Police obligations by law often contradict harm reduction objectives.

Police officers, in the course of their daily work, often encounter persons who use drugs and are required by law to arrest. This manual assists police and police cadet trainers refer to up-to-date materials on harm reduction, and to progress through sessions in a structured and comprehensive manner.

Harm Reduction Police Training Manual

Resources and Materials for Trainers in the Royal Malaysia Police

Fifa Rahman

Authorship Fifa Rahman, Policy Executive, Advocacy Department, Malaysian AIDS Council Zamzuri Abd Malik, Manager, Training Department, Malaysian AIDS Council For further information please contact: Malaysian AIDS Council, or email fifarahman@hotmail.com Acknowledgements

Content
1. Glossary 2. How to Use this Manual

Glossary
AIDS ART ARV ELISA GFATM HARM REDUCTION Acquired Immune Deficiency Syndrome Antiretroviral Therapy | Terapi Antiretorviral Antiretroviral Enzyme Linked Immunosorbent Assay Global Fund to Fight AIDS, Tuberculosis & Malaria Harm reduction in the context of this manual refers to a concept to reduce harms to persons who are dependent on drugs, persons who use drugs and persons affected by drug laws. Harm reduction may include any measures to prevent illness in drug users such as needle-and-syringe exchange programs, or measures to reduce harms incidental to or resulting from chronic drug use, such as psychosocial therapy and social services. Hepatitis B Virus Hepatitis C Virus Human Immunodeficiency Virus Injecting Drug Users Malaysian AIDS Council Malaysian AIDS Foundation Methadone is an opioid substitute that mitigates opioid withdrawal symptoms. Men who have sex with Men Mother-to-child Transmission

HBV HCV HIV IDU MAC MAF Methadone

MSM MTCT

NSEP PEP PLHIV PO STI STD TB UNAIDS UNGASS VCT WHO

Needle Syringe Exchange Program Post Exposure Prophylaxis People Living with HIV Partner Organization Sexual Transmitted Infection Sexual Transmitted Disease Tuberculosis | Batuk Kering Joint United Nation s Program on HIV/AIDS United Nations General Assembly Special Session on HIV/AIDS Voluntary Counseling and Testing | Ujian dan Kaunseling secara sukarela World Health Organization

How to Use this Manual

This manual is intended to provide information and comprehensive training to police and police cadets on harm reduction and rights-based drug policy. It is carried out in an interactive and fun manner to ensure that participants actively take part in discussion and workshop activities, and is designed so any conflicts between harm reduction and drug laws can be ironed out in a conducive manner. Training in this manual should not be carried out in the form of lectures, although short explanations should be given. It should be carried out in a workshop manner with interesting activities with plenty of opportunities for participants to engage with trainers. Due to the fact that this manual is written for police and police cadets, the trainer must keep in mind the background and experience of the participants. Mid- to high-level police officers are likely to have had many drug arrests under their belts, for example. Police stationed in stations and police in charge of lock-ups are also more likely to have had increased contact with persons arrested for drug offences. The trainer should use appropriate language and salutations in each exchange and activity. The trainer must ensure that workshop materials are updated and relevant to current harm reduction practices. The trainer should also be aware of potential concerns or conflicts that police might have with harm reduction. All facts and figures should be accurate, and training should be in line with the most recent police standard operating procedure on harm reduction. The trainer must keep up-to-date with recent reports, statistics and documents related to harm reduction. This is to ensure that the Trainers are more convincing and hence interest participants to take part actively in discussion. It is also useful for trainers to be aware of reasons why police at the top-level is supportive of harm reduction, and how harm reduction and rights-based drug policy can allow them to focus more on large scale trafficking, and increase job satisfaction. In addition to that, the trainer should have a passion for harm reduction and welfare of individuals affected by harm reduction policies and drug laws.

Executive Summary
Harm Reduction Police Training Manual This manual contains information and key materials required for the understanding of harm reduction and how police practice and obligations by law may be balanced with harm reduction activities.

