When grammars collide: Harm reduction, drug detention and the challenges of international policy reform efforts in Vietnam

Abstract

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.

Keywords:

• harm reduction
• drug detention
• HIV/AIDS
• Vietnam
• methadone

Acknowledgements

The authors would like to thank the careful efforts of the anonymous peer-reviewers and the Editorial Board of Global Public Health, and to extend a special thanks to the Social Science Training and Research Partnership (Columbia University and Hanoi Medical University) for their generous funding and support.

Notes

1. The use of the term ‘grammar’ in relation to harm reduction first appeared in the context of an interview with one of our respondents. ‘Grammar’ is typically used in linguistics and literary theory to denote the structure of the text, or a set of rules that organise narratives or ways of knowing (see Foucault 1970).

2. For more on the goals and strategies of the contemporary international harm reduction movement, see Donor Conference on Harm Reduction (2010).

3. It is important to note that similar kinds of conversations about harm reduction policy are happening concomitantly in China (e.g. Sullivan and Wu 2007, Hammett et al. 2008).

4. See, for example, from UNAIDS 2009, ‘HIV has long been of lower priority for the GOV than poverty or corruption. A new Socio-Economic Development Plan is due for 2011–2015. Preparations for this, which will be supported by the UN, offer an opportunity to stress the link between HIV and poverty, to advance the argument for multisectoral working, and to mainstream HIV into national programmes’.

5. For more on local innovations in harm reduction programs in Vietnam, see WHO, DFID and NORAD (2009).

6. For an account of an especially successful initiative working with local police in the promotion of harm reduction, see Hammett et al. (2005).