Harm reduction and injecting drug user
organization in Asia
A scoping report for AIVL
December 2007
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Table of contents
Acronyms used in this document ................................................................................ 3
1. Introduction ............................................................................................................. 4
2. Is there scope for a regional Asia drug user organization/network? ....................... 6
Regional level drug user organization activity and contacts...................................... 6
Existing drug user organizations identified through the scoping activity: ................. 8
3. Country reports ..................................................................................................... 10
Indonesia ................................................................................................................... 10
China (Yunnan and Guangxi) ................................................................................... 12
Burma........................................................................................................................ 14
Vietnam ..................................................................................................................... 17
Philippines ................................................................................................................ 19
Cambodia .................................................................................................................. 12
Laos ........................................................................................................................... 20
4. Recommendations: Potential partners and activities ............................................ 22
5. Challenges ..............................................................Error! Bookmark not defined.
References ..................................................................Error! Bookmark not defined.
Appendices ........................................................................................................................ 28
1. Indonesian Organisations: ................................................................................. 28
2. Cambodia .......................................................................................................... 30
3. Burma organizations: ........................................................................................ 31
4. AHRN Myanmar:.............................................................................................. 33
5. Nepal IDU organizations: ................................................................................. 33
6. Articles on the founding of INPUD Asia (background). .................................. 35
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Acronyms used in this document
APN+:
ADB:
AHRN:
ARHP:
ATS:
CCDAC
FHI:
GFATM:
GONGO:
HAARP:
IA:
ICAAP:
IHPCPP:
INGO:
INPUD:
IPPNI/IDUSA:
MMT:
NEIHRN:
NSP:
OSI:
PLHA:
PSI:
SIDA:
SASO
TDN:
UNODC:
WHO:
Asia Pacific Network for PLHA
Asia Development Bank
Asian Harm Reduction Network
AusAID Asia Regional HIV/AIDS Project
Amphetamine-Type Stimulants
Central Committee for Drug Abuse Control (Burma)
Family Health International
Global fund for AIDS, TB and Malaria.
Government Organised NGO
AusAID HIV/AIDS Asian Regional Project
INPUD Asia
International Conference on HIV/AIDS in the Asia and the Pacific.
AusAID Indonesia HIV/AIDS Prevention and Care Project
International non-government organization
International Network of People who Use Drugs.
Indonesian Network of People who Use Drugs.
Methadone Maintenance Therapy
NE Indian Harm Reduction Network
Needle Syringe Program
Open Society Institute
People Living with HIV/AIDS.
Population Services International.
Swedish International Development Agency
Social Awareness Service Association
Thai Drug Users Network.
UN Office for Drugs and Crime
World Health Organisation
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1. Introduction
This report will be used as an internal document to inform the AIVL contribution to the
Australian HIV organizations consortium proposal for the AusAID HIV/AIDS Capacity
Building Program 2007-2011.
AIVL is aiming to work with civil society, particularly drug user organizations, to
enhance capacity for regional level advocacy, and to train and mentor harm reduction
staff to contribute to workforce scale-up for Indonesia, China (Yunnan and Guangxi),
Vietnam, Burma, Laos, Cambodia and the Philippines.
The report includes a regional and country-by-country summary of:
 harm reduction policy and activity,
 existing technical and donor support for this activity (highlighting apparent gaps),
 peer-based networks or organizations,
 potential partners (and summary of dialogue initiated with these),
 recommendations and challenges.
HIV/AIDS and injecting drug use in Asia
Across Asia, access to HIV risk-reduction services for drug users remains unacceptably
low – reaching on average a maximum of 5.4% of the target population. The shared use
of injecting equipment is a major factor fuelling the HIV epidemic in the South, SouthEast and East Asia Region, accounting for 50–70% of HIV infections in some countries.
Of the 13 million estimated IDUs in the world, 78% live in developing and transitional
countries, and with as many as half being in the Asia region. There is a wide variation in
HIV prevalence within the nominated countries and the region.
With the exception of the Philippines, the countries included in this report are all located
in illicit drug trafficking routes and/or production areas. (Laos, Vietnam, Yunnan
Province PRC, and Burma all make up parts of the Golden Triangle, renowned for opium
production. Cambodia, southern China and Laos are regarded as major manufacturers of
illicit amphetamine-type substances – ATS.) Indonesia now has a sizable illicit drug
demand/market of its own. Use of injectable pharmaceutical drugs, and the potential for
injecting use of ATS are increasingly reported in the region. Crossover between injecting
drug user and sex worker communities is also documented across Asia.
All countries referred to are parties to the 1961 United Nations Single Convention, the
1971 UN Convention on Psychotropic Substances and the 1988 UN Convention against
Illicit Trafficking in Narcotics. All countries are also in support of the ASEAN
commitment of being drug-free by 2015.
Many countries in the region continue with a predominantly punitive response to drug
use (including use of capital punishment) with a lesser concern for the impact of
HIV/AIDS. Drug users who are incarcerated face overt discrimination and limited or no
access to health services. Police officers are underpaid, under-trained and under-equipped
in much of Asia. As in many other countries, the police are susceptible to corruption and
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use of unnecessary force. Health care systems in Asia generally lack experience and
capacity in dealing with HIV/AIDS among people who inject drugs. Discrimination and
ignorance are the norm.
Crackdowns aimed at drug users tend to drive drug use further underground, making it
difficult to mobilize civil society groups and to conduct harm reduction programs. Social
constraints, including widespread stigmatization of drug users, religious and other
cultural factors also mitigate formation of “representative” drug user organizations. In
some countries (Myanmar, China, Vietnam), political and legal constraints also hamper
potential for autonomous drug user organisation – or indeed any NGO (although
formation of user-run support groups in these countries has begun at a small scale).
While most countries have ratified public health policies (such as National HIV/AIDS
Strategies) which support implementation of harm reduction approaches, attempts to
operationalise these strategies has highlighted the inconsistency and conflict in overall
policy towards injecting drug users.
Nonetheless, throughout the 1990s, various HIV-prevention programs for injecting drug
users were established throughout Asia. Today, NSPs are operational – though small in
scale and numbers – in Vietnam, China, Nepal, India, Myanmar, India, Bangladesh,
Pakistan, Vietnam, Thailand, Indonesia and the Philippines. Drug user organizations have
sprung from the harshest of environments (including Thailand and Burma) and the Asian
Network of People who Use Drugs was recently founded.
Despite these initiatives, the implementation of HIV/AIDS prevention and control
measures for people who inject drugs has been slow. There is an urgent need to scale up
the harm reduction implementing workforce across Asia. Civil society involvement
(through peer-based harm reduction programs and through drug user organizations) could
make a significant contribution to both filling the workforce gap (provided appropriate
training, conditions etc), and in ensuring maximum impact, relevance, credibility and
quality of HIV-related services for drug users.
Funding for HIV prevention among drug users remains inadequate and consistently
supportive multi-sectoral policies are lacking. Data on injecting drug use is generally of
low quality if collected at all. In the meantime, HIV continues to infect injecting drug
users and their communities in Asia (and is recognized as the most significant harm
associated with injecting drug use across the region).
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2. Is there scope for a regional Asia drug user organization/network?
Asian drug users face some commonalties that set them apart from injecting drug users in
other parts of the world. They share governments who have imposed overwhelmingly
oppressive and punitive measures to address illicit drug use. This has had the unintended
consequences of failing to reduce drug use and causing extreme marginalisation of drug
users. With the emergence of HIV, (which is increasingly seen by governments in the
region as a larger threat than drug use itself), the marginalization of injecting drug users
has meant that they are often beyond the reach of mainstream HIV-related and other
health services.
Some countries (Indonesia, Cambodia, India, Nepal, Thailand, Malaysia), have
established drug user organizations (or their beginnings) over the past few years. In other
countries such as China, Burma and Vietnam, the political environment does not yet
allow the emergence of autonomous drug user organizations. However, in China, with
the expansion of MMT, a few drug user groups have been formed with support from
International HIV/AIDS Alliance. These are essentially PLHA and methadone support
groups (the PLHA ex-users group provides NSP and the other provides psycho-social
support for MMT clients), however they are working under county level government
through Centres for Disease Control, and as “groups” have very little capacity for selfdirection.
There are some NSPs with peer-based outreach in Burma, China and Vietnam that may
recruit active or ex-drug users as outreach workers. However, these outreach workers
generally have little say in service design or delivery, and very limited (if any)
opportunities to network with one another. The Philippines has little harm reduction
activity and Laos has none at all.
Regional level drug user organization activity and contacts
While opportunities for Asian drug user organization have been discussed for some years,
donor interest has (in the main) only recently emerged in the region. However, funding
and other resourcing opportunities are rare, indicating a need to work closely with other
agencies to maximize output (i.e. capacity building for the peer-based harm reduction
workforce). In the meantime, more and more drug user groups are forming across Asia,
funded or not.
INPUD Asia.
Formed in 2007, one of the focuses of INPUD Asia (IA) is to expand and strengthen the
IA network in the region. IA is, so far, a list of signatory supporters, individuals and
organizations who were registered during and after ICAAP 2007. The INPUD Central
board will make final decisions on these memberships. However, to date, INPUD Asia
has 3 kinds of membership:
1. Individual (users only)
2. Users group/organizations
3. Supportive (individuals/group)
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Any users organization can be a member of IA or INPUD, however, at the time of
researching this document (November 2007), only one group applied for the membership
from the AusAID funded countries: Indonesia.