Basics 1) What is harm reduction? - Treatment, needle-and-syringe exchange programs, methadone, social services, anything that reduces harms caused by drugs. 2) HIV/AIDS 101 3) Methadone maintenance therapy 4) Needle-and-syringe exchange programs 5) Police Standard Operating Procedure 6) Proof of efficacy overseas - Examples of police support of harm reduction programs - Reasons why police support harm reduction programs - Statistics showing reduction of communicable diseases, crime rates, better employment rates, reduction in homelessness and overdose deaths 7) Alternatives to punitive practice After the training, participants should be able to: 1) Understand that persons who use drugs face significant discrimination and other obstacles that can impede harm reduction objectives. 2) Understand how HIV/AIDS and Hepatitis C is transmitted and how they are prevented. 3) Understand why the role of police is paramount in assisting to reduce drug-related harms. 4) Comprehend police support of harm reduction elsewhere. 5) Know statistics on reduction of crime and increase in health outcomes caused by positive harm reduction efforts. 6) Understand possible future directions in Malaysian drug policy.

Logistics and Training Administration

Training Rooms Characteristics of suitable training rooms are as follows: 1) 2) 3) 4) 5) 6) Carpeted Air-conditioned No pillars or other obstacles in the middle Projector on the ceiling Projector screen on the wall in front of the projector Brightly lit

Room arrangement

Training Plan
INTRODUCTION
Objectives To open the session To get the participants into the right mind set Procesess 1. Tell the Officers why the Training Program exists and why it is important. 2. You should include: a. Officers have many roles and there job is difficult. b. Officers can play an important role in helping to reduce or prevent the transmission of infections such as HIV/AIDS. c. At the same time as helping to prevent HIV/AIDS they do not have to spend any less time or resources on preventing and investigating burglaries, robberies, muggings, etc. They can still track down and arrest people who are committed crime such as burglaries and robberies. d. It is most likely that by implementing strategies to reduce HIV/AIDS from Injecting Drug Use, their time and job satisfaction will increase. e. Police are busy and have limited resources. They usually use these resources wisely by concentrating on those criminals that cause the most harm to the community. They do this by concentrating on tracking down and arresting those criminal who cause the most harm in the community. f. There is a lot of interest in this country and in other countries in strategies that Police can use to help prevent the transmission of HIV/AIDS among and from Injecting Drug Use. There is also a lot of interest in what strategies are ineffective. In any case, Officers deserve to know what Police strategies are effective and how to use them. g. This Training Program is designed to help you support effective strategies. It is understood that Officers will not necessarily be able to simply support or implement strategies immediately. 3. Explain the way the trainings will be conducted a. Interactive lecture b. Sharing c. Small group activities d. Presentations e. Videos

4. Tell the Officers that there is no need to take notes and inform the Officers about whether they will be receiving the Hand outs (Trainee Resource Kit) 5. Before we start this first Topic, are there any questions? a. Allow the Officers to ask some questions as this makes Officers feel that they are valued and can help them be more interested in the material you are presenting. If someone asks a question, thank them for asking it. 6. If the questions can be answered immediately and are not too involved, answer them now. 7. If the questions will be answered by the material you are to present, inform them of this. 8. If the questions are on some issue that is not to be covered, inform them and take note of the questions. If you are able to help the Officer later or can direct the Officer to somewhere where they can find the answer, do so.

TOPIC 1: What is Harm Reduction?

Objectives 1) As basic preparations for participants to understand activities during the workshop. 2) To define what harm reduction is. 3) To give a basic picture of how harm reduction has many positive effects. Processes 1) 2) 3) 4) 5) 6) To welcome participants To introduce trainers To explain the objective of the entire course To explain what harm reduction is. To give examples of harm reduction modalities. To explain history of harm reduction in Malaysia (to show when it was endorsed by government and which organs endorsed it) 7) To show statistics of positive effects of harm reduction. Time 30 minutes Training Materials What is Harm Reduction? Slides Apparatus
Projector Projector Screen Table for projector (if projector is not connected to the ceiling) Amplifiers AV cables Wireless microphones

TRAINERS NOTES Slide Slide No 1 Trainers Note

The need to be sensitive It is important to take into consideration that many people can have some difficulty discussing issues such as infection and sickness, sexual activity, and drug use. Also some people can have very strong opinions about them. Some people have had family members, relatives, neighbours, and friends affected by HIV/AIDS and drugs. Perhaps some of your work colleagues and the Officers in your class have had friends and family affected by HIV/AIDS or drug use. The need to cope with strong opinions The Trainer has to be prepared for a variety of opinions among the Officers. Most Officers have had many experiences dealing with Injecting Drug Users. Some of these experiences will have been positive but many will have been negative. These experiences should be treated as a benefit to the delivery of the Training Program rather than a problem. However, sometimes it can be quite disruptive if a person has a strong opinion and continually expresses it. The Trainer needs to use his or her skill to encourage the Officers to speak and discuss the issues but also needs to use their skill to ensure that the Officers do not disrupt the delivery of the Training Program or start talking about issues which are not relevant to the Training Program.

