When grammars collide: Harm reduction, drug detention and the challenges of international policy reform efforts in Vietnam.
Throughout the 1990s, a dramatic rise in HIV prevalence rates among drug users in Vietnam attracted the attention of international observers concerned about the prospect of a more generalised epidemic. Vietnam subsequently became the target of extensive funding and advocacy which sought to introduce needle exchange and methadone in a country where drug use was considered a 'social evil', and drug users were subjected to what international observers viewed as draconian incarceration measures. What were the goals of proponents of harm reduction when they came to Vietnam? How did they perceive the state of prevailing approaches to drug users in the context of the Vietnamese HIV epidemic? How did they understand the strategic challenges they faced and the dilemmas they had to confront? Based on in-depth interviews with international harm reduction proponents working in Vietnam, this paper explores the encounter of two grammars of harm reduction, one based on broadly accepted international approaches, the other rooted in Vietnam's own history and politics. From this encounter a set of policies and practices characterised by needle exchange and methadone maintenance emerged, as well as an extensive network of closed centres where tens of thousands of drug users are currently detained.
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA. cee2106@columbia.edu
Claire
C
Edington
Ronald
R
Bayer
D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D040261:Harm Reduction; D006801:Humans; D007390:International Agencies; D007407:Interviews as Topic; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D018671:Needle-Exchange Programs; D015995:Prevalence; D011640:Public Policy; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D014744:Vietnam / Q000453:epidemiology
D009294:Narcotics; D008691:Methadone