Behind a stupa in the Thursday afternoon sun, two young men smoked amphetamines from a pipe constructed from tin foil and a bendable straw. They squatted on ground littered with small plastic bags, cigarette butts and blood-encrusted syringes. When the amphetamine pill appeared finished, Map, 23, tapped the residue out of the straw and began again.
As they smoked, Map’s brother Phan, 24, wandered by. Even after a few puffs, he remained subdued, digging holes in the dirt with a stick, then shaving its bark with a broken razor blade. He had track marks on his wrist. Rolling up his sleeve, he revealed that they continued up the inside of his arm to just above the elbow.
Map and Phan are beneficiaries of a needle-exchange program started three months ago by Mith Samlanh/Friends, an NGO that works with street children. The program, Friends representatives say, is designed to address the growing problem of HIV transmission through shared needles. Nonetheless, since the group publicized the program at a Tuesday seminar, it has been criticized by the National Authority for Combating Drugs.
Khieu Sopheak, deputy secretary general of the authority, said the program violated the law because it “encourages people to inject heroin.” The authority has asked Friends to stop the program, he said Thursday.
Friends Coordinator Sebastien Marot said the needle exchange could be viewed from either a crime or a public health perspective. He was confident Friends would be able to work with the government “to prevent drugs from becoming the new vector for HIV/AIDS” in Cambodia, as in China and Vietnam.
“Time is short,” Marot warned Thursday. In the last two years, he said, the injection of illegal drugs has exploded “beyond belief.”
He said Friends had an appointment with the National AIDS Authority and hoped to meet with the drug authority soon.
Dr Tia Phalla, secretary general of the authority, said Thursday that whether the needle program could continue was not up to him, but that similar programs in other areas had been proven to “reduce HIV transmission.”
Phan gets needles from Friends. Before the program started, he tried not to share needles, “but sometimes I had no choice.” Now he only shares needles with his brother.
Map is married and said he sees his wife and baby daughter every few days, although “I used to visit every day.” He said he took an HIV test that came back negative. Now, he said, he boils the needles after his brother uses them, because he fears Phan has unprotected sex with prostitutes.
After he finished smoking, Map took a pen out of an Evian box where he keeps his belongings. He took it apart and played with the spring inside. “When I smoke I just feel like doing something,” he said. On Wednesday, he said, another boy who lives at the stupa found a hand phone and sold it, and Map smoked 16 amphetamine tablets with the windfall.
David Harding, technical adviser at Friends, said the program began about three months ago when the organization’s outreach staff found five “pockets” of intravenous drug users, totaling about 47 people. Of those, 15 agreed to an HIV test and 45 percent tested positive.
Intravenous drug use has drawn children from more stable backgrounds to “dip into” life on the streets, Harding said. And many street children are “highly mobile,” some working in the sex industry to support themselves and their habits, he said.
So the repercussions of street children’s needle use are “crossing all levels of society,” he said. And Friends has not found all the users. “There are more than we think, more than we know,” he said. “If [the needle exchange] doesn’t happen, a lot of people could die.”
The one-for-one needle exchange at Friends is an “emergency measure” to curtail HIV transmission. “Drugs are not the core issue here,” Harding said, although Friends has programs for those who want to quit.
Needles are available once from “outreach teams” who find addicts around Phnom Penh and afterward from a drop-in center. Harding said Friends distributes 20 to 30 needles daily on the streets and another 10 at the center.
Friends also provides rubber tourniquets, which slow the drugs’ infusion into the bloodstream, and sterile water. Users mix heroin with puddle water, gas, alcohol and “whatever they could find,” Harding said.
On the grounds of the pagoda where Phan and Map live, several tattooed boys and a woman lounged in a filthy shrine with a Buddha statue in the back. Da, 20, said she had been using heroin for two or three years, scavenging to support her habit.
With Friends’ help, she said, she is trying to quit. “The organization knows us and educates us,” she said Thursday. “If they encouraged drug use, they would not try to persuade us to quit.”