Case study: Methadone maintenance treatment in Hanoi, Vietnam

Methadone maintenance therapy (MMT) was introduced in the rapidly developing semi-rural district of Tu Liem in Hanoi in December, 2009. Located at the District Health Centre, the MMT program complemented a variety of other HIV prevention services being offered including the distribution of clean needles, syringes and condoms, as well as HIV testing and counselling and peer education for people who are at higher risk of HIV transmission, specifically injecting drug users (IDUs). Initially, only 15 IDUs were permitted to commence MMT in 2009, but by March 2012, the MMT program had expanded to include 250 clients. Health centre staff hoped the program would be expanded further.“The commune police are the most important because they directly monitor, filter and choose which IDUs will be selected for the MMT program” (District Health Centre staff)The role of commune police in drug law enforcement conflicts with their legislated role in referring IDUs to MMT. Police in Vietnam have to meet annual quotas of IDUs sent to compulsory detention centres. Commune police reported that these quotas were becoming more difficult to meet following the introduction and expansion of MMT in Tu Liem. Whilst police from both the district and commune level regarded the overall responsibility of the MMT program to be of the Ministry of Health, the commune police are firmly linked to the processes surrounding MMT accessibility for IDUs because it is their role to compile lists of IDUs who are eligible for MMT.District Health Centre staff reported that commune police were the most crucial to the MMT program because they acted as a ‘filter’ in determining who is not only permitted to commence, but continue, using MMT. The filtering process is carried out by commune police in a number of ways. Initially, commune police distinguish between ‘good’ and ‘bad’ IDUs (the distinction is described further below) and compile a list of those eligible for MMT. The commune police influence selection for MM