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In the last decade, the use of methamphetamine – also referred to as ‘meth’ or ‘ice’ – has increased significantly throughout Southeast Asia. And Vietnam is not an exception.
Meth is a strong stimulant drug, which – depending on its form – is smoked, injected or ingested. This ‘upper’ increases wakefulness, focus and confidence. It can elevate someone’s mood and provide feelings of power. It can also decrease fatigue and appetite. And, among many groups, meth is associated with an increased sex drive and delayed and/or more intense orgasms. These effects make the drug popular among groups who work long hours or night shifts. Sex workers in Southeast Asia also commonly use meth: 50.6% of the sex workers in this region have used methamphetamine (UNODC, 2012).
However, like every drug, meth has clear downsides. It can produce nervousness or anxiety and, in some cases, psychosis and suicidal thoughts (e.g. Holman, 1994; EMCDDA, 2007; Hildrey et al., 2009; Pates and Riley, 2009). Research shows that meth use is associated with an increased risk of contracting HIV in a range of populations. These include people who inject drugs, but also non-injecting drug users. A recent study by Mainline’s partner Atma Jaya Catholic University confirmed these risks for meth users in Indonesia. The same risks exist for sex workers and for men-who-have-sex-with-men (MSM) under the influence of meth.
Ice in Vietnam
Although we know that ice is a widely popular drug in Vietnam, most of the evidence is anecdotal or relatively outdated. We are not sure how big the meth-using population is in Vietnam, or which groups are at the most risk of damaging their health. Nor do we know how many people encounter legal, social or economic problems as a consequence of their meth use. In a country like Vietnam, where punishment for drug-related crimes is severe, people naturally prefer to hide their use of substances. However, without knowledge about the people who use meth and how they can best be reached, it is hard to provide services to reduce the possible preventable (health) harms. We need information to inform harm reduction programmes.
For this reason, Mainline, SOA AIDS the Netherlands and SCDI initiated a pilot study to estimate the size of the group of meth users and to get a better understanding of the potential risky behaviours. This assessment is being implemented in Ho Chi Minh City between February and July 2018 and is part of the Bridging the Gaps programme. The study is primarily meant to inform future harm reduction programming and consists of:
Our partners in Vietnam
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The study is implemented by the local networks for people who use drugs and sex workers – who function under the SCDI network. We found that the outreach workers from these networks are best equipped to talk to people about drugs and sexual risk behaviour. Mainline trained a group of ten outreach workers in the research methodology and they will now set out to interview their peers. Their efforts will result in a recommendation for a harm reduction programme aimed at meth users in Ho Chi Minh City and possibly for other cities in Vietnam.
Nepal
Mainline is asked to review the current harm reduction programmes in Nepal from the perspective of women who inject drugs. Based on interviews with women we hope to formulate recommendations to improve service delivery.
Vietnam
In 2021 and 2022, SCDI in Vietnam and Mainline can continue to strengthen and expand the available harm reduction offer for people who use meth-amphetamines. After establishing the regional field lab in 2019 and 2020 we now have the opportunity to push this innovative initiative to the next level. One important element: to improve and expand the community mental health response. Moreover, the skills that were built in Hanoi's field lab are ready to be further disseminated across the South East Asian Region.
Iran
Iran is renowned for its harm reduction programme. It was one of the first countries in this geographical region to adopt a harm reduction approach. Government supports and funds the programme. But the drug scene in Iran has changed over the past 20 years. More people are using stimulant drugs and, due to economic circumstances, more people who use drugs have become homeless. Mainline sets out to see whether the current programme in Tehran still fits the needs of the local people who use drugs.
Zimbabwe
Mainline have been asked to assess the drug scene in five provinces in Zimbabwe. A team of three researchers worked in close collaboration with the Zimbabwe Civil Liberties Drug Network throughout 2022. The goal: to gain an insight into which drugs are commonly used and to recommend health interventions.
United Kingdom, Finland, Greece, Estonia, Serbia, Portugal, the Netherlands
Harm reduction approaches are rarely applied in a recreational sports setting. And why would we - sport equals health, right? Not always. Research shows that the use of performance and image-enhancing drugs (PIEDs) is quite common in various recreational sport scenes. And for those people who use frequently and in high doses, harm reduction can make a big difference.
Netherlands, Belgium, Spain, Greece, Germany, France
Several risk factors increase the vulnerability of (new) groups of migrants to engage in problematic drug use. These risk factors include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs.
Burkina Faso, Burundi, Egypt, Kenya, Marocco, Mozambique, Nigeria, South Africa, Uganda, Zimbabwe
Mainline is a partner in the Love Alliance programme. The Love Alliance brings together organisations led by communities most affected by HIV and AIDS.
Global
The use of drugs during sex is a growing worldwide phenomenon among men who have sex with men (MSM). Mainline has built a unique track record while working in the frontline of the Dutch 'chemsex' scene. Now, we also apply this expertise in an international context. The best place to start? Our chemsex e-learning.
Zambia
Harm reduction is new in Zambia. Mainline was asked to estimate how many people inject drugs in the country and to map the already existing harm reduction and HIV services for people who use drugs. Based on this information, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.
South Africa
Women Who Use Drugs face additional problems compared to their male counterparts. The harm reduction field far too often neglects the needs of women. To some extent, the same is true for peer workers: incredibly valuable staff in any impactful service. How can local services make sure that peer workers are valued, supported and living up to their full potential? And how can access for women who use drugs be improved?
Kenya
Women who use drugs in Kenya face violence every day: At home. On the streets. By the police. In their communities. A unique study - conducted in Mombasa, Kenya - sheds light on the tough realities these women encounter. Urgent action is needed.
Kenya, South Africa
Young people use drugs - including minors. It's an inconvenient truth: societies usually seek to prevent young people from damaging their health and there is a big taboo on drug use among young kids. But are stigma, legislation or moral judgement keeping young people away from harm reduction services? This project aims to find and improve access to services.
Indonesia
Prisons in Indonesia are overcrowded and health services are limited. Is quality prison health too expensive? Not according to findings from Atma Jaya University, who applied the method of 'economic modelling' to prison health services, including drug dependency programmes. The findings fed important advocacy messages to improve the prison system in 2021. Moreover, Atma Jaya - via a 2021 implementation study - succesfully introduced motivational interviewing into the prison setting: an evidence-based method to assist people who are dependent on drugs and would like to reduce or quit their drug use.
South Africa
Together with activists and peer- and outreach workers in South Africa, Mainline worked on a practical guide about involving peers in harm reduction work.
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