A critical exploration of professional perceptions of harm reduction policy and practice in Vietnam

Throughout the 1990s, Vietnam experienced a dramatic rise in the prevalence of HIV among people who use drugs. In response, Vietnam’s Ministry of Health implemented several legal and policy interventions in the name of harm reduction. However, perceptions about drug use, people who use drugs, addiction and the nature of official interventions are contested. For many Vietnamese officials, abstinence remains the dominant philosophy. Drug use is considered a ‘social evil’ in Vietnam and people who use drugs face draconian controls and incarceration in the name of treatment and crime prevention.  Against this background, this thesis explores how key stakeholders perceive harm reduction philosophy and how they apply it in policy and practice. Based on qualitative and quantitative methods, it presents findings from a survey with 250 respondents and 26 semi-structured interviews, all with professionals involved in responding to drug use in Vietnam. The thesis illustrates that these professionals prefer abstinence approaches, and often see addiction as the result of moral failings and brain diseases.  While some interventions in the name of harm reduction are accepted, they are firmly rooted within a narrow public health perspective. Professional misperceptions about the key principles and practices of ‘authentic’ harm reduction are widespread. Many professionals believe, for example, that harms can only be limited through reductions in the demand and supply of drugs, or that detaining people who use drugs in compulsory treatment centres is a form of harm reduction.  These rationales have resulted in continuing police crackdowns, and the use of ‘pseudo’ harm reduction strategies to control and punish people who use drugs. Meanwhile, there are limited official attempts to address problems experienced by people who use drugs, like social isolation, stigma, discrimination, human rights violations, or problems of community reintegration. In conclusion, while a harm reduction rhetoric is regularly employed in Vietnam, ‘pseudo’ harm reduction strategies are carried out.