Presentation

1. Presentation Greg Denham Coordinator - Law Enforcement and HIV Network (LEAHN) ‘Importance of law enforcement engagement with public health interventions’ Seminar on Responding to Drug Use and HIV: collaborating for a public health approach in Myanmar 19-20 June 2014

2. BACKGROUND In many parts of the world HIV impacts people involved in risky behaviours such as injecting drugs and unprotected sex (key affected populations - KAP) Also, in many parts of the world these risky behaviours are often unsanctioned and in some case illegal Harm reduction strategies are evidence-informed interventions that are effective in reducing the risk of HIV amongst key affected populations (KAP): people who inject drugs, men who have sex with men, transgender people, sex workers and the broader community So, it is inevitable that in many parts of the world police will come into contact with KAP and harm reduction services This may cause a dilemma for police: ‘how to follow the law and still help prevent the spread of HIV in the community?’

3. Police Attitudes Toward Drugs and Harm Reduction Influenced By: • responding to many situations where people’s lives are adversely affected by illicit drugs - the user, their families and victims of crime • enforcing laws that aim to prevent or deter drug use, yet despite these efforts many people continue to use drugs and frustrate police efforts • pressure from many sectors with constant demands to remove illicit drugs from the community, including the more ‘visible presence’ of the problem • policing ‘systems’ that seek to define effective policing outcomes in terms of ‘clean up rates’ (numbers of arrests) • political and media messages driving police work as the ‘war on drugs’. .

4. Negative Attitude Among Police Consequently many police may have developed negative attitudes about harm reduction services such as needle exchange, methadone and condom distribution which aim to stop the spread of HIV. .

5. Key Issues: Police actions can be one of the strongest determinants of whether a person uses harm reduction services or not Police support for harm reduction approaches is critical in facilitating ‘enabling environments’ for harm reduction .

6. Key Message ‘Police can be the best friend - or the worst enemy - of harm reduction’ ‘Harm reduction cannot - and will not work as effectivelywithout the active participation and support from police’. .

7. Police activities that increase the risk of HIV spreading: • police target or actively patrol near the vicinity of harm reduction services, e.g. needle and syringe programmes and drop in centres, to apprehend drug users • police conduct street sweeps and ‘moving on’ techniques, conduct ‘shake down’ searches, removing injecting equipment • police search or detain outreach workers and peer educators • police are generally unsupportive and lobby for the removal of programs. .

8. Outcomes from non-supportive police activities:

9. Goal of Law Enforcement and Harm Reduction: To develop and maintain a supportive and enabling environment for harm reduction approaches.

10. Case Study 1: Australia All Australian Police Services base their policies and practices on the premise of ‘Harm Minimisation’ which has been the National Policy in Australia since the late 1980’s and is based on three strategic directions: Supply Demand Harm Reduction

11. Case Study 2: Australia • Documented police policies supporting: • Needle and Syringe Programs • Custodial medicine (for example methadone) • Supervised Injecting Facility • Drug Diversion Programs • Court Referral to Treatment • Prevention of Overdose

12. Case Study 2: Malaysia In 2005 a National Task Force on Harm Reduction, made up of representatives from the National Anti-Drugs Agency, Ministry of Health, Royal Malaysian Police, Prisons Department, academics and representatives of NGOs, acted in a steering and guidance capacity. In January 2006 the publication of the ‘Needle and Syringe Exchange Program Pilot Project - Standard Operating Policy’ was released.

13. Case Study 2: Malaysia Police guidelines recognize the important role that police play in facilitating the effective conduct of needle exchange programs. ‘3.1.4. The success of this exchange model will also largely depend on the local police operations. Local policies and National Guidelines for police will have to be developed to assist in this pilot project’ The ‘National Guideline for Police on NSEP’ have also been developed and endorsed by the Malaysian Royal Police (PDRM).

14. Case Study 2: Malaysia ‘There is the need for police to consider the operation of Needle and Syringe Exchange Programs (NSEPs) when carrying out their duties in the areas where these programs are situated. Without restricting their day to day duties and obligations, police should be mindful not to carry out unwarranted patrols in the vicinity of NSEPs that might discourage injecting drug users from attending.’

15. Police and Harm Reduction What might be some benefits to police in creating an enabling environment for harm reduction?

16. Police and Harm Reduction • Harm reduction services provide a ‘bridge to treatment’. Evidence shows that people who inject drugs will readily seek user-friendly services. Once engaged they will request assistance to access drug treatment such as methadone. Other programs, including employment and social services, can also reduce drug use problems.

17. Police and Harm Reduction 2. Harm reduction programs can improve the amenity of an area. Harm reduction services are set up in areas where drug use is an existing problem. Harm reduction workers can conduct street sweeps to collect discarded syringes etc. Staff can provide sharps containers and literature for clients on safe disposal. Staff can provide collection services for the community.

18. Police and Harm Reduction 3. Harm reduction programs have been shown to reduce crime. International research clearly demonstrates that by providing treatment such as methadone involvement in crime is reduce significantly.

19. Police and Harm Reduction 4. Police resources can be used more efficiently and effectively. Through re-directing resources away from minor street- level drug use (and allowing harm reduction services to operate), police can focus on the more harmful aspects of the illicit drug trade, such as trafficking, or direct resources toward substances that may be causing more damage to the community, such as alcohol.

20. Police and Harm Reduction 5. Harm reduction programs reduce the spread of HIV and therefore reduce the risk to police. Harm reduction has been shown to be effective in preventing the spread of HIV in both high- risk groups and the general community. By supporting harm reduction, police can reduce the risks to themselves, particularly through occupational exposure, as well as to their families and friends.

21. Police and Harm Reduction 6. Police resources are limited. By supporting harm reduction police can develop effective working relationships with other agencies, such as health departments and NGOs to share resources. There is often an unrealistic expectation that police are the only answer to the ‘drug’ problem. If police engage with other stakeholders such as education and health agencies and share resources and expertise, the drug issue will be seen as community problem, not just on for the police.

22. Challenges Balancing their role in drug law enforcement and responding to concerns about HIV and other drug related harms from a health perspective can present police with many challenges. .

23. Police – Health Relationships • Collaboration between police, health, other agencies and the communityis the key to reducing the spread of HIV and other harms from drug use!

24. What is LEAHN? The Law Enforcement and HIV Network (LEAHN) is a global network of police and health professionals with a focus on HIV prevention. LEAHN helps professionals understand the role of law enforcement in public health and the importance of collaborative response to reducing the incidence of HIV. LEAHN has established a network of senior police offers in various parts of the world who are key contacts for LEAHN, these police are known as 'Country Focal Points' (CFPs). .

25. Thank You! LEAHN website: www.leahn.org