Rapid spread of HIV among drug users calls for action<\/p>\n
Joyce Djaelani Gordon, Chairperson, Kita Foundation, Addiction
\nTreatment and Community, Recovery Center in West Java, Jakarta<\/p>\n
The latest, most up-to-date report on the spread of HIV in
\nAsia released by the Monitoring the AIDS Pandemic (MAP) Network
\nshows how Indonesia, Iran, Japan, Nepal and Vietnam have
\nregistered a marked increases in HIV infection.<\/p>\n
Two years ago, these countries reported a fairly slow spread
\nof Human Immunodeficiency Virus (HIV).<\/p>\n
The report, which was released on the eve of the 6th
\nInternational Congress on AIDS in Asia and the Pacific (ICAAP) in
\nMelbourne last month, highlights specific examples of the rapid
\nHIV spread among specific sub-populations, such as among
\ninjecting drug users (IDUs) in Indonesia, where HIV levels have
\nincreased from around 15 percent in 1999 to 40 percent in 2000.<\/p>\n
The increase of HIV prevalence among IDUs in Vietnam and Nepal
\nhave also been similarly dramatic in recent years.<\/p>\n
According to the MAP Network, the interface between sexual and
\ndrug-using behavior indicates that the spread of HIV between
\npopulation groups is more widespread than previously thought.
\n"Most drug users are sexually active men. Many have steady
\npartners, are sex work clients and some finance their drug habit
\nby selling sex. A recent phenomenon is that many sex workers are
\nturning to intravenous drugs." Translated into simple terms,
\nreducing harm among IDUs will rapidly reduce HIV among the
\ngeneral population.<\/p>\n
In a special session titled "Scaling Up Harm Reduction in
\nAsia", which was co-sponsored by the World Health Organization
\n(WHO) and the Asian Harm Reduction Network during the AIDS
\nCongress in Melbourne, WHO's director Gundo Weiler emphasized the
\nrole of harm reduction as a crucial element of comprehensive
\nHIV\/AIDS strategies.<\/p>\n
It is clear that WHO is now advocating harm reduction
\nstrategies in the region. Therefore, the Indonesian government is
\nlikely to follow future regional guidelines on this issue and
\nprepare to undertake harm reduction work with IDUs. The drug-for-
\ndrug strategy the government is now slating is a simple beginning
\nto more comprehensive harm reduction strategies.<\/p>\n
The dramatic increase of HIV infection among IDUs in Indonesia
\nis worrying. We are not fully prepared to face an epidemic when
\nwe are already burdened with various other issues. That is why
\neffective and proven prevention strategies should be carried out
\nimmediately.<\/p>\n
Yet, although support to move in this direction is beginning
\nto increase, there are still some who are against these
\nstrategies, either because they are misinformed, do not
\nunderstand addiction, or because they are even less aware about
\nHIV, drug-related harm and how this affects the country on a
\nnational scale.<\/p>\n
In confronting drug problems, there are groups who can be
\ncategorized as "supply reductionists" -- those who believe that
\nfocus should be given to finding ways to cut supplies of illicit
\ndrugs and using the full strength of law enforcement. Another
\ngroup, "demand reductionists", are those who believe we should
\nfocus on finding ways to prevent drug use and to rehabilitate
\nthose with drug problems. With HIV in mind, we now have "harm
\nreductionists" who are more concerned about cutting down the
\namount of harm that is related to drugs. There is a place for
\neach of these approaches and there are places where supply
\nreduction, demand reduction and harm reduction overlap.<\/p>\n
Those focused on supply reduction strategies - feeling that
\ndemand reduction programs are a waste of money - often make calls
\nfor tougher laws as the panacea for drug problems in the country.
\nDemand reductionists on the other hand, often think that we can
\ncure every single case. The reality is, putting people in prison
\nnot only places a financial burden on the government but it is
\nalso not much of a solution because many prisons do not have
\nprograms to deal with drug abuse.<\/p>\n
News of rampant drug dealing in prison is still fresh in our
\nminds. IDUs, who have been through prison, report a very high
\nincidence of needle sharing, leading to the rampant spread of HIV
\nand Hepatitis C Virus (HCV) in prison, which in turn leads to an
\nadded health cost to be carried by the government in later years.
\nEven countries with stringent laws continue to fail to keep their
\ncountries free of drugs.<\/p>\n
On the other hand, demand reductionists who call for
\nprevention and rehabilitation often forget that most are not
\ngoing to listen to prevention messages, even if the messages are
\naccurate, comprehensive and widespread, like what we find in
\ndeveloped countries. And those who do become addicted will only
\nfind themselves admitted to a rehabilitation center after years
\nof use.<\/p>\n
Imprisonment, death by overdose or driving accidents under the
\ninfluence of alcohol and drugs, drug-induced mental damage and
\nfinally infection of incurable blood-borne viruses such as HIV
\nand hepatitis, are just some of the costs we must look at. And if
\nwe are to rehabilitate all cases of drug abuse and addiction, we
\nmust remember that we are dealing with close to four million drug
\nusers. Indonesia simply does not have the resources, manpower and
\nthe finances necessary to do this on a national level. However,
\nif we wait for more resources and manpower, many lives will
\nalready have been lost.<\/p>\n
Demand reductionists hope that drug abusers will achieve
\nsustained abstinence. There is nothing wrong with that, because
\nsustained change or abstinence is ideal, so ideal that it is
\nparallel to achieving a gold medal in sports. Yet, we know that
\nwinning a gold medal takes learning and practice. In other words
\nit is a process.<\/p>\n
From the perspective of harm reduction, would it be acceptable
\nto teach a person how to swim if the conditions for learning puts
\nthem in real danger of losing their life? If a person cannot
\nswim, do we take them to the deep end of a pool for their first
\nlesson and leave them there? If we know that a person may
\nrelapse, as most addicts do, is it acceptable for us to risk
\ntheir life by withholding lifesaving information and tools to
\nprotect them and others around them from ever getting infected by
\nHIV and HCV? Would that not be parallel to shooting them on the
\nspot, along with their sexual partners and those they have shared
\nrisky behavior with?<\/p>\n
Tools to reduce harm can be applied in all situations, be it
\non the street level, where resources are low and hamper
\ntreatment-seeking behavior, in prison, or in counseling centers
\nor any other service points where the drug abuser or addict may
\nshow up. Its simple objective, which is to reduce harm for anyone
\nusing drugs, decreases potential harm and cost to those around
\nthem. It has also been shown that harm reduction approaches often
\nmotivate people to ultimately stop using drugs.<\/p>\n
Are you sure your loved ones are not using drugs? Or perhaps,
\nthat your child is not using drugs, or dating and having sex with
\nan IDU? If you are a typical parent, like many parents of addicts
\nwho come to Yayasan Kita recovery center in Cipayung, you
\nprobably don't know. Most parents find out that their children
\nuse drugs only a year or so after they have first started. You
\ncannot always tell an addict from their appearance and you cannot
\ntell who has HIV or HCV from how they look. And if your loved
\nones are in fact using drugs, would it not be better if you could
\nget them off drugs before they get HIV or HCV from needle
\nsharing? Would it not be great if someone out there told them the
\nfacts and gave them lifesaving tools while you yourself were
\nsleeping?<\/p>",
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