IA is not funded by any donor agencies. (see appendix for more background on INPUD
Asia).Other IA activities to date include:
 Initiated the IA list server and discussion forum
 Helping 3 users to attend RAR training provided by AHRN
 Trying to organize skill building session in 2008 Goa conference (have received
$10 000 from OSI for INPUD involvement in Goa conference).
Summary of discussion with Anan Pun regarding INPUD Asia and possible collaboration with
AIVL (early November 2007):
INPUD Asia is open to have a dialogue with and willing to work with AIVL. In
principle, IA supports the notion of, and need for, a regional level network linking drug
user organizations and other user-based activities in countries where drug user
organization is not yet possible. Anan indicated that it would be plausible - insofar as IA
is concerned – to collaborate with AIVL to support peer organizations/programs in
AusAID funded countries, and that, in order to gain cross-border relevance and increase
momentum for Asian user organization capacity building, this network should also
involve other countries with user organizations (current and future) in the region
(including those in Nepal and South Asian countries).
Apart from providing a network secretariat for information exchange; alliance building;
advocacy; identifying, organizing and mobilising new groups in the regions etc, initial
identified needs (according to the discussion held at ICAAP in Sri Lanka), were:
* Overdose management training
* Training on Hep C
* Legal aid training
* Network development
* Community organizing
* Peer education
* Training on Harm reduction
* Human rights, advocacy and leadership.
Anan Pun also remarked that it would be good if INPUD members get an opportunity for
a study/exposure visit to AIVL, where they can have chance to discuss and learn from
one another.
INPUD Asia: Anan Pun: Office: +97712111107; cell: +9779841513534
Email: recovernp@wlink.com.np, ananpun@gmail.com (Nepal).
IA Involvement with other agencies includes:
 APN+ will be providing a position in their Bangkok regional office for an IA
representative. The focus will be on PLHA who inject drugs, and HIV/AIDS
treatment access.
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
AHRN have been providing support to IA for organisational development.
In order to complement existing and planned activities, it was suggested (by AHRN) that
AIVL consider providing IS with advocacy skills training.
Summary of discussion with Pascal Tanguay – AHRN, 28 November 2007
“The main aspect that I would emphasize is regarding INPUD Asia and their need for
capacity and skills around advocacy. AHRN is very keen in providing support to INPUD
Asia but AHRN is not peer led and AIVL would have an important role to play in that
respect. If we could arrange to link both INPUD Asia and AIVL, I would be willing to
invest some time and energy in fostering a partnership there.”
Pascal Tanguy: pascal@ahrn.net
Summary of discussion with Gerry Stimson, October 2007.
“IHRA is funding INPUD ($40,000 per year over 3-4 years) as part of the DFID program
of work. IHRA is aware that INPUD is developing sub-branches in different regions
including INPUD Asia. IHRA has no money to expand INPUD or sub groups of INPUD.
However we are looking out all the time for funding opportunities to expand and
strengthen INPUD, which rapidly needs to add some additional funding.
“IHRA support the notion that AIVL provide some secretariat function for drug user
organizations in Asia , this would be an appropriate complement to the activities that
IHRA are funding. INPUD is an independent organization, therefore free to raise funds
from wherever (including for regional level support).“
Gerry Stimson: gerry.stimson@ihra.net
Existing drug user organizations identified through the scoping activity:
 Indonesia: Indonesia Exceed, Stigma, IPPNI/IDUSA (see appendix).
 Cambodia: Korsang (see appendix summary regarding Korsang – a model for other
countries to replicate)
 Thailand:
(Thai
Drug
Users
Network)
TDN
(see
http://hrw.org/english/docs/2004/07/13/thaila9053.htm for more details)
 China: Two International HIV/AIDS Alliance programs. Contact Umesh Sharma
(regional IDU coordinator): <husharma@loxinfo.co.th>; Alliance China Director:
Graham Smith: graham@alliancechina.org;
 APN+ regional office is also working with drug use issues in Vietnam, Thailand,
Indonesia, India. (For more information, contact Mr Shiba: shiba@apnplus.org)
 Burma: The Black Sheep and SWIFT. Contact Willy DeMaere: willy@idu.org.mm;
and Siddharth Singh: siddharth@idu.org.mm regarding The Black Sheep. SWIFT
contact is Myo Kyaw Lynn (nickname Tom): mklynn.tom@gmail.com.
 Nepal: (see appendix) Bijay (Recovering Nepal): bigjoy@wlink.com.np
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 India: Possibly the NE India harm reduction network (contact Mr Raju who is now
heading Indian Harm Reduction network in Delhi. horai@rediffmail.com. (He was
the head of NEIHRN from 2002-2007). SASO, in Manipur is a drug user
organization. The contact person is Mr Tiken: rktiken@rediffmail.com
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3. Country reports
Indonesia
The estimated number of injecting drug users is around 200,000, and the main drugs
injected are heroin, methamphetamine and cocaine. As of 2003, 80% of new HIV
infections were linked to IDU, with HIV seroprevalence rates found to be as high as 40–
53 per cent in various sites such as prisons and drug treatment centres.
Harm reduction policy
Legislation in Indonesia has evolved over the past five years to allow programs to assist
in controlling the HIV epidemic among people who inject drugs. The Sentani
Commitment1 specifically supports needle and syringe programs, as well as methadone.
The National HIV/AIDS Strategy makes supportive mention of harm reduction and sets
ambitious targets for scale-up. The Memoranda of Understanding signed between the
National AIDS Commission and the National Bureau on Narcotics have also assisted in
creating an enabling environment for harm reduction approaches. The President and the
Vice-President of Indonesia have made statements that demonstrate support for harm
reduction Interestingly, some religious leaders are more resistant to the promotion of safe
sex than to the promotion of safer use of drugs.
There is no law against harm reduction in Indonesia but the continued enforcement of
harsh drug laws makes it difficult for harm reduction interventions to have an optimal
effect.
Harm reduction activity
Yayasan Hati-hati located in Bali was the first NGO providing harm reduction services in
Indonesia (from 1998). The primary source of financial support for harm reduction NGOs
remains international donors (mainly from IHPCP/AusAID and FHI/USAID). In total, 41
NGOs are working in the field of harm reduction. Among these, 16 are conducting NSP.
Government community health centres (puskesmas) are also conducting harm reduction
activities, including needle and syringe exchange. By 2006, the number of puskesmas
providing harm reduction services had swelled to 65, making the total number of NSP
sites 115. The 2006 coverage rate of these programs was estimated to be approximately
3% of the total injecting drug user population. Jangkar, the National Network of Harm
Reduction Implementing Agencies, coordinates between implementers and promotes
harm reduction in the country. As of 2005 the network was made up of 38 NGOs focused
on drug use and HIV/AIDS.
MMT was first provided in Indonesia in 2003 with assistance from WHO and the
Ministry of Health in two pilot projects. In 2006, there were seven clinics serving
approximately 1000 clients.
1
The Sentani Commitment to Fight HIV/AIDS in Indonesia (2004) Available online at:
http://www.ahrn.net/index.php?option=com_library_display&AlbumID=2626&task=show
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In Kerobakan prison Bali, there is distribution of bleach and condoms for prisoners, as
well as treatment with methadone and ARV. Indonesia is the only country in Asia that
does not restrict access for people who inject drugs (including current users) to ARV
treatment.
User organizations/involvement
Drug user involvement is finding a role in the Indonesian response to the epidemic. In
addition to Jangkar, there is also IDUSA/IPPNI, the National Drug Users Network (see
appendix).
Summary of discussion with Wulan Sari, President (Ikatan Persaudaraan Pengguna Napza
Indonesia) Indonesian Drug Users Network (IPPNI/IDUSA.)October 2007.
IPPNI/IDUSA are interested in further exploration regarding collaboration with AIVL.
The organization is already receiving funding and support through OSI.
IPPNI is not currently funded for, but needs support in:
- team building
- organizational structure
- strategic plan development
- network expansion (local, national, international)
- developing the drug user movement
- setting goals
- financial management
- negotiating skills
- guiding principles/values development
- managing a national network
- effective lobbying of government and other stakeholders.
IPPNI has established some initial links with government by attending meetings at the
National AIDS Commission when the theme is associated with harm reduction (together
with Jangkar, UNODC, UNAIDS, etc ).
Wulan Sari. IDUSA President: Wulan <our_stigma@yahoo.com>;
Also contact IPPNI staff:
Adit
: betarakresna@yahoo.com (R&D division in IPPNI)
Patri
: patrihandoyo@ihpcp.or.id (IPPNI coordinator)
Lette
: milette@cbn.net.id (IPPNI coordinator)
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Cambodia
With great disparity between official and unofficial estimates, there are up to 520,000
drug users in Cambodia. The most used illicit drugs are ATS (mostly as pills), and the
main drugs injected are heroin and methamphetamine. There are strong indications of a
general change in mode of administration from smoking to injecting of opiates.
Estimated prevalence of HIV infection among IDUs in Cambodia suffer from insufficient
surveillance, but appear to range from 14-38%.
Other recent studies have highlighted the following risk factors:
 Re-use of injecting equipment is common among injecting drug users.
 Other unsafe injecting practices are also seen and documented by local outreach
teams, including “dry” injecting i.e. using blood to dissolve heroin in the syringe
and then sharing this among IDU (also found in parts of Burma).
 Drug users often having multiple sexual partners and practising unsafe sex, with
rates of around 40% reporting irregular or no condom use.
