Tag: prevention

Drug Court sending addicts to jail after detox centres reach capacity

With government detox facilities at capacity the Drug Court is sending addicts to jail in the interim, prompting the Maldives’ National Drug Agency to call on private businesses and NGOs to fill the gap.

Twenty-four men have been sent to prison for 90 days, or until space becomes available for treatment, in accordance with the Drug Act which states the court has the authority to do so if “rehabilitation centers are unable to facilitate treatment”, according to local media.

All emergency medical detox centers are full nationwide – the Himmafushi Island, Villingili Island, Fuvamulah and Addu, National Drug Agency (NDA) Chairperson and State Health Minister Lubna Mohamed Zahir Hussain confirmed to Minivan News today (May 1).

“Rehab is not full, however detox is full for the next 14 days. Demand is so high that clients are waiting in prison,” said Zahir.

“The Drug Court is sentencing too many people every day. There are so many – too many – cases. The court doesn’t want to delay sentencing, so people eligible for rehab must wait in prison – for a maximum of three months,” she added.

Zahir stated that 24 men currently in jail – awaiting the first phase of rehab, which is detoxification – will be moved to the drug rehabilitation center on Himmafushi island within two weeks. No women are awaiting detox, claimed Zahir.

“We are calling for help”

Zahir emphasised that current government regulations allow for the privatisation of rehabilitation centers and the NDA has requested bids for private companies in the government gazette, however no applications have been submitted thus far.

“We are looking forward to receiving applications. It’s time the government opened international bidding to do so,” declared Zahir.

“[The NDA] is open for discussions about opening a rehabilitation resort. A similar program to cabins in Chiang Mai, Thailand, which is a really good program.

“For example, foreigners can come to the island destination [for drug rehabilitation], the profits of which could be used to subsidise treatment for Maldivians,” Zahir explained.

The private rehabilitation centers would be supplementary to the national treatment center for men and women, which is required by law, according to Zahir.

She also highlighted the need to strengthen aftercare programs in partnership with local communities. This is a particular challenge for NGOs who are working with drug addicts.

“Communities fail to understand the work NGOs are doing with drop-in clients. Awareness and education are needed, because NGOs are running into lots of problems with communities,” said Zahir.

Political polarisation and the focus on the upcoming presidential elections seems to be preventing this work from occurring, claims Zahir.

“It is easy [for NGOs] to apply for and get community [drug] rehab licences to conduct relapse prevention. And we are really calling for help,” she implored.

NDA has also issued requests for qualified people to apply for councillor positions with NDA to support their outpatient community rehabilitation programs.

There are between 200 and 400 clients, but very few councilors, Zahir explained.

Facilities lacking

The limited space within the Himmafushi rehabilitation center becomes available on a revolving basis – as clients complete their treatment – however capacity to conduct the three day emergency medical detoxification is extremely restricted.

The Himmafushi center has space to detox about 20 people at any given time, however it only has the capacity to manage about 10 individuals. The center is able to conduct drug rehabilitation for 150 men and 12 women maximum. Additionally, 12 detox spaces are available on each of the islands of Villingili, Fuvamulah and Addu.

“Two years ago we used a detox dorm for women on Himmafushi, however they were shifted to the female specific unit established on Villingili June 26, 2011,” explained Zahir.

“The NDA and Gender Department – under the Health Ministry – ran the rehabilitation center for women on Villingili. But it was closed in 2012 when the Gender Department became the Gender Ministry and took over the building.

“We requested from [former Gender, Family and Human Rights Minister] Diyana Saeed to keep center. Demand is high, we need a unit always,” she added.

Subsequently, women in need of drug treatment did not have a center for seven months until the original female dorm located on Himmafushi was reopened.

The NDA is planning to add three additional units to the Himmafushi drug treatment center and had requested government funds for the project, according to Zahir.

“NDA lacks implementation capacity”

“Drug abuse is too much money for the government to bear, because the problem is so wide-spread and the cost is so high,” an expert in holistic drug prevention, treatment, and aftercare told Minivan News today.

“The government is doing almost nothing for drug prevention, which then puts a huge burden on the government, including the public health sector. There is also a dire need for early intervention,” claims the source.

“NDA lacks the capacity and staff to do everything. They are not able to handle prevention, inpatient or outpatient treatment. Currently, they do not even have a CEO and are operating outside of the law,” the source continued.

