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The following is an excerpt from an ANCD report:

The link between amphetamine-type stimulant use and the transmission of HIV and other blood-borne viruses in the Southeast Asia region.

Cambodia, officially known as the Kingdom of Cambodia, is a monarchy with a parliamentary system. It borders Thailand to the west and north-west, Lao PDR to the north-east and Viet Nam to the south-west. It has a population of almost 15 million with more than 2 million residing in the capital, Phnom Penh. Cambodia is a signatory to the Integrated Drug Abuse Drug Information Network (IDADIN).

Amphetamine-type stimulant use

The drugs of most concern in Cambodia in 2009 were crystal methamphetamine and ATS pills. Between 2003 and 2006 the trend was towards increasing use of crystal methamphetamine (2007 to 2009 trend was not reported) (United Nations Office on Drugs and Crime, 2010b). The United Nations Office on Drugs and Crime (2010b) reported approximately 6800 drug users but noted that in the absence of national surveys this is likely to be an under-estimate. In 2004, an expert consensus group estimated there to be 20 000 ATS users (Cambodia National AIDS Authority, 2008). It appears drug use largely affects young people with 60 per cent of drug users aged 18–25 years and 17 per cent aged 10–17 years. A survey of street children found almost half had used an illicit drug in their lifetime and use of ATS pills had increased among this population from 12 per cent in 2000 to 87 per cent in 2007 (United Nations Office on Drugs and Crime, 2010b). The source of crystal methamphetamine in Cambodia was predominantly Thailand but since 2003 drugs have trafficked through Lao, in particular from the Mekong Delta (United Nations Office on Drugs and Crime, 2010b). The original source of ATS is Myanmar and reports have been received that quantities of ATS from this source are being re-tableted in Cambodia for the domestic street market. There is also evidence that a substantial proportion of the drugs trafficked into Cambodia are actually destined for markets other than domestic.

Injecting drug use

There are no official recent national size estimates of PWID in Cambodia. The most recent figures for PWID in Cambodia are from 2004 and suggest there are between 1000 and 7500 PWID in Cambodia (Mathers et al., 2008). However, non-government organisations in Cambodia reported referring almost 1500 persons to government-managed counselling and testing services and, of these, half (788) were reported to be people who inject drugs (United Nations Office on Drugs and Crime, 2010b). The Integrated Drug Abuse Drug Information Network is a UNODC F-97 regional project, ‘Improving ATS Data and Information Systems’, which aims to establish an infrastructure for better understanding of the patterns of ATS use and for exchanging data pertinent to ATS abuse prevention and control. Based on a population prevalence (15–64 years) of PWID in the range of 0.01–0.09 per cent.

Drug-related arrests

Between 2007 and 2008, the number of arrests for crystal methamphetamine increased from 41 to 139 (a 57% increase), while arrests for ATS pills also increased from 199 to 232 (United Nations Office on Drugs and Crime, 2010b). Furthermore, the majority of arrests related to illicit substances were for ATS pills (61%) and crystal methamphetamine (37%). There were 615 drug-related arrests in Cambodia in 2009, but figures were not separated by drug type (United Nations Office on Drugs and Crime, 2010b).

Drug seizures

ATS pill seizures increased 18 per cent between 2008 (116 772 pills) and 2009 (137 249 pills) and crystal methamphetamine seizures more than doubled from 1.9kg to 4.6kg (United Nations Office on Drugs and Crime, 2010b). However, these figures are significantly lower than those reported for the 2006 period (ATS pills 428 553 and crystal methamphetamine 16.2kg). There have also been recent increases in the manufacture of ATS in Cambodia, with five manufacturing sites being dismantled in 2009 and significant seizures of precursor materials reported (United Nations Office on Drugs and Crime, 2010b).

Drug treatment

In 2008 there were 14 compulsory drug treatment centres in Cambodia, the majority run by the military or civilian police. In the same year 2382 people were detained in these centres, the majority young males aged 19–25 years (United Nations Office on Drugs and Crime, 2010b). Detention for the use of crystal methamphetamine and ATS pills dominated. A relapse rate following discharge from these centres has been estimated to be up to 100 per cent (World Health Organization, 2009).

Drug prevention activities

Primary drug prevention occurs in schools and in the community but is reportedly limited.

HIV in the community and among high-risk groups

Between 2003 and 2006 HIV population prevalence among adults aged 15–49 years decreased from 1.2 per cent to an estimated 0.9 per cent (68 000 cases; 51% female) (UNAIDS, 2010a). In 2006 an estimated 22.8 per cent of PWID in Cambodia were positive for HIV (Mathers et al., 2008). The first-ever survey of drug users in Cambodia (n=528) found 24.4 per cent of injectors were HIV-positive compared to 1 per cent of non-injectors (Cambodia National AIDS Authority, 2010). This report did not discriminate between drug types and, since heroin injecting also occurs in Cambodia, the risk associated with ATS is unknown. HIV prevalence among PWID referred to government-managed counselling in 2007 was 35 per cent, a significant increase from the 14 per cent found in the same population in 2006 (United Nations Office on Drugs and Crime, 2010b).

Prevalence of HIV among female sex workers varies between provinces and is reported to be between 20 and 30 per cent. Among men who have sex with men in Phnom Penh, HIV was 8.7 per cent while in two rural towns it was 2 per cent. Prevalence was highest among transgender groups (17%) (Cambodia National AIDS Authority, 2010).

HIV prevention among high-risk groups

In 2007, 93 per cent of brothel-based and 90 per cent of non-brothel-based sex workers reported they had received prevention education. In the same year 68 per cent of brothelbased and 51 per cent of non-brothel-based sex workers reportedly had been tested for HIV and knew their results (Cambodia National AIDS Authority, 2010). There are no previous measures of this variable with which to compare these figures. A behavioural survey conducted among MSM reported that 96 per cent of MSM had received HIV prevention information in the six months prior to interview (Cambodia National AIDS Authority, 2010). While a survey among PWID in treatment found that 99 per cent of PWID knew where to access clean needles and syringes, more than 30 per cent reported sharing needles the last time they injected. The remainder reported using ‘clean’ needles but this included sterile units and needles and syringes that had been cleaned prior to re-use (Cambodia National AIDS Authority, 2010).

In recent guidelines for the prevention and treatment of HIV and other sexually transmitted infections among MSM and transgender people, the influence of the use of ATS on sexual behaviour was noted (World Health Organization, 2011).

HIV and anti-retroviral treatment (ART)

There was an increase in facilities providing ART therapy from 16 in 2005 to 20 in 2007. A total of 37 315 people were receiving ART in 2009 (World Health Organization, 2010b), three times the figure recorded in 2005 (12 247) (UNAIDS, 2010a). No figures on ART availability for PWID were available, although ART is linked to OST clinics and available in some prisons (Mesquita et al., 2008).

Harm reduction

More than a quarter of a million needles and syringes were distributed through two sites in Phnom Penh in 2007 (Hagarty, 2010). In 2009, NGOs distributed 92 000 sterile needles and syringes. The first OST program in Cambodia commenced in 2010.