 Low awareness of HIV transmission through injecting practices in both illicit
drug using populations and other vulnerable groups such as sex workers.
 Significant crossover between injecting drug use and sex work.
 Little access to services for drug users who are living with HIV/AIDS. As in
many cities in Asia, many of the hospitals and clinics in Phnom Penh discriminate
harshly against IDUs, as well as IDU PLHA. Commonly, doctors refuse to admit
or treat them.
Harm reduction policy
The Royal Government of Cambodia established the National Authority for Combating
Drugs (NACD) in 1995 to manage all aspects of drug control in the country. Among the
drug control strategies adopted is the reduction of risks caused by drug use. This includes
a comprehensive approach to HIV/AIDS and other harms in drug users. Specifically, the
5-year master plan (2005-2010) lists the following harm reduction related objectives:
• Regular monitoring and evaluation of drug abuse prevention and education
activities (Strategy 2.4.2d, p20).
• Ensure that existing drug abusers are given adequate health and education
services and that a comprehensive approach to HIV/AIDS awareness and
prevention be provided to such people in a legal manner to reduce their demand
for illicit drugs and to prevent the spread of HIV/AIDS through illicit drug use
(Strategy 2.4.2f, p20).
The Illicit Drugs related HIV/AIDS Working Group performs the following roles and
duties:
• Ongoing estimations of the number of drug users living with HIV/AIDS and
research to identify risk factors for HIV infection in this population. Provide drug
users with reliable, evidence-based information about HIV/AIDS related to drug
use;
• Develop strategies, methods and plans of action to address the problems
associated with HIV epidemic caused by drug abuse;
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•
•
Provide a forum for governmental and non-governmental organizations to
collaborate, on a regular basis, to combat HIV transmission through drug abuse in
Cambodia.
Give advice and monitor all activities related to dissemination, education,
treatment, rehabilitation and other programmes involved in drug use and HIV
prevention.
Harm reduction activity
Services which specifically target drug users and IDUs for outreach and HIV prevention
education are limited. Until Korsang was founded in 2003, there were no official NSPs in
Cambodia. Currently, there are only 2 NGO services offering NSP in Cambodia (Korsang
and Mith Samlanh–Friends) both located in Phnom Penh (see appendix). Some sex
worker HIV prevention activities are underway in Cambodia (see appendix) but, other
than recent initiatives by Korsang, there appears to be few interventions addressing the
drug use/ sex work crossover. Substitution therapy is currently unavailable in Cambodia,
however there is mounting official commitment to provide MMT, and one NGO in
Phnom Penh has been identified to pilot this program (expected to commence in 2008).
User organizations/involvement
Although the injecting drug use level appears to be increasing, injecting drug users have
so far played little part in the Cambodia’s HIV/AIDS epidemic. Korsang, while strictly
speaking not a drug user organisation but primarily a harm reduction program, does
nurture and involve a growing pool of peer educators and harm reduction workers in a
spirit of participatory management (see appendix for Korsang overview), and is interested
in assisting with forming a Cambodian drug user organisation.
Summary of discussions held with Holly Bradford, Founder, Korsang in October 2007
She is looking forward to further dialogue on this matter with AIVL in December/
January. Korsang is a peer-based organisation providing harm reduction services to over
1000 street-based IDU in Phnom Penh. The organization has links with Ministry of
Health (MoH), National AIDS Authority (NAA), and the NACD (National Authority for
the Combating of Drugs). Funding is from USAID, UNICEF, CEIDA, HAARP/AusAID,
and AFAO (which is funding the peer education program).
Korsang does have contact with sex workers, many of whom are also using drugs, and
has recently submitted a funding application to UNICEF to provide services (health,
parenting etc) to this group.
Korsang would like to be involved in developing a Cambodian user organization. This
might involve providing a stipend and/or meals for users to meet regularly to identify
needs and options, leadership training, and a staff person to provide initial facilitation.
Other unmet needs include support around MMT (which is just starting in Cambodia) –
this could include developing psycho-social supports for MMT clients, income
generation schemes etc.
Contact: Holly Bradford: hollis3387@yahoo.com, Tel 85 512207047
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Burma
Burma (Mynamar) is the second largest producer of opium in the world (after
Afghanistan). The Burmese approach to drug use has been increasingly tough: it requires
that drug users register and undergo detoxification for 6 weeks. Failure to register results
in a five-year prison sentence. A cumulative total of approximately 66,850 drug users
have been registered since 1974. Most people who inject drugs in Myanmar do not
register. There are an estimated 250,000 people who inject drugs in Myanmar.
Drug offenders make up to approximately 70% of the prison population and HIV
transmission amongst prison inmates contributes significantly to the epidemic.. This,
together with the high mobility, high imprisonment rates and needle sharing common
among people who inject, all point to an expanding HIV epidemic.
The estimated prevalence of HIV infection among IDUs is 70%, making HIV prevalence
rates among IDUs in Myanmar are among the highest in the world. Sentinel surveillance
and studies of IDUs at drug treatment centres show HIV prevalence of 50–90%.
Notwithstanding this, there have been substantive changes in the Myanmar Government
attitude towards HIV/AIDS prevention, and HIV/AIDS has now been declared a matter
of national concern.
Harm reduction policy
Possession of a needle and syringe is still illegal and drug users who fail to register
themselves can be punished. In order for HIV prevention programs to operate, the
Ministry for Home Affairs and the CCDAC have determined to relax or lift
implementation of certain laws and regulations in the implementation areas for certain
harm reduction programs. The particular laws referred to relate to the compulsory
registration of drug users, to “inducing to use drugs”, and to injecting paraphernalia.
Unless modified (or not enforced), these laws represent a direct obstacle to the proper
functioning of harm reduction programs (NSPs, outreach education etc).
Over the past five years, there has been movement towards the adoption of harm
reduction approaches in Myanmar. The multi-ministerial CCDAC (with considerable
impact in shaping policy at a central level), has become an important player in promoting
health policies such as harm reduction within Myanmar by, for example, facilitating
permission to establish harm reduction interventions, permission to travel, relaxing
registration and needle syringe possession law enforcement in implementation areas.
Harm reduction activity
The Fund for HIV/AIDS Myanmar (FHAM) {now the “3 Diseases Fund”} together with
the AusAID HIV/AIDS Regional Project {now supported through HAARP}are
implementing harm reduction activities in Burma, particularly in the North East part of
Shan State. NSPs, which are run from both a fixed site or “drop in centre” and through
14
outreach, have expanded and the distribution of sterile needles had increased. The
number of NSPs (16 as of the end of 2006) are reaching only a fraction of those in need.
MMT programs were recently introduced but they remain minor in scale and limited to
four sites and small client loads.
User organizations/involvement
Two drug user organisations were identified:
 Established following a peer educators training program in Lashio, Shan State, in
mid-2006 the Black Sheep was formed as a self-help group. One of the peer
educators, Khin Maung Oo (member of this group) is also registered as the INPUD
rep for Myanmar.
 The lead person of SWIFT, a drug user peer group from Yangon, is Myo Kyaw Lynn
(nickname Tom), e-mail mklynn.tom@gmail.com. (also see appendix outline on the
Burma groups).
The group/s are integrated with other AHRN-led planning and implementation. They
operate across the continuum from abstinence (seen as an ultimate but not often feasible
goal) to dependent use. (They do not include NA or similar). The drug user groups have
established working groups on MMT, income generation, and a female drug use group.
Some group members work with AHRN as paid peer educators, and assist with needle
patrol etc.
One of the strategies listed in the AusAID ARHP Advocacy strategy for Burma was:
Strategy 3.1: Where it is possible and appropriate, and causes no harm, build on existing
ARHP efforts at local level to encourage the participation of current and former drug
users in policies and programs that affect their lives. This will strengthen the
effectiveness of the policies and programs to address the needs of drug users.
China (Yunnan and Guangxi)
The actual number of drug users in China is difficult to estimate; some suggest the
number of drug users ranges from an estimated 6–8 million; unofficially, estimates are as
high as 12 million. As of 2003 the prevalence of reported HIV among IDUs was 44%. In
some areas the prevalence rises above 80%.
Harm reduction policy
Harm reduction approaches are supported in the National HIV/AIDS Strategy, and other
provincial level regulations. Yunnan legalised this approach in a March 2004 law. NSP
and outreach programs have been implemented in six other provinces in areas where HIV
is most prevalent among people who inject drugs (including Yunnan and Guangxi)
In the lead up to the Beijing Olympics, drug enforcement agencies have been launching
increasingly concentrated campaigns against drug use. According to Chinese law, drug
users must be “rehabilitated”. “Treatment” has largely been a matter of incarceration in
15
police-run detoxification and rehabilitation centres, but it is generally known that the
relapse rates are very high. There are also large numbers of drug users in the prison
population.
Harm reduction activity
Existing harm reduction efforts include the 10 AusAID “EAPs” (Effective Approaches
Projects, ARHP/HAARP) – each providing peer education, outreach and NSP; 4 in
Yunnan and 6 in Guangxi. Each EAP site has formed a local level steering committee
involving health and law enforcement sectors, and with potential to include a “client
member” particularly now that some injecting drug users are relatively “liberated” by
being on MMT.
Other INGOs and government agencies are expanding harm reduction services in both
provinces (primarily through state and GFATM funding). There has been a beginning in
educating drug users about HIV transmission at detoxification centres by INGOs (PSI,
ARHP), and the Department of Public Security at some pilot sites in Yunnan and
Guangxi.