“NDA should act as a governing body and watchdog only. Otherwise they cannot handle the demand,” added the source. “There is only one rehabilitation centre and it’s always full because there are so many people in need.”

The source suggested that the state-run detox and treatment centers should be outsourced to private or civil society institutions, leaving room for the NDA to oversee and regulate. Additionally, building NGO capacity to address drug abuse would “benefit the entire nation”.

“There is no one to monitor and make them responsible if NDA is the implementing body,” said the source.

A “clear cut” country strategy – similar to the recently released 2013-2020 European Union drug strategy – needs to be developed in the Maldives, the source believes. The entire sector in Maldives works at cross-purposes and is not aiming for one particular prevention, treatment, or aftercare goal.

“Addiction is a lifelong chronic, relapsing brain disease. A person will relapse six to eight times or more before they completely stop using and live a sober life,” explained the source.

“Relapse is not failure, rather it’s due to the treatment program or person lacking some kind of support. Addiction is a very complex disease and affects each person differently.

“Often addiction is accompanied by another disease, such as depression or other mental health issue, but treatment in the Maldives does not address this. Thus, people relapse easily, which adds to the stigma surrounding drug users.

“This concept needs to be internalized in the Maldives and a continuum of care must be provided. This includes environment based intervention, evidence based and client focused treatments, as well as continuing guidance, education and support programs,” said the source.

The source further recommended referring to the US National Institute on Drug Abuse to structure these programs.

“The government spends so much money and this is such a small place, they should be able to do something,” concluded the source.

Nationwide drug abuse controversy

The United Nations Office on Drugs and Crime (UNODC) and NDA published a survey in February, claiming there are 7496 drug users in the Maldives.

Informed sources who participated in the survey process previously expressed serious concerns about the “flawed methodology” of the data collection process, which they claimed had produced a final report that inaccurately and grossly underestimates drug use in the Maldives. Key populations such as those in jail, women, and users of ‘party drugs’ were left out of the survey.

The NDA subsequently refuted criticisms over the drug report’s methodology in a letter sent to Minivan News.

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Maldives identifies “first” child HIV infection

Senior health figures have called on the government, NGOs and members of the private sector to help step up attempts to promote AIDS prevention in the country after authorities discovered that a two year-old child had tested HIV positive earlier this year.

While accepting that HIV infection rates remained relatively low in the Maldives, Minister of State for Health Lubna Zahir Hussain said that efforts needed to be increased across all sectors of society to tackle attitudes towards high-risk behaviours that allow the virus to be transmitted.

Lubna heads the National Drug Agency (NDA). Her comments followed the hosting of a special NDA workshop on HIV prevention held on December 1 to commemorate World AIDS Day. The workshop was focused particularly on the HIV infection through drug abuse.

Though statistics indicate HIV infection rates have been limited in the Maldives over the space of the last two decades, health officials in the Maldives have begun to raise concerns about the risk of cases spreading across the country.

In October Minister of Health Dr Ahmed Jamsheed Mohamed claimed it was only through “incredible luck” that HIV had not spread across the Maldives, considering the prolific levels of unprotected sex and intravenous drug use.

Addressing concerns raised by Health Minister Jamsheed about the potential scope for HIV to spread beyond high-risk communities such as drug users, Lubna said greater effort was needed to address attitudes of the general public to the spread of the virus.

“I think what the health minister was saying is that it is not only people living bad lifestyles that are at risk [of HIV infection],” she said, reiterating concerns about the number of young people engaged in intravenous drug use and potentially dangerous sexual practices.

She spoke about a child who was suspected of having been infected from her mother at birth.

“We were first made aware of the case in April 2012 and as far as I know, this is the first case [of a child in the Maldives being born HIV positive],” she said. “However, I think it is important for the public to know the reality of the situation right now, whilst respecting [the child’s] privacy and well being.”

Lubna said she was ultimately encouraged by the work of the country’s health authorities in trying to address the HIV risk from national attitudes towards sex and drug use in the country, yet warned against complacency.

“This doesn’t mean that we continue to work at this pace to try and address attitudes towards AIDS and its spread,” she said.

Lubna called on civil society, the business community and government to speed up efforts to hold awareness and education events about the dangers posed through unprotected sex and intravenous drug use, and to promote preventative measures to reduce the national HIV risk.

Attempts have been made to work with local drug NGOs such as Male’-based Journey on running special outreach programs and blood tests to try and monitor and manage infection rates.

