“In the Name of Creating Drug Free Society”: a Qualitative Investigation on Implications of Drug Law Enforcement on Harm Reduction Programs and People Who Inject Drugs in Kathmandu Valley, Nepal

Abstract

Background: A polarized approach to drug use endures in Nepal. The Ministry of Home Affairs (MoHA) enforces criminal drug law to create a drug free society, while the Ministry of Health and Population (MoHP) advocates and endorses harm reduction policies to reduce drug-related harms, HIV and other BBI epidemics.

Methods: This study employed qualitative methods to explore the implications of drug law enforcement as possible barriers to accessing harm reduction services, human rights violations and risky behavior among PWID. In June 2016, 28 in-depth interviews were conducted with four distinct population categories [Policy level (1), national HIV program level (7), harm reduction service delivery level (5) and community level (15)]. A maximum variance sampling technique - strategy for purposeful sampling aimed at capturing and describing the central themes that cut across a great deal of variation was applied.

Results: Drug laws provided ultimate power to law enforcement authorities and concomitant fear to PWID. Abuse of such power resulted in range of human rights violations, including sexual harassment, brutal torture and financial hassle, in part due to a nexus between some field authorities and drug rehabilitation providers, and increased barriers to accessing harm reduction services as well as increasing risky behavior practices among PWID. Law enforcement was associated with high drug price, which often were associated with delinquent activities and risky behaviors. Findings suggested that most of the law enforcement related impediments were occurring due to lack of awareness, and failure in flow of information within government agencies and law enforcement authorities, and good monitoring and governance. Knowledge of harm reduction services resulted in changes in law enforcement activities, such as referrals and service intake while in custody.

Conclusion: Consistent coordination, monitoring mechanisms and education for law enforcement authorities should be initiated as an immediate response to improve the dire situation of PWID. However, the long-term health development of PWID cannot be envisaged without favorable policy and law reform around age of consent, appropriate police academy curricula and drug control law that recognizes public health implications, human rights and evidence-based harm reduction approaches, and a participatory process.