Over the past few years, there has been a rapid scaling up of methadone maintenance
therapy (MMT), with several hundred clinics in operation by 2007.
User organizations/involvement
As with Vietnam and Burma, “NGOs” are, in the main, actually “GONGOs” (i.e.
government organized). Furthermore, both sex work and injecting drug use are
criminalized, so any formal user organization must operate carefully – usually with
primary functions as “PLHA” or “support” groups.
The China branch of the International HIV/AIDS Alliance (funded by USAID) supports
two IDU Groups. In Yunnan, the group is named “Sunflower Garden” and provides peer
based support to PLHA; peer support for ARV treatment; information; group activities
and family support2. And one in Sichuan Province (neighbouring Yunnan Province) –
called “Five Hearts Centre”, providing prevention of HIV among IDU and NSP. Both
groups have low capacity in areas such as advocacy (including media management) and
building working partnerships with government.
Recommendations from the recent AusAID ARHP Advocacy Strategy for China
included:
2

Involve former and current drug users in a variety of roles where their valuable
experience, views and insight can contribute to decision making bodies at central
government and provincial levels by providing advice as to how to respond to the
needs and concerns of drug users in the community.

At the community level, former and current drug users should be effectively
involved in the delivery of health care services such as outreach work and
FHI run another group for IDUs in Gejiu.
16
managing NSP (as shown by the ARHP China EAPs). ARHP experience in
engaging and working with drug users to provide harm reduction services should
be replicated. Ensure other national and international implementing agencies and
coordinating mechanisms are aware of the advantages of involving drug users in
the response to HIV, and of the ARHP experience in peer based outreach services.
Vietnam
Since the introduction of ‘Doi Moi’ (innovation) policy in 1986, the country has
experienced increased economic growth. There has also been widespread unemployment,
widening income levels, increasing rural-urban immigration, the disruption of rural
family life, and a rise in drug use and sex work.
There are now an estimated 200,000-500,000 drug users in Vietnam, and most commonly
used drugs include heroin and opium. At the end of 2006, according to Ministry of Public
Security there were 160,226 registered IDUs, and 80% of these use heroin; 60% of HIV
cases in Vietnam are associated with sharing injecting equipment, and prevalence among
injecting drug users ranges between 40% and 80% across several provinces.
Harm reduction policy
Drug use and sex work are illegal in Vietnam and are officially labeled as ‘social evils’
under the government’s anti-prostitution and anti-drugs laws. The ‘social evil’ approach
involves repressive interventions such as rounding-up of drug users and sex workers and
placing them in mandatory rehabilitation centres.
However, some supportive policy is now in place for harm reduction approaches
including the National HIV/AIDS Strategy, and an associated national harm reduction
work plan. Further, the HIV/AIDS Law, Government decree No 108 and National
Program of Intervention for Harm Reduction in the period 2007-2010, as well as the
Hanoi Program of Intervention for Harm Reduction in the period 2007-2010, are
assisting towards an enabling environment for harm reduction.
Harm reduction activity
Progress towards the scale-up of harm reduction has been a long and slow process. The
National AIDS Standing Bureau of Vietnam (NASB), within Vietnam's Ministry of
Health, is responsible for coordinating national HIV prevention efforts. The NASB
officially approves peer education programs whether programs are supported
domestically or funded through international donor organizations.
This first assessment of peer education programs in Vietnam (2000) identified a number
of concerns about the extent of program coverage. Coverage has indeed been limited:
some provinces with high numbers of persons reported with HIV/AIDS have few peer
educators. The services provided by peer educators are primarily delivering information
either through word of mouth, pamphlets, or brochures, providing condoms, and
sometimes providing syringes and needles. Skills building support is rarely provided.
There are about 200 NSPs in total, located across 25-30 provinces. Most of the programs
do not apply a monitoring and evaluation component, and workforce capacity is thought
to be low.
17
Methadone maintenance therapy has been piloted in Vietnam over the past decade, and is
currently being evaluated in a limited number of sites.
User organizations/involvement
The first model of peer education for IDUs was implemented in 1993-94 in two districts:
Dong Da in Hanoi and district No 1. The main activities included behaviour change
communication, including through use of mass media (TV, newspapers, radio), peer
education, and some NSP.
The most common recruitment criteria for peer educators are a history of high-risk
behavior such as injecting drug use or sex work (15 provinces). However, active or
current injection drug use or sex work is also considered appropriate in many cases (7
provinces).
From 1994 to the present, most of the peer education projects have depended on foreign
support. However, in recent years, more programs are being partly supported by
government funds.
From 1997-1999 and 2001-2003, peer education was carried out in 5 districts in Hanoi,
with the support of GTZ. From 2000, each district of Hanoi has a peer education team
supported by Hanoi government funds. Since 2003, peer education conducted in 11 out of
14 districts is funded by Life GAP, DFID and DKT, but the coverage is limited in pilot
communes/wards, and not available in all localities.
The AusAID ARHP Advocacy Strategy for Vietnam made the following
recommendation:
Strategy 4.1. At the community level, current and former drug users can be effectively
involved in the delivery of health care services such as outreach work and managing
needle and syringe programs.
Other supporting programs:
 Community action in HIV/AIDS funded by ADB in 5 provinces (STIs and condoms)
 Peer-based comprehensive interventions for IDUs in Lang Son provinces funded by
Ford Foundation including vocational training, project loan, post drug treatment
support.
International agencies involved in harm reduction implementation in Vietnam:
 GTZ Room 402, 4th floor, 4 Tran Hung Dao, Hanoi, +84 (4)9331379 or
9331380
 DFID 7th floor, Central building, 31 Hai Ba Trung, Hanoi, 9360555. Ms.
Brighde, HIV program Consultant, 0902137742
 Life GAP 138A Giang Vo Str. Hanoi, +84 (4)9745338
 DKT 1501 Block 17T1 Trung Hoa Nhan Chinh +84 (4)2812658
 Ford Foundation Suites 1405-1408, Pacific Place, 83B Ly Thuong Kiet Str. 14th
FI, Hoan Kiem district, Hanoi +84 (4)9461428 Ford-Hanoi@fordfound.org
18
Philippines
Little injecting drug use has been documented in the Philippines, although data systems
on drug use are generally poor. The most used drugs are thought to be ATS and cannabis
and drug use is concentrated in several urban centres. With one of the lowest rates of
HIV infection in Asia, HIV in the Philippines has been categorised as ‘low and slow’.
The predominant mode of HIV transmission is through heterosexual sex, with very few
cases attributed to injecting drug use.
There is no room for complacency, as all the ingredients for an explosive epidemic are
pre-existing in the Philippines:
 The country’s thriving sex industry
 High rates of sexually transmitted infections (STIs) in both vulnerable
subpopulations and the general population and low level of condom use among
high-risk groups
 Inadequate access to STI treatment and poor health-seeking behavior
 The emerging problem of injecting drug use
 High levels of needle sharing amongst injecting drug users in Cebu City: a 2002
estimate of sharing amongst IDUs in Cebu City was reported to be 77 per cent.
 Instances of casual sex among young people
 Incorrect and inconsistent condom use
 Low level of knowledge in correctly identifying ways of contracting and
preventing the disease.
Harm reduction policy
The mainstay of the national response to HIV/AIDS is the enactment of the Philippine
AIDS Prevention and Control Act of 1998 (Republic Act 8504), considered a model for
HIV/AIDS-related human rights legislation. Efforts have also been under way to localize
the response to the epidemic by forming and energizing local AIDS councils, some of
which are NGO-led and some of which are piloted by the government.
Harm reduction activity
Harm reduction interventions are limited in Cebu, Mandaue and Lapulapu Cities, with
only a few small scale NSPs.
The GFATM is assisting with outreach and education activities, including condom
promotion and a needles/syringe program; capacity building of service providers and
vulnerable populations; and strengthening of monitoring and evaluation. SIDA/ADB are
also implementing a small pilot program for injecting drug users.
In 1994, the International HIV/AIDS Alliance set up the Philippines NGO Support
Program (PHANSuP). PHANSuP runs an annual youth camp for peer educators working
on HIV/AIDS and reproductive health. The International HIV/AIDS Alliance has also
supported PHANSuP to strengthen HIV-prevention efforts with key populations,
particularly with IDUs and men who have sex with men.
19
User organizations/involvement
Although there are no actual formalised drug user networks, there are small informal
networks that have some level of leadership.
Laos
Laos has a tradition of opium use and, although injecting drug use rates appear currently
low, there are concerns regarding a shift from smoking to injecting, particularly in the
capital, Vientiane.
The apparent very low level of injecting drug use in Laos was confirmed in a recent
consultation report with agencies working on drug use and related HIV/AIDS issues.
There was a disturbing finding from HIV/AIDS surveillance that about 12% of sex
workers surveyed in Boten, a city in the province of Luang Nam Tha, reported injecting
ATS, which suggests that there may be overlapping HIV epidemics among drug users
and sex workers. Several respondents indicated that drug use continues in drug treatment
centres and in prisons.
Harm reduction policy
Law enforcement responses have dominated the national approach to drug use issues.
Although harm reduction has been acknowledged as a major strategy for controlling HIV
and STI amongst drug users in Laos, there is no clear plan for the delivery of harm
reduction services. There is a lack of technical assistance in all aspects of comprehensive
service provision for injecting and non-injecting drug use. Currently there is virtually no
quantitative and qualitative survey or surveillance data related to illicit drug use and
associated health risks.