However Lubna said that drug use was not the only area of concern in trying to curb HIV infection.

“Prostitution is another area that needs to be looked into. Awareness work in this area needs to be seen immediately,” she said.

She said greater awareness was needed not just among the general public, but by government authorities and law enforcement agencies.

First Lady’s concerns

During the NDA workshop, First Lady Ilham Hussain stressed that growing numbers of the country’s youth were subjected to dangerous habits that could potentially lead to HIV infection.  She highlighted recreational drug use in particular as the leading cause of the virus spreading nationally.

“Incredible luck”

Speaking earlier this year on the issue of HIV infection rates, Health Minister Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

“What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire,” he said at the time.

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.

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Addicts, dealers and NGOs: dealing with drugs in the Maldives

A coalition of local NGOs conducted a workshop yesterday to review new drug laws proposed by the government.

Ahmed Adam, chairperson of drugs NGO Journey, said drug abuse was a “national issue” that urgently required a solution.

”We wish the MPs would cooperate with us hope they do not think this bill was politically motivated,” he said.

A number of participants at the workshop expressed concern about the difficulty they had reaching MPs. Adam said MPs had not even attended meetings to discuss the bill despite numerous invitations.

Among the NGOs represented at the workshop were Journey, Hand to Hand, Maldivian Detainee Network and Transparency Maldives.

History of drug use

Adam, a recovered drug addict, spoke briefly about the history of drug use in the Maldives.

Historical documents that reveal travellers who visited to the Maldives in the 16th century observed opium being used inside the palace, he said.

Moreover, in the 18th century, Indian traders introduced cannabis to the country.

”In 1972, with the advent of tourism in the country, most people started smoking grass,” he said.

The government was only alerted to what was happening much later, he added.

Adam said ‘brown sugar’, the low-grade heroin that is prevalent in the country, was introduced after the mass arrests of marijuana users in the early 90s.

A drug centre was established for the first time in the Maldives in 1997.

NGOs discussion

The discussions at the workshop focused on both the reasons why people get hooked on drugs and methods of prevention.

NGOs were divided into four groups and together discussed the drug epidemic and ways to solve it.

Among the factors identified that drove people to drug use were parental neglect, congestion and lack of privacy and space at home that draws children out to streets, peer pressure, lifestyle decisions as well as lack of job opportunities and proper role models.

The NGOs argued in favour of categorisation of drugs in the bill and called for the introduction of different methods and models for treatment apart from the existing therapeutic community (TC) model.

TC was not adequate for all types of drug addicts, they insisted.

While drug smuggling could be prevented by imposing penalties on customs officials suspected of accepting bribes, higher penalties should be imposed on convicted drug dealers, they agreed.

Drug traffickers and money they earn

Minivan News spoke anonymously to an individual who divulged information on drug trafficking in the Maldives.

He claimed that he sold drugs because he felt “pity for the sick people” [drug addicts] and did not want “to isolate them from society.”

He added that he did not face “any trouble” in attracting customers.

”If we sell good quality stuff to one person, he will go and tell his friends that we have good stuff and they also will start buying from us,” he said.

He claimed to earn “at least Rf15,000 every day” (US$1167) selling drugs, approximately Rf465,000 per month (US$36,186).

”Everyday one person will buy at least three to five packets, sometimes people from the islands come and buy 40 packets also,” he said, claiming that each 0.03 gram packet (of brown sugar) cost Rf100.

Almost one or two kilograms were smuggled into the country at a time, he explained.

The rise in crime was because drug addicts needed to feed their addiction, he said.

“All gangs are operated by people and money. Gangs earn money by selling drugs. If someone gets stabbed also the gangs would provide them with medication and financial assistance.”

Moreover, he said, “gangsters” would not have any source of income without dealing drugs.

“Real drug dealers” meanwhile, do not use drugs themselves, he said. The drug of choice for Maldivian youth was brown sugar, he added.

“There’s also hash oil, ‘white stuff’ and Charas [resin from the hemp plant] also in the market.”

While more treatment facilities and job opportunities should be offered to combat drug addiction, he said, ”drug dealers should be stopped first, but [the government] can never do that. Drug dealers are assisted by high-profile people in the country,” he said.

“First, they should figure out who they are and stop them, then come after the drug dealers. Then there will be no drug abusers in the country.”

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