‘Using the heart’: law enforcement and people who use drugs in Asia

HIV Australia | Vol. 12 No. 2 | July 2014

By Fifa Rahman, Hong Reaksmey, Pham Hoi Thanh and Olga Golichenko

‘These addicts, actually they are patients!’

In countless countries around the world law enforcement officials continue to be at the forefront of the failing war on drugs and can be a major obstacle when it comes to implementing evidence-based HIV prevention and treatment interventions.

It’s not all doom and gloom, however, and thanks to the energy of progressive champions within the police and cooperation with civil society, the police are changing from the inside in some places.

Learning from the Australian experience

Australia, particularly law enforcement in the state of Victoria, is at the forefront of such changes and is stimulating similar developments in other countries, most notably in parts of Asia.

It’s one of the few countries in the world where civil penalty schemes allow the police to issue fines for minor drug offences;²the police can exercise the discretion to be able to divert people who use drugs towards the health system (before or after arrest); and individuals in police custody are allowed access to HIV medicines, methadone and medical services.³

Police officers in Victoria have a good understanding of public health and harm reduction.⁴ For example, they do not park patrol cars in front of or in close proximity to a needle and syringe exchange site because this might scare people off from accessing the services.⁵

By comparison, our research in Malaysia⁶ shows that the police lack information about the links between harm reduction and public health. For example, law enforcement members in Kuala Lumpur do not know that needle and syringe exchange programs reduce the risk not only of HIV infection but also of hepatitis C. The police authorities there tend to challenge the scientific evidence relating to the efficacy of methadone.

Police organisations in Victoria care about the levels of public confidence in their work⁷ as well as being concerned with the public health needs of people who use drugs. Deprivation of medication in detention is considered a disciplinary offence in Victoria.

Malaysian police at a training session to raise awareness of harm reduction approaches.Photo: Fifa Rahman for the Malaysian AIDS Council.

Police officials together with community advocates from Cambodia (KHANA⁸), Malaysia (Malaysian AIDS Council [MAC]) and Vietnam (Supporting Community Development Initiatives [SCDI]) visited Victoria and New South Wales in Australia last summer to find out more about law enforcement practices with a view to increasing political support of a harm reduction approach among police officials in each country.

The study visits were organised as part of the Asia Action on Harm Reduction program⁹ which is coordinated by the International HIV/AIDS Alliance with support from the European Union, and in partnership with the Australian Police Leadership program run by the Law Enforcement and HIV Network (LEAHN) with support from the Australian government.

Working with the Melbourne and Bishkek-based LEAHN global network of police and health professionals provided participants with considerable food for thought, not least because the network practises a ‘police talking to police about HIV prevention’ approach, working in countries through experienced police focal points.

LEAHN also champions the Statement of Support by Law Enforcement Agents for Harm Reduction and Related Policies for HIV Prevention, which has been signed by more than 5,000 police officers worldwide and an increasing number of police agencies.

Following the study visits, country cooperation platforms among police and civil society are in the process of being established in Malaysia and Cambodia. In this article we describe our main learnings from the study visit to Victoria and next steps.

Malaysia: police support for health services in detention

In Malaysia, healthcare services are not available for people who use drugs in pre-trial detention. According to Ng Soon Wah, Assistant Superintendent in the Royal Malaysian Police’s Narcotic Crimes Investigation Department, who took part in the study visit:

‘The most interesting point was the health management services provided by Victoria Police at the police remand centre. Victoria Police have their own doctors, pharmacists and nurses to check and take care of detainees under police custody, including patients living with HIV. This practice should be implemented in Malaysia.’

The study visit report¹⁰ and the fostering of close relations with the police officials who participated have helped MAC to get police buy-in for the introduction of medical services for those detained in holding cells.

With support from key champions in the police, a committee has been established under the auspices of the Ministry of Home Affairs to discuss a pilot project to introduce healthcare services in detention settings, starting with the police custody system at Jinjang integrated lockup centre.

Drawing on the experiences of multiple stakeholders’ forums in Australia, MAC now convenes the Kuala Lumpur Health and Drugs Forum which brings together different stakeholders, including the Royal Malaysian Police, to look at HIV and drug issues. A commitment has also been received from the Royal Malaysian Police to introduce the concept of harm reduction to the training curriculum for police cadets.

Cambodia: a ‘softer’ implementation of the Village/ Commune Safety Policy

The Village/Commune Safety Policy was launched by Cambodia’s Ministry of Interior in 2010 and due to a priority focus on ‘cleaning the streets’, has driven people who inject drugs underground.

This has created significant difficulties for HIV prevention programs but unfortunately the popularity of the policy among the public and politicians leaves little opportunity to advocate for changes.

However, local police forces are able to apply a certain level of discretion to implement the policy in a ‘softer’ way, for example by referring people who inject drugs to harm reduction programs instead of arresting them.

Since last year, KHANA, jointly with the Ministry of Interior’s AIDS Secretariat, has been implementing the Police–Community Partnership Initiative (PCPI), which builds police awareness of harm reduction through training.

It also develops police platforms on harm reduction at a district and community level in Phnom Penh together with local community participation.

To encourage international best practice and create stronger linkages between the Ministry of Interior and other stakeholders, KHANA has seconded its communication officer to the AIDS Secretariat to help inform the PCPI training.

Some 200 police officers have already participated, together with 150 commune council members, drug users’ representatives and other local stakeholders.

Dr Hy Someth is program manager with the AIDS Secretariat and took part in the study visit to Australia.