The broad operational framework of the Lao PDR drug policy is based on the
implementation
of three strategies:
 prevention, treatment and rehabilitation of drug users
 alternative options for illicit crop farmers
 enforcement of adequate laws to fight against traffickers.
The National Committee for the Control of HIV’s most recent National Action Plan on
HIV/AIDS/STI (2002–2005) lists five priority areas of which prevention of HIV/AIDS
and STI among drug users is fifth.
Harm reduction activity
The few interventions addressing HIV/AIDS related to drug use are limited in Vientiane,
where services include drug treatment and some limited HIV prevention activities related
to drug use. These activities are of limited impact and in need of capacity building. In
provincial areas, these problems are worsened by staff shortages, lack of infrastructure
such as passable roads, very low general levels of education, and very few international
assistance programs. Potential partners to implement projects on HIV/AIDS related to
drug use in Laos are rare.
20
Although methadone is available, its use in not common and it is mainly reserved for
assisting in detoxification.
User organizations/involvement
WHO are facilitating use of some upcoming SIDA (Swedish) funding, some of which is
earmarked for IDU activity. According to WHO, there are some NGOs interested in this
sort of involvement, but none have, as yet, recruited IDUs as staff or volunteers.
For further discussion, contact Dominique Ricard: ricardd@lao.wpro.who.int
21
4. Recommendations: Potential partners and activities
This section sets out, at regional and country level, recommendations for AIVL’s
consideration. It then lists those consulted and other relevant contacts.
Overview
AIVL must take a highly consultative role in any dealings with agencies in the region,
and be mindful of political and cultural contexts as well as existing bilateral relations
with each country. It would be inappropriate for AIVL to take a “leading role” in
“teaching” Asian organizations. Rather, it is strongly advised that AIVL take a “shared
learning” approach in collaboration with potential partners.
Burma is currently suffering from violent political upheaval. This can directly impact on
the operating environment, communications and travel. The other countries discussed
also face political or religious constraints.
Drug user organization and involvement are at varied stages and types of development in
Asia, and within different political and cultural contexts. While they share the need for
capacity building in a range of areas, an appreciation of context, with sensitivity and
diplomacy in approach, are vital.
Support for a regional network secretariat (in collaboration with IA, AHRN and APN+)
may be viable on a limited budget, but translation and interpretation costs would be
significant. An added challenge in forming a regional network would be to maintain
relevance to a varied range of peer-based groups, organisations and programs operating
in different cultural and political environments.
Recommendations (regional level):
1. That AIVL consider, as a possible proposal focus (and in consultation with APN+ and
AHRN), providing a secretariat for peer-based programs and organisations in Asia to link
with one another and maximize shared learning. AIVL could also coordinate with other
agencies to channel commonly needed technical assistance (TA) through the secretariat.
Technical assistance could potentially include (according to INPUD Asia) the following
areas:


Networking, coordination and alliance building
Strengthening the network of users and their organizations. This could be
achieved through both fostering of existing civil society efforts, as well as by
identifying, facilitating and mobilising new groups in the region.
 Advocacy
 Information sharing (and other needs as listed in discussion with Mr Pun above).
There is also a need to develop the capacity of INPUD Asia in governance and
partnership building.
22
If there were to be a formal partnership with IA and INPUD, it is envisaged that AIVL as the funded agency - would have direction over any of the activity they decide upon,
but that this would be heavily guided by ongoing consultation with the Asian member
organisations and programs. The INPUD role would then become a collaborative one
where information is circulated as relevant and (perhaps as INPUD grows and gets more
funding) INPUD could become an additional technical resource. (This suggestion has
been made to the INPUD Board for comment and further advice - email sent early
November. No final response has been received from the INPUD Board on this question
to date).
2. That AIVL explore potential areas for partnership with INPUD Asia, especially:


Capacity building: Work together with INPUD Asia to develop the capacity of
users in the region (leadership training etc)
Establishing a regional network of drug user organizations in Asia
The experience of countries like Indonesia (with a developed national drug user network,
and pace-setting interventions such as methadone in prisons, and ARV for active drug
users), should and could be actively shared throughout the region through such a regional
network. Similarly, Korsang and TDN have much experience to share with other
countries in the region. Language barriers and additional costs for translation are
considered a significant obstacle but AIVL could seek support from UNODC and/or
WHO for translation/interpretation assistance in building a viable regional network.
HAARP might be approached to assist with areas such as meeting costs. Collaboration
with UNODC in the up-coming user consultation meeting could also ensure maximum
efficiency and purpose in building and strengthening the proposed regional network.
A regional network of peer-based groups or programs would need to coordinate closely
with other relevant regional or international agencies including:
 HAARP HAARP have some budget for Civil Society initiatives, but specific
activities
are
not
yet
determined. (contact
Gordon
Mortimore
gordon.mortimore@hlspworldwide.org to follow-up on this).
 APN+ Mr Shiba: shiba@apnplus.org
 UN Task force on HIV and injecting drug use (now under UNODC)
 UNODC (planning to coordinate a regional IDU organization consultation in
March 2008) (for more information, contact <gray.sattler@unodc.org>)
 AHRN (Asian Harm Reduction Network: suggested initial contact: Pascal
Tanguay pascal@ahrn.net regarding possible collaboration of harmonization of
activities between AHRN and AIVL).
 WHO- WPRO office IDU Officer: Fabio Mesquita <famesq@terra.com.br>;
 International HIV/AIDS Alliance: Umesh Sharma <husharma@loxinfo.co.th>;
 INPUD Asia: Anan Pun: Office: +97712111107 +9779841513534 cell. Email:
recovernp@wlink.com.np, ananpun@gmail.com (Nepal). Fredy Malik
6281563243580, fr_edy78@yahoo.com (Indonesia)
23
Recommendations (country level):
Indonesia
3. That AIVL conduct a follow-up consultation with IPPNI (to further explore
opportunities and mechanisms to support IPPNI in one or more of the following
identified areas:
- team building
- strengthening organizational structure
- strategic plan development
- network expansion (local, national, international).
AIVL could also play a role in networking with other relevant agencies (AusAID,
USAID, UNODC, WHO, Jangkar) to ensure maximum efficiency in use of resources
targeting IDU civil society involvement and capacity building in Indonesia.
AIVL may also want to make contact with Jangkar (Info Jangkar <info@jangkar.net>;
gogon <gogon@jangkar.net>;) to discuss possible TA support which could be channeled
through the national harm reduction implementing agencies network.
Contact: Wulan Sari. (President, IPPNI) Tel/fax : 62.21.75904240 / 62.21.68264647
Email : our_stigma@yahoo.com Adit
: betarakresna@yahoo.com (R&D division in
IPPNI). Patri : patrihandoyo@ihpcp.or.id (IPPNI coordinator). Lette :
milette@cbn.net.id (IPPNI coordinator)
Cambodia
4. That AIVL hold follow-up discussions with Holly Bradford regarding the possible
formation of a Cambodian drug user organization in collaboration with Korsang.
AIVL could also investigate other possibilities for providing TA to the two NSP and
initial MMT programs in Cambodia.
Contact: Holly Bradford: hollis3387@yahoo.com, Tel 85 512207047
Burma
5. That AIVL liaise with AHRN regarding the existing user groups and peer involvement
in harm reduction activity in Burma; identify capacity building needs and possible
support mechanisms for Burmese drug user groups.
AIVL should also consider working with HAARP and the township-level harm reduction
steering committees to establish user/client representation, and provide leadership
training and mentoring for a pool of user committee members.
Contact:
Black Sheep Self-Help Group, Aye Min Tun
AHRN Facilitator/Outreach Worker, Northern Shan State
Tel: + (95 82) 22046, and + (95 82) 23907
eMail: ahrn@baganmail.net.mm
24
SWIFT, a drug user peer group from Yangon: Myo Kyaw Lynn. (nickname Tom), his email mklynn.tom@gmail.com.
AHRN Myanmar: willy <willy@idu.org.mm>; siddharth singh siddharth@idu.org.mm
China
6. In line with recommendations made in the AusAID ARHP Advocacy Strategy for
China, that AIVL coordinate with International HIV/AIDS Alliance, HAARP, Global
Fund and UNAIDS to establish mechanisms of support for the two Alliance-supported
user organizations in Yunnan and Sichuan, as well as for peer-based harm reduction
programs in Yunnan and Guangxi.
Provided a translation budget can be secured, it could be of immense benefit if these
fledgling and struggling China user groups could be connected to a peer-based network –
and perhaps even twinned/mentored by a more established program elsewhere in the
country/region. Likewise, the existing peer run outreach workforce would, if provided
with access to such a network, be less isolated and more supported in their efforts.
Regarding the two International HIV/AIDS Alliance programs in China, contact Umesh
Sharma (Alliance regional IDU coordinator): <husharma@loxinfo.co.th>; Alliance China
Director: Graham Smith: graham@alliancechina.org
HAARP: Contact Gordon Mortimer: gordon.mortimore@hlspworldwide.org
Vietnam
7. That AIVL explore, with relevant agencies, means for supporting capacity building for
peer outreach workers. In particular, there is a clear need for support around monitoring
and evaluation of peer-based harm reduction programs. Concerted advocacy is required
on the urgent need to scale up MMT. (Discuss further with Dr Khaot:
<vicomchn@viettel.vn)
Philippines
8. That AIVL make contact through the Global Fund NSP, and PHANSuP to assist in
identifying informal networks as well as any peer educators associated with the NSP.
