How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Abstract

BackgroundHarm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders.MethodsThis qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns.ResultsThere was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD.ConclusionsThere is a lack of common understanding of the drug-related law and policy and their implications to harm reduction services among both law enforcement officers and PWID/PWUD. Thus, there is a need to mainstream and simplify the law and policy for better comprehension among these actors. To improve the quality and coverage of harm reduction interventions, the gap of understanding and enforcement of laws and policies should be narrowed, and coordination between the government and NGOs and other key stakeholders should be strengthened.

Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study

“…51 A following qualitative study in 2017 also revealed that negative experiences of PWUD, such as being arrested, discriminated or mistreated, have further discouraged and pushed them away from accessing harm-reduction and public health services. 30 In this study, 15.9% PWUD reported having ever been to a drug rehabilitation centre, which refers to the government and NGOs' compulsory detention. According to the standard operating procedures for HIV prevention, care, treatment, and support in prisons and correctional centres in Cambodia, voluntary HIV testing and counselling is provided at the correctional facilities every 6 months.…”

“… 51 A following qualitative study in 2017 also revealed that negative experiences of PWUD, such as being arrested, discriminated or mistreated, have further discouraged and pushed them away from accessing harm-reduction and public health services. 30 …”

“…However, even though a higher likelihood of getting an HIV test as accounted in this study, it was frequently reported that there is a lack of comprehensive services package and referral mechanism in the centres. 30 As a result, linkage to post-release services for HIV treatment, care, and prevention is often unclear or disrupted. Besides, human rights violations, including forced labour, physical abuse and sexual violence, and high levels of psychological distress were reported by PWUD, who had been to the mandatory rehabilitation centres.…”

“…25 26 PWUD face unique challenges, including punitive or suppressive policies, high level of stigmatisation, and condemnation of illicit drug consumption and addiction, which often hamper their access to the continuum of care of HIV and mainstream public health services. [27][28][29][30] Studies in the Asia-Pacific region indicated that HIV testing among PWUD was associated with sociodemographic characteristics, history of injection drug use, sexually transmitted infections (STIs), history of incarceration and HIV-related knowledge. [31][32][33] Under the Cambodian National Strategic Plan IV (2015-2020), individuals at high risk for HIV, including PWUD, are recommended to have an HIV test every 6 months to ensure early diagnosis and ongoing health literacy on HIV prevention.…”

Evaluation of Harm Reduction Strategies in the Psychosocial Care Network

“…Misinterpretation of the current HR policies, and the lack of involvement of other community devices with these strategies still exist. [8][9][10] Thus, given the importance of qualifying the understanding of HR strategies -a guideline of the Brazilian mental health policy -to address the consumption of psychoactive substances, and considering the need to understand the challenges that this policy has regarding its operationalization in the health care networks, we propose to investigate the following guiding question: how are harm reduction strategies evaluated in the experience of workers and managers of a Psychosocial Care Network? The research aimed to evaluate the Harm Reduction strategies in the Psychosocial Care Network of a small city in the South of Brazil.…”