Arresting HIV: The Importance of Law Enforcement and Harm Reduction Program Partnerships

1. Arresting HIV: The Importance of Law Enforcement and Harm Reduction Program Partnerships Dr Nicholas Thomson Nossal Institute for Global Health 6th HAARP Consultation and Coordination Forum, Siem Reap, April 2012

2. Enhancing the enabling environment? • What does this mean in the context of harm reduction? • How do we actually do it? • What are some of the factors that “enhance the enabling environment”?

3. Enabling the Legal and Policy Environment • We understand the importance of an enabling legal and policy environments in the context of drug use and HIV……….(HAARP’s Legal and Policy Review) • The same discussion is being had for all HIV prevention among Key Affected Populations • UNESCAP High level meeting, Universal Access, UNDP Global Commission on the Law and HIV • National and Global Policy Debates and Civil Society issues based movements

7. But its only part of the “enabling environment” equation • What else are critical components of the enabling environment? • Best practice, evidenced-based comprehensive programs ultimately funded by the state

8. But to create an enabling environment…….. • It’s the intersection of law enforcement and HIV programs and the people they work with that ultimately dictates how “enabling” the enabling environment is

9. Understanding the dynamics between law enforcement and HIV programs • We haven’t been able to influence law enforcement agencies : why not? • How can we work with police to reinvigorate their ability to become significantly better harm reduction program supporters and indeed public health actors?

10. How is our perception shaped? • Multiple (and substantiated) reports of rights violations • Really, really high rates of lifetime history of arrest, incarceration, re-arrest and further incarceration of drug users and sex workers

12. How do we understand police culture? • Action orientated; reactive rather than proactive • Achievement measured according to arrests=promotion • Extension of conservative state approaches • Discouraging of innovation and creativity • Police see a “war on drugs” as their national security duty

13. There must be a better way? • How many of us have tried working with police on a regular and ongoing manner? • How many of us have really tried to understand the operational culture of policing? • How do we create an enabling environment where the police are fully engaged in their role in HIV prevention?

15. Understanding the factors that create an enabling environment • We have started a series of research projects to understand the dynamics of the enabling environment • UNESCAP Best Practice • Law Enforcement and Harm Reduction Research Network

16. Enabling environment exploration • Examined enabling environments across the Asia Pacific • Case studies included if actions taken by either civil society, government or police (in isolation or separately) had contributed to a “BETTER ENABLING ENVIRONMENT” • Measured by: decreasing prevalence of HIV risk behaviour, uptake in service delivery

17. Some examples • Community mobilisation in AVAHAN projects in India • Efforts to enhance communication between police and drug user networks in Indonesia • Significant engagement between the Blue Diamond Society in Nepal with the police • Sex worker led interventions with police in Thailand (SWING) and Fiji • Human rights policing efforts in Indonesia • Harm reduction training curriculum in Cambodia, Malaysia and Yunnan

18. Evidence of effectiveness? • Less brutality experienced by sex workers in Fiji leading to increase condom use • Female sex workers reform police practices in southern India • Workplace policies on HIV in the police department in Nagaland • But how can we scale up LE and HIV program partnerships? • And how can we monitor the implementation and success?

19. What are the key factors • 1) The Importance of LEADERSHIP • Leadership from both police and civil society • We need people who can meet regularly and represent the views of their organisations. • Respectful and collaborative leadership

20. Civil Society • 2) Importance of growing of Civil Society Networks • Case examples highlight that building civil society networks and their ability to collectively represent themselves made significant impacts on police practices towards them • The role of paralegal services, rights documentation etc

21. Police Reform • 3) The importance of police operational, educational and cultural reform • Development of harm reduction and HIV prevention curriculum (role of police) • Without police reform progress difficult • Police need to feel supported in their reform efforts

22. Communication • 4) The Importance of formal and informal communication channels between police and civil society and HIV programs • National and local task forces • Key actors from both sectors knowing each other

23. Addressing the Structural Drivers • 5) Addressing Structural Drivers • Violence, intimidation • Employment and education • Policy and practices • Scaled up programs • Program design that specifically prioritises a Law Enforcement Advocacy and Partnership plan

24. Monitoring and Evaluation • 6) The need for monitoring and evaluation of the enabling environment • What are the variable of interest? • Decrease incidence of police harassment • Increase in service uptake

25. Law enforcement and harm reduction research network • The role of harm reduction programs on policing practices • Laos, Vietnam and Cambodia • What have we found????

26. Principles of police and harm reduction programs • The involvement of law enforcement is critical to the success of harm reduction programs at all levels – regional, national and local. • There is a pressing need for law enforcement agencies and authorities to share ownership of harm reduction. • Police must be engaged early by harm reduction programs; not as a subsidiary but as a core partner. • There need to be multi-sectoral structures among all key agencies involved at all levels, so that working relationships can be established and maintained.

27. The Role of HAARP • Have a long history going back to original design of Asia HIV/AIDS Regional Project (ARHP) • Police trainings • Sustained involvement: Takes time • Working with Yunnan Police Academy (almost 15 year relationship • HAARP cross border work pioneering Law Enforcement and Public Health cooperation cross border…………We need to document lessons!!

28. Communication?????? • “We heard about the program from our bosses but we were never approached by anyone running the program to inform us about how it would work” • Program design, police liaison officers?

29. Thank You • Law Enforcement & Harm Reduction Network (LEAHRN) • www.leahrn.org • Special Edition of the International Harm Reduction journal and dissemination events in Thailand, Laos, Cambodia and Vietnam • Policing and Public Health, LEPH 2012: The First International Conference on the Intersection of Law Enforcement and Public Health, Melbourne November 11-14, 2012 "Working Together, sharing success"www.Policing-and-Public-Health.com

30. Contact • For more information on our growing Law Enforcement and Public Health Program • Email: nthomson@jhsph.edu