Combating drug abuse, law enforcement is necessary but not sufficient

Sudirman Nasir, Victoria

The new chief of the Indonesian police, Gen. Sutanto, has frequently stated his commitment to combat crime such as gambling, illegal logging and drug trafficking in the country. Sutanto's strong will seems promising, however, many studies show that relying solely on law enforcement in combating drug trafficking and drug abuse is not sufficient nor a strategic measure, albeit necessary.

There are many reasons why tackling drug abuse through more stringent law enforcement, popularly known as supply reduction is never adequate. First, drug trafficking is unquestionably part of "illicit global trade", an industry worth over US$500 billion annually. The drug trade is mainly controlled by international criminal syndicates that have wide networks, funds and sophisticated technology that enables them to overshadow the capacity of police institutions in developed countries, let alone in developing countries.

As an illustration, each year the U.S. government (federal and states) spend $30 billion, most of it on law enforcement to combat illegal drugs, nevertheless, the availability of drugs in the streets has never significantly reduced. The U.S. "zero tolerance policy" even creates unintended results particularly in increasing high-risk behaviors among drug users such as injecting drug use. Many drug users start to inject drugs because it is more economical compare to oral, smoking and sniffing practices. In addition, the ritual of injecting drugs is perceived to be more challenging by many drug users than the more conservative ways.

Second, it has become apparent that drug abuse is not simply a legal problem but should be considered a public health problem. The adverse physical and psychological consequences of drug abuse are widely known. Many diseases and disorders caused by drug abuse such as lowering of the body's immunity, organ damage and psychiatric disorders such as depression, anxiety, or even psychosis.

Moreover, the emergence of injecting drug use has triggered the spread of HIV and other blood borne viruses (BBV) like hepatitis B and hepatitis C among injecting drug users (IDUs), and from IDUs to their sexual partners, to their children and then to the general population. High risk behavior such as sharing needles and other paraphernalia, such as the syringe, the water used to dilute drugs, the cooker used to prepare the drugs, the cotton used to filter the dissolved intoxicant, and rinse water are effective ways to spread HIV and other BBV.

Furthermore, high risk behavior among IDUs such as multiple sexual partners and the low level of condom use should also be taken into account since most of them are sexually active. The combination of injecting drug use and risky sexual behavior has lead many studies to conclude that drug use (especially injecting drug use) and HIV infection tend to be dual epidemics in many countries, including Indonesia.

The Ministry of Health states as of December 2004 there were 3368 HIV-positive cases and 2682 AIDS cases in the country. The heterosexual route accounted for 51 percent of HIV transmission, injecting drug use for 26 percent and sex between men for 9 percent. Nevertheless, those numbers are obviously just the tip of the iceberg. WHO and UNAIDS (2004) maintain that in 2003 there were 53,000 -- 180,000 people living with HIV/AIDS in Indonesia.

Reid and Costigan (2002) estimate that of 1.3 million to 2 million drug users in the country, one million of them are IDUs. Moreover, UNAIDS and WHO (2003) state that there are at least 43,000 IDUs who are HIV seropositive and 9,747 sexual partners of IDUs who are HIV seropositive in the country. The exact number of drug users and IDUs is hard to obtain due its clandestine and illegal nature.

The Indonesian government has recognized that its economic and social development efforts could be jeopardized if the HIV/AIDS and drug use epidemics are not controlled. The National Commission on HIV/AIDS was established in 1994 and was followed up by instruction to provincial and district governments to establish their local commission on HIV/AIDS. Although the commission performance was still far from sufficient, the commission is undoubtedly a milestone in Indonesia's efforts to combat the epidemic.

In addition, the Indonesian government has also established a national and provincial board on narcotics. However, just recently the coordination between the two bodies was improved. For a long time, HIV and drug use was perceived as separate things. HIV was perceived as a public health issue, whereas drug use was perceived simply as a legal issue.

The increasing prevalence of HIV among IDUs in Indonesia facilitates the perception that HIV and drug use are a dual epidemic and the coordination between AIDS Commission and Narcotic Boards is urgently required. Therefore, Indonesian National AIDS Strategy (2003-2007) has already addressed the necessity of harm reduction programs. Harm reduction is a public health approach to minimize the harms of drug use without necessarily reducing drug consumption and without insisting on abstinence as the only choice in the short-term which is unrealistic among most IDUs.

It is apparent that harm reduction is a realistic, humanistic and pragmatic method to work in tandem with supply and demand reduction. Harm reduction programs consist of a wide range of activities such as peer outreach, peer educators, needle and syringe exchanges, safer sex education such as condom promotion, voluntary counseling test, methadone maintenance programs, drug treatment and rehabilitation, and primary health care for IDUs.

Moreover, a memorandum of understanding (MOU) has been signed by the National AIDS Commission with the National Narcotics Board (Indonesian Police Office) to integrate efforts to control HIV infection among IDUs. Currently, there are many NGOs that are criticizing and asking that the narcotics law be amended as it is too punitive toward drug users and not supportive of harm reduction programs. A National Implementation Team has been established to follow up the MOU.

In addition, there are many NGOs working to combat HIV and drug use epidemics in Indonesia. Those NGOs initiated their programs long before the Indonesian government acknowledged the threat of HIV and drug use. However, the response of the Indonesian government and NGOs is still far from adequate.

The major challenge to combat drug abuse and HIV in Indonesia, therefore, is to integrate law enforcement and the public health approach, and to increase coordination between bodies responsible to combat these dual epidemics.

The writer is a postgraduate student at the University of Melbourne. He is writing a thesis on Drug subculture and the social context of HIV high risk behavior among intravenous drug users in Makassar. He can be reached at s.nasir@pgrad.unimelb.edu.au.