from tainted needles could go on to pass the virus to husbands, wives, boyfriends and girlfriends, he said.
“I would say this is a developing health crisis,” Harding said. “What we have right now is a situation where we simply don’t know how serious this is going to get.”
Advocates say needle-distribution programmes are a valuable tool in cutting the spread of HIV among drug users.
While Cambodia has been lauded for managing to reduce its overall rate of HIV transmission among adults, figures from the World Health Organisation suggest that the HIV rate among injecting drug users in Cambodia stands at around 24 percent.
NSP programmes are “extremely important, because the transmission of the virus through sharing needles among injecting drug users is very high”, said Tea Phauly, most at-risk populations adviser with UNAIDS in Cambodia. “If people have no access to new syringes, this is a major concern for UNAIDS.”
The Global Fund to Fight AIDS, Tuberculosis and Malaria, which has pledged more than US$200 million to the national health system and funds HIV-reduction initiatives, including some of Korsang’s services, has also urged the government to support NSPs.
The Global Fund “expressed our support to renewing the licence of all NSP service providers, based on concerns that reducing the distribution of clean needles in the capital city could pose a significant public health risk and possibly rapidly escalate HIV transmission among the drug using population,” the organisation said in a December e-mail.
In the meantime, Korsang held a prayer for drug users at a local pagoda Sunday.
“I came to the pagoda to pray and make a dedication to my friends who died after using drugs,” said Him Sophorn.
Thon Visoth said he knows the dangers of sharing needles, but uses them when he feels he has no other options.
“When we use drugs, we don’t care about getting diseases from our friends, because all we are thinking is that using drugs will make us feel happy,” he said.