‘After the harm reduction training, the police will use not only their heads and hands but also their hearts to support people who use drugs,’ he said.

As well as applying his experiences from Australia to the PCPI training, Dr Someth is also supportive of KHANA’s advocacy efforts to extend methadone maintenance therapy (MMT) services to prisons and to offer MMT takeaway doses to current patients.

‘Once a drug user is sent to prison, the police are no longer responsible but we acknowledge that MMT substitutes heroin and normalises drug users’ behaviour towards stopping using illegal drugs,’ Dr Someth said.

Vietnam: gaining police support for harm reduction

Last October the People’s Police Academy, jointly with LEAHN and SCDI, organised a meeting about harm reduction between officials from Vietnam’s Ministry of Public Security and civil society representatives.

It was the first time such a dialogue had occurred. The ongoing collaboration between the People’s Police Academy and SCDI includes research about the effects of relapse on drug use and the associated risk of criminal activity.

SCDI is also working closely with the police to gain their support for the development of harm reduction and community-based rehabilitation services in Bac Giang province.

Where to from here

In many countries in Asia, such as Indonesia, Malaysia, China and India, there are some progressive policies in place that allow the implementation of harm reduction services and diversion from arrests to treatment.

However they are not being implemented properly because of law enforcement policies such as police arrest quotas, which lead to the arrest and harassment of outreach workers and people who use drugs. In such cases police leadership and collaboration is required to ensure an effective implementation of drug and harm reduction policies.

In Indonesia for example, the diversion policy outlined in Narcotics Law #35, which seeks to divert people suspected of drug use and possession for personal use to treatment and harm reduction services instead of the criminal justice process and potentially prison, can only work if police officials (as well as prosecutors and judges) are aware of the policy – and willing to implement it.

This year the Asia Action on Harm Reduction program will support police officials and community advocates from Indonesia to learn from the Australian model.

The study tour will include a visit to Harm Reduction Victoria, a peer-based organisation of people who use drugs.

Participants hope to learn about various strategies to engage with people who use drugs and the support services they provide to their members.

There will be discussions about how to work with police and government to develop policies that recognised the importance of civil society collaborating with the criminal justice system.

Policy manager Ardhany Suryadarma already knows the change he wants to see:

‘The police have the authority to divert people who use drugs in Indonesia from prison towards treatment but this is not happening because of a number of structural barriers. I hope to learn from the police in Australia to help us to improve the implementation of Narcotics Law #35.’

In the majority of countries in Asia, policies on drug use and harm reduction need to be amended and introduced first before, or at the same time as, asking for police leadership and collaboration.

Improving relationships with law enforcement officials and understanding harm reduction through their ‘lens’ is critical.

The study visits to Victoria have helped build trust and partnership between community advocates and police officials.

As well as creating harm reduction champions within law enforcement sectors, the visits are contributing to in-country changes where both police and community advocates work together.

In Malaysia, for example, law enforcement members who participated in the trip are now facilitating police training and high level briefings on HIV/AIDS and harm reduction.

According to Professor Nick Crofts from LEAHN:

‘Together with other stakeholders, LEAHN focal points are building police leadership in harm reduction in countries following the study visits. What we need is the political support from governments and resources from donors to institutionalise this leadership’.

It’s imperative that key donors, particularly the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, as well as governments in Asia, fund interventions that will build support of harm reduction approaches within the law enforcement sector.

This will help create an enabling environment for harm reduction services at a community level.

Asia Action on Harm Reduction is a European Union funded program which enables civil society advocates in China, India, Malaysia, Indonesia, Cambodia and Vietnam to advocate for harm reduction. This is done through creating evidence-based advocacy calls, and by improving knowledge and building support for harm reduction among policy makers. The contents of this article are the sole responsibility of the International HIV/AIDS Alliance and do not necessarily reflect the opinion of the European Union.

Fifa Rahman is Policy Manager at the Malaysian AIDS Council.

Hong Reaksmey is Policy Manager at KHANA.

Pham Hoi Thanh is Policy Manager at Supporting Community Development Initiatives, Vietnam.

Olga Golichenko is Senior Advisor: Harm Reduction Advocacy at the International HIV/AIDS Alliance.

References

1 Source: Corporal of the Narcotics Department in the state of Pahang, Malaysia (where police practice towards people who use drugs is considered to be less repressive) during an interview with the Malaysian AIDS Council. Research presented at the Eighth Annual Conference of the International Society for the Study of Drug Policy Conference, Rome, 21–23 May, 2014.

2 Stoicescu, C. (ed.) (2012). The Global State of Harm Reduction 2012: Towards an integrated response. Harm Reduction International, London. 159. Retrieved from: www.ihra.net

3 Rahman, F. (2013). Police Leadership in Public Health. Study Tour to Melbourne, Australia. Malaysian AIDS Council. Retrieved from: www.mac.org.my

4 ibid.

5 Mike Anderson, quoted in ibid.

6 Poster presentation. (2014). Harm Reduction Services and Police Involvement in Malaysia. Poster presented at the Eighth Annual Conference of the International Society for the Study of Drug Policy Conference, Rome, 21–23 May, 2014.

7 Public confidence is one of the indicators of the police work performance and is reported to the public in the Victoria Police Annual Report 2012–2013. Retrieved from: www.police.vic.gov.au/annualreports/ebooks/2013/index.html

8 KHANA is the largest national NGO providing integrated HIV prevention, care and support services at the community level in Cambodia. See: www.khana.org.kh

9 For further information see: www.aidsalliance.org/Pagedetails.aspx?Id=543

10 Rahman, F. (2013). op cit.