But as mentioned earlier, there is growing opposition from the public who regard the program as a way to promote the injection of drugs by drug users. Below are some of the key concerns that are being raised:
Does a needles and syringes program increase the number of people who inject drugs?
- Have NSPs led to an increase in injecting drug use in Cambodia?
- Has the number of drug users increased in Cambodia since the beginning of NSPs?
- Does injecting drug use only occur in those Cambodian cities/provinces which have NSPs?
- What does evidence from other countries tell us?
Presently, there is lack of reliable evidence to show whether the number of IDUs has increased before or after the NSPs. The available data does not show a significant increase.
More than 200 research papers that have been published about NSPs over the last two decades in Asia, Europe, America, Australia and New Zealand do not show any evidence of NSPs increasing numbers of IDUs. Also, there is no evidence that NSPs increase transition from non-injecting to injecting drug use.
A study carried out in the US through interviews with IDUs who had used NSP and those who had not indicated that IDUs who had used NSP were less likely to inject drugs or injected less frequently and they were more likely to enter into treatment for drug dependence.
People who use NSPs are less likely to share needles/syringes and less likely to have unsafer sex and at the same time, the cities with NSPs have fewer discarded needles/syringes in the community.
In Australia, $AU 130 million was spent on needles and syringes programs in 10 years. Within those years, NSPs prevented 25,000 new cases of HIV and 21,000 cases of hepatitis C and saved $AU 7.8 billion in treatment costs for HIV and hepatitis C.
In Cambodia, it is unclear whether NSPs lead to more IDUs but evidence from other countries have revealed that they do not lead to an increase in the number of IDUs. However, one thing which is certain is that HIV infection can explode within the community of IDUs.
Will Cambodia be able to achieve the national universal access target of reaching 80% of IDUs by 2010, if this community is living in fear, hidden, criminalized and stigmatized?
1. Dolan, K. MacDonald, M., Silins, E. & Topp, L. 2005. Needle and syringe programs: A review of the evidence. Canberra: Australian Government Department of Health and Ageing.
2. Hagan H et al. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment, 2000, 19(3):247-52.
3. Wodak, A. and Cooney, A. 2004. Evidence for action technical papers: effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization.
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