Needs analysis, and for example, facilitation in establishing partnerships and
strengthening user organization could be offered. Networking with other user-based
organizations and programs in the region would also be of benefit. Advocacy may be a
priority in a country that is yet to experience a higher level HIV epidemic. For further
initial discussion, contact: Bob Nebrida; the Director of PHANSuP:
raonebrida@yahoo.com. Also visit: http://www.phansup.org
25
Dr Aura Corpuz; works on HIV Surveillance for the Dept. of Health, and Vic Salas who
works for PRIMEX (a consulting company who are implementing an IDU pilot for
SIDA/Asian Development Bank). Aura’s e-mail is: aura_corpuz@yahoo.com
Vic’s e-mail is: v.s.salas@gmail.com
Nepal:
Recovering Nepal and Naya Goreto (Nepal). bigjoy@wlink.com.np: Bijay (recovering
Nepal)
Thailand
TDN (see http://hrw.org/english/docs/2004/07/13/thaila9053.htm from more details), or
email: Paisan Swannawong <paisan.suwannawong@gmail.com>; <ott1@ksc.th.com>;
Karyn Kaplan <karyn.kaplan@gmail.com>; <karyn@ksc.th.com>
India
NE India network contact Mr Raju who is now heading Indian Harm Reduction network
in Delhi: horai@rediffmail.com. (Head of NEIHRN from 2002-2007)
SASO, in Manipur is a drug user organisation. The contact person is Mr Tiken:
rktiken@rediffmail.com
26
Bibliography
Asia Regional HIV/AIDS Project. Strategic Recommendations for Advocacy for Harm Reduction
in China/Myanmar/Vietnam. December 2006 (http://www.arhp.org.vn/)
Birgin, R. Review of the Drug User Registration System. (for WHO Myanmar). Melbourne:
Burnet Institute, Centre for Harm Reduction. 2004
Burrows D, Walsh N, Aramrattana A, Narayanan P. Assessment of Injecting Drug Use and
Related HIV Infection for Program Planning in the Kingdom of Thailand and the Lao People’s
Democratic Republic. AIDS Projects Management Group. June 2005
Dang Van Khoat; Gary R. West; Ronald O. Valdiserri; Ngoc Thi Phan. Peer education for HIV
prevention in the Socialist Republic of Vietnam: a national assessment.
Journal of Community Health, v28 i1 p1(17), Feb 2003
Drug Use and HIV Vulnerability. Policy Research Study in Asia. Task Force on Drug Use and
HIV Vulnerability. Oct 2000.
Le Hegarat G, Dorabjee, WHO SEARO Workshop on Scaling-up of HIV/AIDS/STI Prevention
Efforts in Myanmar with a Focus on Injecting Drug Users. Taunggyi, January, 2004.
Lorete I. Harm reduction among Asian injecting drug users. Sexual Health Exchange 2003-1
Mesquita F, Winarso I, Atmosukarto I, Eka B, Nevendorff L, Rahmah A, Handoyo P, Anastasia
P, Angela R. Public health the leading force of the Indonesian response to the HIV/AIDS crisis
among people who inject drugs. Harm Reduction Journal, Vol 4. 2007.
Ngo, A. D., Ratliff, E. A., McCurdy, S. A., Ross, M. W., Markham, C. and Pham, H. T. B.
Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex
workers in Vietnam, AIDS Care, 19:7, 878 – 887. 2007
Ngo, Anh D., McCurdy, Sheryl A., Ross, Michael W., Markham, Christine, Ratliff, Eric A. and
Pham, Hang T. B. (2007) 'The lives of female sex workers in Vietnam: Findings from a
qualitative study', Culture, Health & Sexuality, 9:6, 555 – 570
Mith Samlanh Report, 2004; Mith Samlanh and Korsang routine surveillance
Reid,G. Costigan,G Revisiting the Hidden Epidemic. CHR. Burnet Institute. Jan 2002
Situational analysis of illicit drug issues and responses in the Asia–Pacific region.
Australian National Council on Drugs. 2006.
UNAIDS
Philippines
Health
Profile
(accessed
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28,
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http://www.synergyaids.com/Profiles_Web/Profiles_PDFs/PhilippinesProfileFINAL2005.pdf
WHO Bi-regional Strategy for Harm Reduction (SEARO/WPRO). 2005-2009. WHO.
27
Appendices
1.
Indonesian Organisations:
IPPNI/IDUSA.
The Association is an idea of drug user’s parity as citizens who have the rights to be protected according to
the constitution of Indonesia Republic (Undang-Undang Dasar Negara Republik Indonesia 1945). Our
country history has shown that drug users have been treated with discrimination, killed, threatened, sited in
a dangerous situation, locked-up, viewed as source of infectious diseases and criminal offenders.
In years, the casualties of Hepatitis, HIV, and other diseases continue increasing from our side. Many of us
were being jailed with no proper and fair trial for drug possession and/or drug use. The number of deaths
that are related to the use of street drugs with no medical or social supervision among our groups arises
every year.
Many parties try to become saviors in this situation; however, their million dollars project is not creating a
massive impact for our community. Sooner, the issues will be affecting community at large, and many
people will become victims like us. In efforts to address drug related issues, our groups still being viewed
as objects and suppressed to the lower level of the community. They let us die in suffering.
It is time for us to change this situation. WE are part of YOU, and TOGETHER we can find a real solution.
We are not just as a part of the problems, but we are also the solution. We are the sons and daughters of the
nation. It is time for us to step forward and make real action.
This Association will ask you to:
1. Develop an understanding of drug user’s human right’s and other Indonesian citizens in your
community;
2. Documenting human rights violation among drug users in your community, particularly in legal and
health care aspects;
3. Organize drug users aspiration in your community to be used as tools in pushing forward policy change
and the improvement of services for drug users in Indonesia
4. Developing a sense of care and awareness of the people on issues related to drug use
and/or drug users in your community
5. Build networks and alliance with non-drug users groups (professionals, academics, politician, etc) in
your community to strengthen and support our efforts.
This initiative has been conducted globally due to the similar condition in other countries around the world.
As guidelines to build drug users involvement and non-drug users brotherhood in your community,
attached with this document is the international declaration of activists who use drugs which was being
stated at the 17th International Conference of Harm Reduction in Vancouver, Canada.
28
EXCEED COMMUNITY consists of People Living with HIV/AIDS (PLHA) with a background as
Injecting Drug Users (IDU) – further on will be referred to as PLHA/xIDUs. We’ve come together under
the same awareness
in fighting for the rights of PLHA/xIDUs to be involved in comprehensive support systems for, and the
empowerment of, PLHA/xIDUs so that we can achieve a more integrated and focused program.
Exceed expands its coverage throughout Jakarta, Depok, Bogor and Bekasi.
Exceed started out as a support group created for PLHA who are x-IDUs. The call for more accessible and
realistic programs that will more realistically be able to accommodate the specific needs of PLHA/xIDUs
has appeared to be a necessity, and has become the common ground for us. We long to see that
PLHA/xIDUs no longer be put in the position which dismembers their ability, but rather they be given a
central role in to helping develop and implement useful actions for the fight against HIV/AIDS.
Our aim is empowerment PLHA/xIDUs in the fight against HIV/AIDS.
Our mission:


To establish, strengthen, expand programs that are immediately related to PLHA/xIDUs, as well as
expanding coverage.
To increase the collaborative role of related institutions and organizations, as well as the wider
society’s participation, in supporting the active involvement of PLHA/xIDUs in programs related to
preventing HIV transmission providing care and support to PLHA.

To gather data and spread information needed in preventing transmission and managing the HIV/AIDS
epidemic among Indonesian IDU.
Our routine activity includes organizing weekly support groups in places close to and easily accessible for
IDUs – their “hang out” places. We also equip them with skills that they can make use of in their daily
lives. This is presented in the form of training by experts who are also PLHA/xIDUs, as well as non
PLHA/xIDUs. Our long-term expectation is that with some skills training support, PLHA/xIDUs can
empower themselves, better fulfill their everyday needs (medical as well as economical), and realise a
central role in all aspects of planning and delivery of programs targeting their own communities. In every
activity, we put PLHA/xIDUs as the subject – not merely objects, encouraging their fullest possible
involvement.
Contact us
Exceed Community
exceed_community@yahoo.co.uk
www.groups.yahoo.com/group/exceed
29
2.
Cambodia
Korsang
Korsang is a grass roots harm reduction organization located in Phnom Penh. Since its founding in
September 2004, Korsang has increased its initial small staff of 5 employees to the current level of 63
employees, consisting of full time, part time and peer educators. Korsang has trained staff to become harm
reductionists working directly with at risk Khmer people in the prevention of HIV and other drug related
harm. The main work of the Korsang team is to engage in intensive, harm reduction based services, through
programs that include Street Based Outreach, a Drop-In Center, provision of Medical Services, conducting
Prevention Education and holding Formal and Informal Educational Classes consisting of: Health classes,
HIV Education, Dance, Music and Art.
Many Korsang employees have graduated from a college level case management course and received
college credit and US standard case management certification.
Korsang attends and is represented at all International HIV and drug events in Cambodia. Korsang has
presented at local, regional and international conferences. Korsang is also very active on Cambodian
television and radio
Korsang staff visits areas where street based injection drug use is a serious issue and sex worker areas
where yama and unprotected sex go hand in hand. Korsang has created multiple educational programs to
reduce the risk of HIV infection among IDUs.
