Combating drug abuse, law enforcement is necessary but not sufficient<\/p>\n
Sudirman Nasir, Victoria<\/p>\n
The new chief of the Indonesian police, Gen. Sutanto, has
\nfrequently stated his commitment to combat crime such as
\ngambling, illegal logging and drug trafficking in the country.
\nSutanto's strong will seems promising, however, many studies show
\nthat relying solely on law enforcement in combating drug
\ntrafficking and drug abuse is not sufficient nor a strategic
\nmeasure, albeit necessary.<\/p>\n
There are many reasons why tackling drug abuse through more
\nstringent law enforcement, popularly known as supply reduction is
\nnever adequate. First, drug trafficking is unquestionably part of
\n\"illicit global trade\", an industry worth over US$500 billion
\nannually. The drug trade is mainly controlled by international
\ncriminal syndicates that have wide networks, funds and
\nsophisticated technology that enables them to overshadow the
\ncapacity of police institutions in developed countries, let alone
\nin developing countries.<\/p>\n
As an illustration, each year the U.S. government (federal
\nand states) spend $30 billion, most of it on law enforcement to
\ncombat illegal drugs, nevertheless, the availability of drugs in
\nthe streets has never significantly reduced. The U.S. \"zero
\ntolerance policy\" even creates unintended results particularly in
\nincreasing high-risk behaviors among drug users such as injecting
\ndrug use. Many drug users start to inject drugs because it is
\nmore economical compare to oral, smoking and sniffing practices.
\nIn addition, the ritual of injecting drugs is perceived to be
\nmore challenging by many drug users than the more conservative
\nways.<\/p>\n
Second, it has become apparent that drug abuse is not simply a
\nlegal problem but should be considered a public health problem.
\nThe adverse physical and psychological consequences of drug abuse
\nare widely known. Many diseases and disorders caused by drug
\nabuse such as lowering of the body's immunity, organ damage and
\npsychiatric disorders such as depression, anxiety, or even
\npsychosis.<\/p>\n
Moreover, the emergence of injecting drug use has triggered
\nthe spread of HIV and other blood borne viruses (BBV) like
\nhepatitis B and hepatitis C among injecting drug users (IDUs),
\nand from IDUs to their sexual partners, to their children and
\nthen to the general population. High risk behavior such as
\nsharing needles and other paraphernalia, such as the syringe, the
\nwater used to dilute drugs, the cooker used to prepare the drugs,
\nthe cotton used to filter the dissolved intoxicant, and rinse
\nwater are effective ways to spread HIV and other BBV.<\/p>\n
Furthermore, high risk behavior among IDUs such as multiple
\nsexual partners and the low level of condom use should also be
\ntaken into account since most of them are sexually active. The
\ncombination of injecting drug use and risky sexual behavior has
\nlead many studies to conclude that drug use (especially injecting
\ndrug use) and HIV infection tend to be dual epidemics in many
\ncountries, including Indonesia.<\/p>\n
The Ministry of Health states as of December 2004 there were
\n3368 HIV-positive cases and 2682 AIDS cases in the country. The
\nheterosexual route accounted for 51 percent of HIV transmission,
\ninjecting drug use for 26 percent and sex between men for 9
\npercent. Nevertheless, those numbers are obviously just the tip
\nof the iceberg. WHO and UNAIDS (2004) maintain that in 2003 there
\nwere 53,000 -- 180,000 people living with HIV\/AIDS in Indonesia.<\/p>\n
Reid and Costigan (2002) estimate that of 1.3 million to 2
\nmillion drug users in the country, one million of them are IDUs.
\nMoreover, UNAIDS and WHO (2003) state that there are at least
\n43,000 IDUs who are HIV seropositive and 9,747 sexual partners of
\nIDUs who are HIV seropositive in the country. The exact number of
\ndrug users and IDUs is hard to obtain due its clandestine and
\nillegal nature.<\/p>\n
The Indonesian government has recognized that its economic and
\nsocial development efforts could be jeopardized if the HIV\/AIDS
\nand drug use epidemics are not controlled. The National
\nCommission on HIV\/AIDS was established in 1994 and was followed
\nup by instruction to provincial and district governments to
\nestablish their local commission on HIV\/AIDS. Although the
\ncommission performance was still far from sufficient, the
\ncommission is undoubtedly a milestone in Indonesia's efforts to
\ncombat the epidemic.<\/p>\n
In addition, the Indonesian government has also established a
\nnational and provincial board on narcotics. However, just
\nrecently the coordination between the two bodies was improved.
\nFor a long time, HIV and drug use was perceived as separate
\nthings. HIV was perceived as a public health issue, whereas drug
\nuse was perceived simply as a legal issue.<\/p>\n
The increasing prevalence of HIV among IDUs in Indonesia
\nfacilitates the perception that HIV and drug use are a dual
\nepidemic and the coordination between AIDS Commission and
\nNarcotic Boards is urgently required. Therefore, Indonesian
\nNational AIDS Strategy (2003-2007) has already addressed the
\nnecessity of harm reduction programs. Harm reduction is a public
\nhealth approach to minimize the harms of drug use without
\nnecessarily reducing drug consumption and without insisting on
\nabstinence as the only choice in the short-term which is
\nunrealistic among most IDUs.<\/p>\n
It is apparent that harm reduction is a realistic, humanistic
\nand pragmatic method to work in tandem with supply and demand
\nreduction. Harm reduction programs consist of a wide range of
\nactivities such as peer outreach, peer educators, needle and
\nsyringe exchanges, safer sex education such as condom promotion,
\nvoluntary counseling test, methadone maintenance programs, drug
\ntreatment and rehabilitation, and primary health care for IDUs.<\/p>\n
Moreover, a memorandum of understanding (MOU) has been signed
\nby the National AIDS Commission with the National Narcotics Board
\n(Indonesian Police Office) to integrate efforts to control HIV
\ninfection among IDUs. Currently, there are many NGOs that are
\ncriticizing and asking that the narcotics law be amended as it is
\ntoo punitive toward drug users and not supportive of harm
\nreduction programs. A National Implementation Team has been
\nestablished to follow up the MOU.<\/p>\n
In addition, there are many NGOs working to combat HIV and
\ndrug use epidemics in Indonesia. Those NGOs initiated their
\nprograms long before the Indonesian government acknowledged the
\nthreat of HIV and drug use. However, the response of the
\nIndonesian government and NGOs is still far from adequate.<\/p>\n
The major challenge to combat drug abuse and HIV in Indonesia,
\ntherefore, is to integrate law enforcement and the public health
\napproach, and to increase coordination between bodies responsible
\nto combat these dual epidemics.<\/p>\n
The writer is a postgraduate student at the University of
\nMelbourne. He is writing a thesis on Drug subculture and the
\nsocial context of HIV high risk behavior among intravenous drug
\nusers in Makassar. He can be reached at
\ns.nasir@pgrad.unimelb.edu.au.<\/p>",
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