Combating drug abuse, law enforcement is necessary but not sufficient

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.