The Shay Rebellion | Christopher Shay

In a dark corner of one of Phnom Penh’s poorest communities, JB, a member of Korsang’s medical crisis team, disinfects and cleans scratches on a young girl. After JB finishes, the girl runs to play in the boggy trash heaps adjacent to her room.

It may not seem like it, but JB’s actions are part of the frontline of Cambodia’s battle against the spread of HIV.

Peer educators from Korsang, a local harm reduction NGO, visit Phnom Penh’s most drug-riddled communities everyday. Most of Korsang’s staff members are former drug users themselves, and they gain the trust of Phnom Penh’s at-risk communities by talking candidly about drug use and HIV risk and by providing basic medical aid.

“We come to this spot every other day so they know who we are, and they’ll be comfortable talking to us. Every time we make contact with someone, we ask if they know their HIV status. Sometimes they tell us, ‘No. I don’t know [my HIV status], but I want to,’ and we can make sure they get tested,” JB said. “Some of the people in poverty don’t even know how HIV is transmitted, what drugs do to their bodies and what options they have.”

Korsang was one of the pioneers in the politically sensitive harm reduction approach in Cambodia — a method that emphasizes engaging with individual users to curtail the harmful effects of drugs on the individual and society but does not insist on abstaining from drugs completely. In a country where cold-turkey, boot camp style treatment was once the norm and where drug addicts are still treated as social pariahs, Korsang became one of the few places where drug users in Phnom Penh were treated with respect.

Today, Korsang’s connections to the drug using community will allow it to play a crucial role in Cambodia’s new strategy to thwart the growing threat of an HIV epidemic caused by an increase in unsafe intravenous drug use.

Gordon Mortimore, a technical advisor to the HIV/AIDS Asia Regional Program (HAARP), said, “Cambodia has a very distinct problem with injections. Though the numbers aren’t large, the problem is growing, and it’s growing month by month.”

The National Strategic Plan for Illicit Drug Use, developed by the National AIDS Authority and National Authority for Combating Drugs with input from NGOs, is a comprehensive plan that focuses on harm reduction strategies. The plan has yet to receive the necessary funding for the full program, but AusAid and HAARP have both pledged financial support.

“We still have many needs… We’re looking for more support from UNAID and others. We need more support,” Thong Sokunthea, the deputy director of Legislation, Prevention and Rehabilitation, said.

The plan itself has been lauded by experts. Mortimore called Cambodia’s plan “a good example for the region,” noting that the National Plan for Illicit Drug Use ensures a coordinated so that international NGOs and civil society groups can avoid funding redundant programs and know where the funding gaps in the plan lie.

Cambodia’s new, holistic approach focuses on drug education, treatment and law enforcement and is supposed to ensure that NGOs, the Ministry of Health and police have the same goals of reducing HIV rates and the stigma of being a drug user. One key aspect of the plan is the introduction of methadone maintenance therapy, which will be available to drug-users in Cambodia for the first time early next year. Though the pilot methadone treatment program run by the Ministry of Health at Russian Hospital is an important step, it represents only part of the solution.

“Our government cannot implement this [the National Strategic Plan] without help from civil society… Drug-users don’t always feel comfortable with government officials, and Korsang has a lot of experience contacting and educating drug users. We need their support for us to be successful,” Thong Sokunthea said.

The government is relying on Korsang to run support services and make referrals for the methadone program, and thankfully, Korsang has the experience and the contacts to help.

“Methadone is requested all the time. They [drug users] tell us they want a medicine to help them quit. They’ve been waiting for it,” JB said.

Even though Korsang has been requesting the rights to run a methadone treatment program for over three years, Holly Bradford, the founder of Korsang, does not think Cambodia is far behind the curve.

“Its [the introduction of a methadone maintenance therapy] timing is good. There’s an emerging injection drug problem,” Bradford said.

Korsang may have started off small, but the organization quickly grew to fill different needs of Phnom Penh’s growing population of drug users.

“Each additional program we implemented came from the drug users themselves. They let us know what they needed,” Short, one of about twenty Cambodian returnees deported from the US who work at Korsang that are known only by street names, said.

In only four years, Korsang has grown to fifty staff members and twenty peer educators. They currently run an outreach program, a 24 hour drop-in centre, a women’s health education program, an infirmary, a needle exchange program and a music and dance program for at-risk youth, but they are about to expand even more.

With promises of financial support for seven years from HAARP, Korsang will be able to run support services for the methadone maintenance therapy in Cambodia and continue running an overnight program for street-based users, Bradford said, making it a key player in ensuring the success of Cambodia’s national drug plan.

According to Cambodian Senator Chhim Kim Yeat’s presentation at the Rights Beyond Borders conference, a regional harm reduction forum held in Phnom Penh last week, the Cambodian government does indeed recognize the importance of a harm reduction plan to ensure the continued decline in the HIV rate in Cambodia.

Chhim Kim Yeat described Cambodia’s fight against HIV as a fragile success story that could be derailed without a collaborative solution to the problem of injection drugs. The HIV rate in Cambodia has dropped sharply, from 3 percent in 1997 to 0.8 percent in 2006, according to government statistics.

“There is a window of opportunity to avoid a crisis… The extent of drugs and poverty may set back our goals,” Chhim Kim Yeat told the audience.

In order to avert an HIV epidemic, Korsang’s grassroots efforts to educate drug users and to refer people to the government run methadone treatment program will be key.

Everyday Korsang’s staff members provide Phnom Penh’s drug users with information about HIV transmission but as Tang, one of the first five staff members at Korsang, pointed out it’s not just what you do that matters, it’s how you do it.

“We make them [drug-users] feel better. They see us; we hug them and talk to them. Treating drug users as friends is what separates us,” he said.

After traipsing through the muddy alley-ways of Louksang and in the dusty tent warren of Thai Buarong — two of about twenty at-risk areas that Korsang visits — JB and three other Korsang staff members finished their rounds. During their outreach, they sat down with a drug user with blood shot eyes and calmly explained the effects of drugs; they checked in on one drug user’s baby to make sure she was still healthy, and a woman, high on yama, screamed at them, demanding medicine they did not have.

In a few hours, they will visit another two sites, and tomorrow, they will do it all again. What keeps them coming back day after day?

“You see people come alive. Day by day, when I see get them better, I feel good,” JB said.