TOPIC 2: HIV/AIDS 101

Objectives 1) To introduce what is HIV/AIDS 2) To explain modes of transmission of HIV/AIDS 3) To give an overview of HIV/AIDS issues, including role of antiretrovirals in treatment of HIV/AIDS patients

Processes 1) 2) 3) 4) Explanation of what is HIV/AIDS Modes of transmission Pictures of persons living with HIV to help destigmatisation amongst participants Describing HIV/AIDS issues - that persons need to take their anti-retroviral medicines at the same time every day (to be considered by police when detaining a PLHIV in lockup) - Stigma as a barrier

Time 30 minutes Training Materials HIV/AIDS 101 Slides

TRAINERS NOTES Slides/Training Materials Slide No Trainers Notes

The Trainer welcome the participants to the session. Inform the participants this is the basic session on HIV and AIDS and appreciates the participants participation by asking questions or giving comments on the subject.

Pre Test

Start the session by distributing the Pre Test Questionnaire. Give the participants 3 minutes to answer all 20 questions.

Inform the participants that the Trainer would like to start the session with a clip on HIV and AIDS. Play the clip.

Inform the participants that according to research 20% of the workforce (and this may include the participants) do not know that they are infected.
3

Ask the participants whether they know what HIV is. Look at their respond. Explain that H I V stands for Human Immunodeficiency Virus.

Explain the basics of HIV, bodily fluid and ways of transmission based on the slide

Explain that we are going to be infected if we are kissing unless like the picture. This is because there is blood involve.

Play the clip that shows How HIV Enters The Body.

Explain the three main modes of trainsmission as per slide.

Explain what is AIDS.

8

Syndrome at the end of the acronym means group of diseases.

Explain what is opportunistic infections.

Explain:
As of 2009, there are 35.9 PLHIV across the globe. The highest number of PLHIV are in Sub Saharan Africa. Malaysia is in the South and South East Asia region and with 4.2 Million people infected, this region is number 2 in the world.

10

Note:
It is very important for the Trainer to know which number to pick up and explain. Explaining all the number might bored the participants. Please pick on or two facts that is important or interesting to share.

11

In Malaysia the highest state is Selangor, Johor and Kelantan.

12

Inform the participants, since 2007 there has been a decrease of 11% in new infection in Malaysia.

13

Script : In previous years we have seen thaht the main reason why Malaysian get HIV is through sharing needles. In 2010 however, the trend shifted. Now the main reason Malaysian is infected with HIV is through unprotected sex.

Explain prevention.
14

Do a condom demonstration with Male and Female condom.

15

Explain the 2 types HIV Screening. The Rapid Test and Lab Test. Also explain the window period.

16

Explain the Highly Active AntiRetroviral Therapy or HAART.

17

Ask the participants, out of all these women on the slide, who is positive. Ask them to point to 1 and ask them why.

The fact of the matter is all the women in the picture are positive. Explain that what they think of somebody else is what we call stigma. When stigma turns into negative action that is discrimination.

18

Note:
Trainer can share stigma and discrimination cases that he/she knows based on experience.

Play Ellas clip. Explain that Ella has been discriminated before but now she is working with MAC and always running around giving awareness talk to public. Hightlight :
19

1. Ella is a positive single mother with 4 negative children 2. Ella proved that being positive, with proper treatment, she can continue living her life like everybody else. 3. What PLHIV need is support from the society.

Ask the participants if there is any questions.

20

If not, distribute the Post Test for the participants to answer

Ask the participants to tick their answers. Write down their mark at bottom right of the Pre and Post Test Questionnaire.

21

Note:
It is highly encourage that the trainer prepare some token to the participants who score the highest for the Post Test.

