Taing Phoeuk, the Khmer-American director of Korsang, glumly brushed the ash from his cigarette on a restaurant balcony overlooking Sihanouk Boulevard. “It’s going to kill us,” he said, contemplating the prospect of his organisation’s demise as its USAID funding evaporates.
Founded in 2004 by American Holly Bradford and a handful of Khmer-American returnees, including Phoeuk, Korsang provides drug users in Phnom Penh with health and counselling services – known as harm reduction. The organisation’s goal is to mitigate the effects of drug abuse, while also lowering users’ risk of contracting and spreading HIV.
For years, Korsang’s team has been one of the few on the ground working one-on-one with users. But a cut in USAID funding, ironically because the total number of Cambodians living with HIV has fallen, is putting its existence in jeopardy and straining other harm reduction organisations.
Last February, Khana, an NGO that specialises in HIV prevention and serves as Korsang’s “flagship” organisation, learned that Korsang would stop receiving USAID funding in 2018.
All of Korsang’s annual budget of approximately $100,000 comes from USAID, said Choub Sok Chamreun, Khana’s director. The cut is quite separate from dramatic proposed cuts leaked in US government documents last week.
Currently, Korsang provides services to 360 drug users. About 80 of these individuals suffer from HIV.
Through Korsang, this population of drug users has access to counselling and needle exchange programs, HIV testing, methadone therapy and antiretroviral treatment. Korsang also runs a drop-in-centre that offers a place to sleep, shower and get information on the services available to them.
According to Sok Chamreun, USAID’s decision to stop funding Khana’s on-the-ground activities is linked to a decline in the prevalence of HIV in Cambodia.
According to a Cambodia Country Progress Report submitted by the National AIDS Authority (NAA) in 2015, HIV rates declined from 2.0 percent of the general population in 1998 to 0.7 percent in 2013. In 2015, UNAIDS placed the prevalence of AIDS among Cambodia’s general population at 0.6 percent.
“The funding now is streamlined, is becoming smaller,” Sok Chamreun said, adding that grants for “service delivery” – in other words, the hands-on, street-level outreach – are no longer available.
US Embassy spokesman Jay Raman declined to comment on the reasoning behind the USAID cuts or their potential impact on harm-reduction services in Cambodia.
David Harding, an independent drug expert with a focus on Cambodia, emphasised that although overall HIV prevalence in Cambodia has subsided, the country still faces a “concentrated epidemic” among injecting drug users.
According to the NAA report, a 2012 survey found that nearly a quarter of people who inject drugs had HIV/AIDS.
A shrinking pool
For Harding, Khana and Korsang’s funding woes are part of a wider trend of disinterest and diminishing financial support.
Because harm reduction services require organisations to connect with people involved in criminal activities, he said, very few want to take on the political risks.
“Cambodia is a society with many NGOS and just a few have involved themselves with people using drugs,” Harding said.
Korsang’s history speaks to these risks. In 2010, the government declined to renew Korsang’s licence for needle distribution after the organisation refused to allow the National Authority for Combating Drugs (NACD) to enrol its clients in a controversial detoxification programme involving a Vietnamese herbal remedy called Bong Sen.
The incident resulted in Korsang founder Bradford’s departure from Cambodia.
While Korsang’s financial pressure coincides with a discussion in the United States about foreign aid and proposed cuts under the Donald Trump administration, it is part of a long-term shift away from harm-reduction services.
Apart from USAID, the Global Fund also provides funding to Khana but it does so from money left over from previous years. Funding Khana used over the last two years came from savings from a previous grant round.
Alongside other service providers, Khana intends to apply for additional funding from the Global Fund, but with USAID out of the picture, that pool of money may be spread thin. It may also be Korsang’s last hope.
James Sutherland, the communications coordinator for Friends International, which partners with harm reduction provider Mith Samlanh, expressed concern about the cut to USAID funding for Korsang, saying the resulting loss of services would require more funding for Mith Samlanh to fill the gap. “To maintain a good level of services, there will have to be alternative sources of funding as of course [Mith Samlanh’s] resources face funding challenges too,” he wrote.
The drug crackdown
The pressure on harm reduction services coincides with an ongoing government campaign to crack down on drug use. By the end of April, according to National Police figures, the campaign yielded more than 7,000 arrests, and as of April 18, 31 of Korsang’s clients had been arrested.
Many others, according to Phoeuk, have avoided arrest by going into hiding, which has complicated efforts to help them.
Asked about the impact of Korsang’s potential closure, Meas Vyrith, the secretary-general of the NACD, said that while it would negatively affect the organisation’s employees and the drug users they helped, it would not impact “the sustainability of the implementation of Cambodia’s fight against drugs”.
As to whether or not the Cambodian government intended to take responsibility for providing harm reduction services to drug users, Vyrith replied with a tentative “yes”, but provided no elaboration.
“If the work is important or [a] priority that requires us to take responsibility, the [NACD] will take responsibility,” he said. Phoeuk, meanwhile, does not have much hope for Korsang’s future.
“Their exit plan sucks,” he said, arguing that USAID should have helped Korsang obtain some means of financial self-sufficiency before pulling out.
Observing the empty restaurant tables before him, Phoeuk wondered aloud about the idea of opening a restaurant that employs recovering drug users, while setting aside profits to finance harm reduction efforts.
Phoeuk’s thoughts, however, quickly returned to what he refers to as “the community” the population of drug users who rely on Korsang for access to health and other services. “They come to us because they feel safe,” he said. “When we go with them, the hospital does not discriminate against them.”
He believes Korsang’s approach of absorbing drug users into the organisation is particularly effective. “When I meet you right away, I can’t just say ‘let’s go get tested [for HIV].’ They feel safe because their peers work with Korsang.
“They’re going to take that out?” asked Phoeuk. “It’s going to be a void.”
Additional reporting by Mech Dara