Out of harm's way

NSW was about to introduce a needle and syringe exchange program and, until then, police had pursued illegal drug users with the force of the law. Now, they were being asked to make a dramatic change in their thinking and approach.

Hansen says that if police wanted to make sure the program didn't work, ''we could simply patrol it and make life difficult''. They didn't, and the change of approach to policing would lay the groundwork for the next big step a decade later - the opening of the safe injecting room at Kings Cross.

''We needed to ensure that the police understood what it was all about, why it was there,'' says Hansen. ''That, of course, was even more critical when you considered people were arriving there in possession of illicit drugs.''

That combination of police intersecting with public health was part of Australia's success in dealing with the HIV epidemic - a recognition that by forcing drug users underground, they were placing them at much greater risk of infection by using dirty syringes and needles.

Almost three decades on, Hansen is leading a group of senior serving and former police officers who are trying to replicate that approach around the world, in countries where police still jail drug users and HIV infection is rampant.

Formed with the support of the Law Enforcement and HIV Network, based in Melbourne, this international police advisory group has underlined the notion that police can be a big barrier to HIV prevention, not only for injecting drug users, but for sex workers and men who have sex with men, and wants to change the approach of police everywhere.

Hansen brings a big reputation to the role, as former chairman of Australia's Intergovernmental Committee on Drugs, rising to the rank of superintendent before he retired in 2010.

The group had its inaugural meeting in Melbourne late last year, and from that came a statement of support for policies that reduce the harmful effects of drug use, such as HIV/AIDS.

More than 4000 serving and retired police from around the world have so far signed a petition urging a harm-reduction approach by police. It was presented to the United Nations Commission on Crime Prevention and Criminal Justice in Vienna in April.

The petition attracted some of the most familiar names in policing, including former Australian Federal Police commissioners Mick Palmer and Mick Keelty.

The delegation that presented the statement included police from Thailand, Ghana and Kyrgystan and, former Victoria Police officer Melissa Jardine, one of the co-ordinators of the network.

Nick Crofts, a director of the Centre for Law Enforcement and Public Health in Melbourne, and a long-time leader in the field, says the push by police to support harm reduction may not seem significant in the Australian context, where the good response to HIV has included partnerships with police.

''But when you step back from Australia and look at the global scene, it's enormously significant,'' he says.

It is that global scene that is a cause for concern. The extent of the problem was set out in a 2012 report by the Global Commission on Drug Policy, which argued that the war on drugs was driving the HIV/AIDS pandemic among drug users and their partners.

The commission is chaired by former US secretary of state George Shultz, who leads an eminent international panel which includes several former heads of state, former US Federal Reserve head Paul Volcker and businessman Richard Branson.

The report found that one-third of all new infections outside sub-Saharan Africa were occurring among injecting drug users.

Australia and several West European countries are singled out for their progressive approach. But the report is damning of those countries where a hardline approach on drugs is still being pursued.

''Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated,'' it says.

The report argues that mass incarceration of non-violent drug users also plays an important role in increasing HIV risk.

''This is a critical public health issue in many countries, including the United States, where as many as 25 per cent of Americans infected with HIV may pass through correctional facilities annually,'' it warns, noting that greater incarceration rates were a key reason for higher HIV rates among African-Americans.

Also singled out for damning criticism is the situation in Russia where, the report says, one in 100 adults are now infected with HIV.

The report quotes one young woman in Moscow talking about the fear caused by aggressive drug law enforcement.

''And not only fear of being caught, but fear that you will be caught, and won't be able to get a fix,'' she says. ''So on top of being pressured and robbed [by police], there's the risk you'll also end up being sick. And that's why you'll use whatever syringe is available right there and then.''

There is also deep concern about human rights abuses in compulsory drug detention centres in Asia. Human Rights Watch has identified the operation of these drug detention centres in several countries, including Vietnam, China, Cambodia and Laos.

The centres are the subject of a recent scathing report by UN special rapporteur on torture, Juan Mendez. ''Sometimes referred to as drug treatment centres or 're-education through labour' centres or camps, these are institutions commonly run by military or paramilitary, police or security forces, or private companies,'' it finds.

''In some countries, a wide range of other marginalised groups, including street children, persons with psychosocial disabilities, sex workers, homeless individuals and tuberculosis patients, are reportedly detained in these centres.''

Mendez finds ''rehabilitation'' included beatings, whippings, ''bread and water therapy'' and electro-shock treatment. He has called on governments to close compulsory drug detention and ''rehabilitation'' centres ''without delay'' and introduce voluntary health and social services in the community.

This broader world view provides some context to the work of the Hansen-led police advisory group and its message of a police strategy of harm reduction, specifically for the impact it can have on containing the spread of HIV. ''It's not like we've won the battle,'' says Crofts.

Crofts says Australia was for a long time a ''one out'' in the region.

''We were the only country in the whole of south and south-east Asia, really, that was driving the AIDS response.''

The battle was to get other countries to acknowledge that there was HIV among injecting drug users, or even that there were injecting drug users. ''It was a 10-year battle to even get harm reduction on to the agenda, '' says Crofts.

''Having got it on to the agenda, the next battle is now [to] bring about an effective multi-sectoral response. That's where we are now starting to make inroads.''

Jardine was hired as a researcher by Crofts, bringing to the job her recent hands-on policing experience combined with Vietnamese language skills and a masters degree in Asian studies.

She knows first-hand the inherent tensions in police seeing themselves in a public health role, rather than one of enforcing the law.

Jardine recalls arresting a drug user in a children's playground shelter, still with a syringe and blood on his arm. She charged him on summons, and sent him to court.

''There's not a really a huge amount of benefit in catching someone who had just used,'' she says. ''It probably jammed up the court system and didn't help him a hell of a lot.

''So diverting people into services is where things should go, because the police don't have the right tools to deal with drug addiction.

''But we have the opportunity to direct them into treatment.''

Jardine says that simply having a policy isn't always enough.

As a newly minted constable, she patrolled around a needle syringe exchange, because, she says, ''I thought it was a great place to catch criminals.''

That happened only once. She soon found out it was against police policy. It illustrates, she says, that while a policy exists, it doesn't necessarily mean everyone knows about it.

She cites the regular crackdowns around Footscray in Melbourne. Crime drops by a third for a couple of months. ''During that time, users stop accessing the needle and syringe programs, so it increases HIV risks that way.''

During one crackdown, users ended up using a needle exchange program in an adjoining suburb, which was so overwhelmed by the demand it had to close.

While the push for harm reduction has a strong base in Australia, it's important to recognise the international nature of the campaign, and the progress that's being made in other countries.

Police in Ghana have made big inroads with a harm reduction approach in dealing with sex workers. While sex work remains illegal, police have not prosecuted anyone for more than three years. In fact, they carry condoms in a ''holster'' on their belts.

''It's an amazing example of how police can use discretion even though the law is still there,'' says Jardine.

One of the delegates to the UN, retired police colonel Aleksandr Zelitchenko, has been recognised for his work in HIV prevention in the Kyrgyz republic, urging police to ''chase the big sharks who deal with drugs, not the small fish who are addicted to drugs''.

Jardine talks about the enthusiastic response the group received in Vienna, which is now taking an advisory role to the UN. Buoyed by the progress, she says: ''It's like a penny's dropped, and people who support harm reduction are realising that police aren't necessarily the enemy, they do have something to contribute and we should engage with them.''