Korsang is the first and only NGO based in Phnom Penh Cambodia to offer 100% direct harm reduction
and educational services to Injection Drug Users, (IDUs) and drug users, (DU’s- serving a population of
over 3,300 users, between 12 and 55 years old.
Since Korsang began serving drug users many, many opportunities have been created to reduce the risk of
drug related HIV transmission, as well as to decrease other drug related harms. Some of these examples
include: Increased Access to HIV testing and case management; Outreach services; NSP; Peer Education;
Medical treatment for drug related harm; Drop-In Center (well located in area where many drug users live
and gather., safe, well attended. Some of the examples of drop in services are as follows: Korsang serves
nutritious meals to an average of 80 drug users twice daily where users can engage in activities or rest.
There are showers, free supplies for personal hygiene, and an area where participants can wash their
clothes).
Korsang is the only harm reduction/drug user NGO to hire active drug users. Twenty-five peer educators
have been trained to assist in Korsang harm reduction outreach and education efforts. Each peer receives a
stipend to become trained in basic HIV prevention harm reduction theory and techniques. Each peer works
with Korsang staff for a minimum of 32 hours each week. Peer educators are invited to accompany
Korsang staff to meetings, trainings, workshops and to our annual retreat.
At Korsang, at no time are the drug using participants allowed to be used and/or exploited, whether it be by
the media, donors, researchers, photographers or visitors. All Korsang participants are protected by the
organization and if they agree to be interviewed or photographed, they will receive a stipend. No one
works or volunteers at Korsang without receiving a cash stipend. All peer educators are paid, and drug
using participants are offered cash based incentives whenever possible. (summary adapted from case study
and website information produced by Korsang)
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Mith Samlanh–Friends works in three areas of Phnom Penh to provide a range of services ; dissemination
of materials, outreach education on drugs, HIV/ AIDS and other topics, referral for HIV testing, medical
assistance, advocacy and vocational training. Peer education for awareness raising is a critical component
of the program. The target population includes about 20,000 street working and 2000 street living children.
Friends services are estimated to reach around 1800 children each day in Phnom Penh. The program also
includes a pilot needle and syringe program. The NSP has contacted 47 IDUs — of this group, 15 have
agreed to be tested, and 45 per cent found to be HIV positive (16)..
Sex worker advocacy in Cambodia.
The Womyn’s Agenda for Change works in several issue areas: advocating for sex workers’ rights, ending
violence against women and children, promoting grassroots trade, and fighting against badly structured
micro-credit programs. Through the Sex Workers Empowerment Project, data is collected for case studies,
mobilizes workers to lobby for their rights, and provides support to an independent union of sex workers.
The Agenda for Change works with team leaders to teach negotiation skills and advocate for safe working
and living conditions as well as for adequate health care. To support women’s issues, the Agenda for
Change helps women workers organize and communicate directly with policymakers and development
agencies through a “Speak Out” program.
For links with this activity, contact Ly Pisey – CAMBODIA, Womyn’s Agenda for Change www.womynsagenda. org
3.
Burma organizations:
Draft only
Black Sheep (Self-Help Group)
Background
In a discussion during a training program for peer educators and Lashio DTC based MMT clients
conducted June 2006, the concept and process of setting up a self help group was explored. This discussion
was taken further to find more details on how a self help group can be formed in a poor resource setting.
The collective efforts made by interested clients and AHRN team members brought more clarity on scope,
nature and structure of first self help group for ex/former and current drug users in Northern Shan State.
Under the project activities AHRN-Myanmar conducts monthly meetings and training for MMT recipients
and regular attendees of AHRN drop-in-centre. The participants of health education sessions expressed
their need to start some kind of support structure which can help people to come out of vicious cycle of
drug using behavior.
Two persons from AHRN team (i.e. Hlaing Min Oo and Mya Thida Aung) were assigned to take over the
responsibility of Black Sheep and represent AHRN in the process of setting up the perceived self help
group. On 29th June 2006 during Monthly Dinner with clients, a general consensus was brought a final
stage including the preliminary structure, shape, and its name. Unanimously clients and AHRN team
members approved “Black Sheep” as official name of this self help group. The same day in an evening
meeting with 15 like-minded clients a structure of proposed self help group was also visualized and
discussed.
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What is Black Sheep Group?
Black Sheep is a self help group of individuals who had problems with their personal drug use and now
they are trying to find the ways to come out of drug use. The sheep are normally white color but the black
one is strange among the sheep for many reasons. The black colored are discriminated from their
community. The drug users have similar experience in their lives as they are the mostly discriminated from
the family, and community because of their drug use.
The members perceived that this name describe their personality as well as personal experience. And they
believe by self help initiatives they can help each other in recovery process and make changes in their lives.
What are our aims and objectives?
 Providing support to the drug users and former drug users maintaining drug free life-style through
group activities reducing drug related stigma and discrimination at family and community level;
 Demonstrating the fact that drug users can also change their lives provided equal opportunities are
ensured and offered to them without judging them;
 Exploring job opportunities, and sustainable income generation for former drug users;
Black Sheep is keen to
 Monthly meetings to discuss problems, possibilities and opportunities;
 Monthly dinner at AHRN drop-in-centre;
 Provide support to ongoing AHRN project activities;
 Quarterly Newsletter (with contribution from Black Sheep members and project staff members);
 Explore income generation through periodic Fund Fairs, supplying mineral drinking water to families
and community;
 Explore job opportunities (i.e. general cleaning work, white-washing, food catering services and
renting mass cooking utensils) through Black Sheep Placement attempts;
Criteria to be board members of Black Sheep Group
 The member who is
o the ex/former drug user or current drug user
o regular in attending the meetings and other activities
o contactable from the member
o keen to represent the Black Sheep Group
o not involved in drug selling
o ready to abide by rules and regulation
Selection of Black Sheep Members
Selection of black sheep members will be decided by the board members with the regardless of race, color,
nationality, caste, creed, HIV status and sex.
For further information please contact
Black Sheep Self-Help Group
Aye Min Tun
AHRN Facilitator/Outreach Worker
Lashio, Northern Shan State
Tel: + (95 82) 22046, and + (95 82) 23907
eMail: ahrn@baganmail.net.mm
Lead person of SWIFT, a drug user peer group from Yangon, with which we will start cooperating in the
near future. His name is Myo Kyaw Lynn (nickname Tom), his e-mail mklynn.tom@gmail.com. You can
use my name as reference.
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4.
AHRN Myanmar:
a. Address:
 AHRN~Myanmar Country Office: Yangon, Myanmar, Tel: (95-1) 539 514 and Tel/Fax: (95-1)
507 089, E-mail: willy@idu.org.mm
 Lashio Address:
o Drop-in-Centre/Outreach Project Office: Northern Shan State Tel: + (95 82) 23907
 Kone Nyaung Address:
o AHRN Primary Health Care Centre: Lashio, Northern Shan State
b. Founded: The country office of AHRN Myanmar was set up in July 2003.
c. MoU Status:
AHRN is currently already operational under the Ministry of Health: visas and travel authorization for
expatriate staff have been issued by the Ministry of Health, as well as permits for activities in field sites.
Funding Sources:
 AHRN Myanmar has been funded by Fund for HIV/AIDS in Myanmar (FHAM) since 2003.
 AHRN Myanmar was also funded by the Global Fund for Aids, Tuberculosis and Malaria
(GFATM) from 2005-2006.
 AHRN Myanmar is currently funded for an HIV and TB project by the 3D Fund.
Key activities: AHRN ~ Myanmar under FHAM and GFATM:
 Advocacy:
 Technical Assistance
 Research
 Management:
 Field Operations (under FHAM, 2004-2007)
AHRN implemented harm reduction program/activities for (injecting) drug users, their families/partners
using the drop-in-centre/outreach model, which are based in the Lashio area, Northern Shan State. Its first
DIC/OPO was set up in Lashio Ward # 4. It was officially opened on 16 th December 2004. AHRN is
designated to implement services in Wards no. 2, 4, and 6 of Lashio Town. In July 2006 AHRN opened a
Primary Health Care Centre/Outreach Program in Kone Nyaung village tracts, outside Lashio, with similar
service provisions.
The service provisions are:
a. Drop-in-Centre/Outreach Project Office (DIC/OPO)
b. Referral-network
c. Methadone Maintenance Therapy (MMT)
5.
Nepal IDU organizations:
Naya Goreto is established with a vision to create enabling and supporting environment for the Harm
Reduction programs to reduce the transmission of HIV/AIDS and other blood borne diseases.
Conducts sensitization, advocacy and provides services to vulnerable people in order to
contribute for poverty alleviation, improvement in health, education and development of society.
Implements capacity building and human resource development programs by working along
with the NGO, CBO, civil society and other institutions to create strong civil society.
Develops a wider network and forge partnership to contribute for achieving goals of poverty
alleviation and inclusive development.
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Implements Harm Reduction program and Behavior Change communication campaign to
achieve positive behavior change to contribute in improvement of health, education and development
of vulnerable community.
Implements empowerment programs for disadvantaged IDUs, PLHAs, and other ethnic groups
to increase their access to poverty alleviation initiatives thereby contributing in poverty alleviation.