TOPIC 3: METHADONE MAINTENANCE THERAPY

Objectives 1) To explain what methadone is. 2) To increase understanding on therapeutic and social benefits of MMT 3) To discuss police roles in supporting MMT Processes 1) Explaining what methadone is, when it began, and the number of clinics providing MMT services. 2) Acknowledge that there are some defects in the system i.e. individuals take methadone with other drugs, private doctors are selling methadone, but full therapeutic effects can be seen where proper treatment and dosage is given. 3) Providing proof that MMT and other OSTs reduce criminality and improve health outcomes. 4) Dispelling myths about MMT 5) Asking participants how they feel they could support MMT, and unearthing obstacles that they face in supporting MMT

Time 30 minutes

Training Materials Methadone Maintenance Therapy Slides

TRAINERS NOTES SLIDE SLID E NO 1 TRAINERS NOTE

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

TOPIC 4: NSEPs

Objectives

1) To explain what NSEPs are. 2) To explain role of NSEPs in preventing infectious disease, and getting injecting drug users in touch with health practitioners and other positive influences. 3) To discuss police roles in supporting NSEPs

Processes 1) Explaining what NSEPs are and when they began. 2) Dispelling the myth that NSEPs encourage drug use. 3) Emphasising that NSEPs allow injecting drug users to get in touch with health practitioners and positive influences. 4) Show statistics on HIV seroconversion rates. 5) Discussing how police can support NSEPs.

Time 30 minutes

Training Materials NSEP Slides

TRAINERS NOTES Slides/Training Materials Slide No Trainers Notes

Dispel the prohibitionist myth that NSEPs encourage drug use. Explain that with or without clean needles, individuals undergoing withdrawal symptoms will inject regardless, and the objective of harm reduction is to reduce the harm of injecting drugs.

TOPIC 5: POLICE SOP

Objectives 1) To explain the Police SOP to participants

Processes 1) To explain why police cooperation is necessary to assist in achieving public health objectives. 2) To explain that certain areas should not be targeted solely because they are places for return of used needles. 3) To describe possible interactions between Police and NSEP Managers/Outreach Workers 4) To explain the possibility of the exercise of discretion when in contact with an individual about to return used syringes.

Activity Roleplay activity outreach worker Time 30 minutes Training Materials Police SOP Slides

TRAINERS NOTES Slide Slide No 1 Trainers Note

Explaining Guideline 4: That unjustified surveillance by police may discourage individuals from accessing harm reduction services, and that police should use their discretion and limit activity in NSEP areas. Explaining Guideline 6: That NGOs should inform police of outreach areas, and that police should not act in a way that would discourage individuals from disposing of needles-andsyringes safely.

TOPIC 6: PROOF OF EFFICACY OF HARM REDUCTION PROGRAMS

Objectives 1) To show evidence of benefits of harm reduction programs locally and elsewhere, including: (a) Reductions in Crime (b) Reductions in Annual Seroconversions (c) Reductions in Overdose Deaths (d) Increase in Overall Health

Processes 1) To describe objectives of harm reduction. 2) To display statistics that prove that harm reduction does achieve positive results in regard to public health and reduction in crime.

Time 15 Minutes Training Materials Efficacy of Harm Reduction Slides

TRAINERS NOTES Slide Slide No 1 Trainers Note

Explain that the reduction in crime in Switzerland was brought about as a result of comprehensive harm reduction and treatment facilities.

TOPIC 7: ALTERNATIVES TO PUNITIVE PRACTICE

Objectives 1) To explain alternatives to incarceration- and caning-based policy 2) To explain benefits of these alternatives.

Processes 1) To emphasise that incarceration has not worked to reduce drug use, and has increased drug-related harms. 2) To explain diversion and decriminalisation in different countries. 3) To dispel the myth that these methods only work in Western countries.

Time 30 minutes Training materials Alternatives to Punitive Practice slides

TRAINERS NOTES Slide Slide No 1 Trainers Note

Explain several types of diversion, eg. in New Zealand the arrestee signs an agreement with police to attend treatment/harm reduction services. If the agreement is breached, the individual faces incarceration. In New South Wales, police give a potential arrestee referral information about treatment and harm reduction options pre-arrest. Explain what decriminalisation is. Distinguish decriminalisation from legalisation. Emphasise that where the person is arrested for drug possession below a certain amount, he is sent to a body called the Dissuasion Commission which arranges for treatment/harm reduction services.

Explain the effect of decriminalisation in Portugal, that drug injection rates have gone down, HIV infection rates have greatly reduced, and overdose deaths have reduced.