Harm Reduction Journal
Introduction: The emergence of widespread amphetamine-type stimulants (ATSs) usage has created signifcant
challenges for drug control and treatment policies in Southeast Asian countries. This study analyses the development
of drug policies and examines current treatment program constraints in Vietnam to deal with ATS misuse. The aim was
to gain insights that may be useful for national and international drug-related policy development and revision.
Methods: A desk review of national policy documents and 22 in-depth key informant interviews were conducted
from 2019 to 2021. Thematic content analysis was employed to identify key themes and their connections.
Results: Analysis identifed Vietnam’s 30-year history of developing policies and formulating strategies to reduce
supply, demand, and harm from illicit drugs. With the increasing number of people who use ATS (PWUA), Vietnam
has recently promoted harsh policy and law enforcement to deter drug use and supply. This policy trend prevails in
many Asian countries. The three main constraints in dealing with ATS misuse emerged from punitive and restrictive
drug policies. First, the general public believed that Centre-based compulsory treatment (CCT) is the only appropriate
treatment for all types of illicit drug addiction despite its low-quality service provision. The rigid drug policy has led
to social persuasion with impractical expectations for CCT efectiveness. Second, the emphasis on punishment and
detention has hampered new drug treatment service development in Vietnam. CCT has become monopolistic in the
context of impoverished services. Third, people who use drugs tend to hide their needs and avoid formal treatment
and support services, resulting in declined social coherence.
Conclusion: While new drugs are constantly evolving, the current law enforcement approach potentially constrains
expertise to adopt efective treatment services. This study suggests that the top-down policing mechanism presently
hinders the development of an appropriate intervention strategy for ATS misuse and diminishes social support to
service providers
Nguyen Thu Trang, Giang Thi Hoang, Duc Quang Nguyen, Anh Huu Nguyen, Ngoc Anh Luong, Didier Laureillard, Nicolas Nagot, Don Des Jarlais, Huong Thi Duong, Thanh Thi Tuyet Nham, Oanh Thi Hai Khuat, Khue Minh Pham, Mai Sao Le, Laurent Michel, Delphine Rapoud, Giang Minh Le
Harm Reduction Journal
Introduction: The COVID-19 outbreak disproportionally afects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and fnancial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework. Method: We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the frst lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic. Results: The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious fnancial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of diferent factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, sufered most from COVID-related fnancial pressure and may have engaged in unsafe sex. Conclusion: While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately afected during the global crisis.
Americal Journal of Public Health
Objectives. To determine how harm reduction should be applied in low-resource countries such as Vietnam by exploring the perspectives of people who use drugs (PWUD), health care professionals, and policymakers regarding methadone treatment and harm reduction strategies. Methods. We conducted 2 qualitative studies in Vietnam between 2016 and 2021. We interviewed 62 PWUD and 22 experts in drug policy development and drug treatment programs, conducted observations at methadone clinics and harm reduction program meetings, and analyzed drug policy documents. Results. PWUD considered methadone treatment only as a transition to a drug-free life. Policymakers deemed harm reduction ineffective and continued to enforce arrest and incarceration of PWUD. Drug intervention programs are not yet geared to providing specialized services. Effective communication strategies and information on evidence-based harm reduction models are inadequate to help policymakers make the right decisions. Conclusions. Harm reduction principles have not been fully adopted in Vietnam. A harm reduction strategy based on a more humanistic approach that goes beyond a biomedicalized approach is urgently needed in Vietnam and other countries in the Global South.
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