Recovering Nepal:
Mission and activities: Recovering Nepal is a national network of drug users and non commercial
partnership of non governmental organizations that promotes comprehensive approach as an effective
strategy to providing HIV prevention and treatment, maintaining public health and realizing civil rights of
drug users and all Nepali citizens.
It is estimated that there are sixty thousand drug users in Nepal UNAIDS 2001 and among them 50% are
Injecting Drug Users. Since the establishment of Recovering Nepal it has reached out drug users through
various support groups. Currently, there are approximately 3000 recovering drug users in Nepal . Most of
the ex-users and some active current IDUs are directly and indirectly involved in this network. Since May
2004, this group is serving as a strong network of committed people, who are helping in addressing the
stigma discrimination, raising voice to promote basic rights, advocating for policy change and increasing
quality access to affordable and comprehensive treatment and care for the drug users who are living with
HIV (PLHIV).
Recovering Nepal aims to influence the policies that improve the quality of lives of drug users, reinstate
their rights and create a supportive environment. In 2003, a series of workshop was held where the
recovering drug users got an opportunity to share their experiences, reflect their
feeling/observations/insights and learn from each other. These interactions led to the legal /registration of
Recovering Nepal. In over 3 years of time a common understanding and unity has been formed among the
drug users to lobby and advocate the issues related to the rights, treatment and care of the drug users.
Recovering Nepal Achievements
Nepal’s first IDU network united IDUs and increased their leadership capacity
Nepal’s first IDU network. What started as the IDU core package has become a long lasting network of
IDUs. Before RN, IDUs did not have a place or group to lead them. RN filled this gap, uniting IDUs and
increasing visibility of drug use and the presence of IDUs. Its capacity building work with IDUs spawned a
movement that institutionalized RN and IDU advocacy. In May 2005, the network was formally registered
with the chief district office and social welfare council of his majesty’s Government of Nepal as
Recovering Nepal, receiving a certificate as proof of registration. RN drafted by-laws and a structure, with
the advisory group being renamed as the executive committee. Its mission is to “advocate for the rights of
drug users so that there is affordable and available treatment for drug users and PLHIV of Nepal.” As of
July 2005, there were 64 members (including four women); 11 were executive members.
Increasing IDU leadership capacity. RN’s series of workshops resulted in a team of IDUs who were aware
of their rights and eager to share their knowledge. Additional workshops, as facilitated through the small
grants and advocacy plans, were successful with IDUs transferring knowledge. As a result of regional
consultation meetings, 238 IDUs were trained
Advocacy in the mainstream media. The Nepali media was a good vehicle for conveying advocacy
messages. Nepal’s media sector has grown a great deal over the last few years, resulting in hundreds of
newspapers and more than 30 FM stations. RN took advantage of this opportunity, engaging the media in
awareness raising and public dialogue on IDU rights and issues. RN’s good relations with newspapers,
radio, and TV stations resulted in transforming media coverage of drug users from promoting negative
stereotypes and attitudes to focusing on rights and positive messages about the IDU network; this coverage
initiated a wide scale awareness raising of risks and prevention. RN also worked with journalists through
press conferences to highlight and disseminate information on HIV/AIDS prevention and the current
situation of recovering drug users and PLHAs in society.
34
As a result of their advocacy activities, RN has continued to receive mainstream media coverage. RN
members were asked to participate in a TV debate program—two episodes will be aired—discussing issues
such as a holistic approach to treatment and substitution programs, along with stigma and discrimination
from media and medical professionals. In addition, RN members participated in radio programs, including
a three-month FM radio program by and for drug users. Late in the project, RN even had the opportunity to
launch its own radio program, which currently airs once a week for an hour. It broadcasts issues of drug
users and PLHAs, and it is entirely conducted by drug users and for drug users.
6.
Articles on the founding of INPUD Asia (background).
Drug users in Asia launched their first regional network “INPUD-Asia”.
Source: International Network of People Who Use Drugs
In an attempt to bring the needs and views of one the most HIV-vulnerable groups to front and centre on
the AIDS agenda, drug users in Asia launched their first regional coalition – the regional section of the
International Network of People Who Use Drugs (INPUD-Asia). With an estimated 6.5 million people
currently injecting drugs in Asia, the new network has a potentially huge constituency.
INPUD-Asia is led by Anan Pun, a founding member of Recovering Nepal, and Fredy Malik from
Indonesia. It is planed to finalize the strategy and the location of the new network during the Users
Congress in January 2008.
"Through INPU-Asia, drug user communities in the region will be able to get support for activities such as
advocacy and strengthen capacity of drug user representatives," said Anan Pun. "We hope that this network
will lead to greater inclusion of drug user communities in the universal access framework and to
improvements in addressing their needs." In an attempt to bring the needs and views of one the most HIVvulnerable groups front and centre on the AIDS agenda, drug users in Asia launched their first regional
coalition in Colombo yesterday.
Evidence indicates that a large part of Asia's HIV epidemic is the result of preventable HIV transmission
among injection drug users. Of the estimated seven million people living with HIV in Thailand, Nepal,
Indonesia, Myanmar, parts of India, Pakistan and China, for example, more than half are thought to inject
drugs.
A group of drug users from across Asia have now come together to set up the regional section of the
International Network of People Who Use Drugs (INPUD-Asia).
INPUD-Asia is led by Anan Pun, a founding member of Recovering Nepal, a national drug user network in
Nepal. Mr Pun traveled to Sri Lanka to encourage his Asian peers to unite their efforts at improving the
health and social care of people using and recovering from drug dependence.
"Through INPU-Asia, drug user communities in the region will be able to get support for activities such as
advocacy and strengthen capacity of drug user representatives," said Mr Pun. "We hope that this network
will lead to greater inclusion of drug user communities in the universal access framework and to
improvements in addressing their needs."
The network members highlighted how funding support for drug-related activities is far behind that of most
other HIV-related needs and priorities, despite what is known about drug use as a major driver of the
epidemic. Out of about USD 8 billion spent on tackling HIV across the world each year, preventing the
spread of HIV among drug users could cost as little as USD 200 million per year. Nevertheless, estimated
coverage of harm reduction services for users in Asia, for example, dropped from just over 5% in 2003 to
about 3% two years later.
"We are people from around the world who use drugs. We are people who have been marginalized and
discriminated against; we have been killed, harmed unnecessarily, put in jail, depicted as evil, and
stereotyped as dangerous and disposable," says a statement describing the global goals of the network.
35
"Now it is time to raise our voices as citizens, establish our rights and reclaim the right to be our own
spokespersons striving for self-representation and self-empowerment."
INPUD-Asia aims to provide a strong mechanism for representation and involvement of people using drugs
across Asia through advocacy, education and networking.
"Ultimately the network should lead to positive changes and a reduction in the HIV vulnerability of drug
users," Mr Pun added.
With an estimated 6.5 million people currently injecting drugs in Asia, the new network has a potentially
huge constituency.
Fredy Malik (INPUD Asia): fr_edy78@yahoo.com
Anan Pun (INPUD Asia): ananpun@gmail.com +9779841513534
Article II: Launch of Asian Network of People who Use Drugs (INPUD ASIA)
PRESS RELEASE
19 August 2007
On August 19, 2007, a group of drugs users from across Asia launched the first regional network for people
who use drugs in Asia under the title “International Network of People who Use Drugs (INPUD - ASIA)”.
The event was held during the International Congress on AIDS in Asia and the Pacific’s Community
Forum at the Sri Lanka Foundation Institute.
INPUD ASIA is chaired by Anan Pun, a founding member of Recovering Nepal, a national network of
drug users in Nepal. Mr. Pun, with support from the Asian Harm Reduction Network (AHRN), traveled to
Sri Lanka to invite his Asian constituents to unite their efforts at improving the health and social care of
people using and recovering from drug dependence by joining the network.
“Through INPUD Asia, drugs user communities in the region will be able to get support for activities such
as advocacy and strengthen capacity of drug user representatives. We hope that this network will lead to
greater inclusion of drug user communities in the Universal Access framework and improvements in
addressing their needs. Ultimately, the Network should lead to positive changes and reduction of
vulnerability to HIV among drug users” said Mr. Pun.
Evidence suggests that the Asian epidemic and its growth have been the result of preventable HIV
transmission cases among injecting drug users. Out of the 7.4 million recorded people living with HIV in
Thailand, Nepal, Indonesia, Myanmar and parts of India, Pakistan and China, more than half inject drugs.
An estimated 6.5 million persons currently inject drugs in Asia and in some areas, 89% of new HIV cases
are attributable to injection drug use.
Out of the USD 8.3 billion available in 2006 to respond to HIV across the world, its prevention among
injecting drug users requires as little as USD 200 million per year. As a matter of common sense, priority in
the response should be to curb transmission where it is most rapidly spreading, where there are fewest
services to address needs, where those most vulnerable face poverty, prejudice, criminalization,
marginalization, stigma and discrimination in a negatively reinforcing relationship, where the very concept
of human rights is foreign and alien, both among civil society and in governments, where resources can be
invested most effectively, and where national resources are scarce and corruption is institutionalized –
among Asian drug users. Yet, the situation of Asian drug users is dire with harm reduction service coverage
dropping from 5.4% in 2003 to 3% in 2005.
While injecting drug use remains the most important – and unaddressed – vector for HIV transmission in
Asia, drug users are rarely consulted and involved in determining how to meet their own needs. INPUD
Asia will therefore provide a strong mechanism for representation and involvement of people using drugs
across Asia through advocacy, education and networking.
36