Drug abuse spurs spread of AIDS in Indonesia

Drug abuse spurs spread of AIDS in Indonesia

Widespread drug abuse has spurred not only social ills in
Indonesia, but also has escalated the spread of AIDS in the
country. AIDS activist Chris W. Green has written the following
three articles in conjunction with World AIDS Day on Dec. 1.

JAKARTA (JP): The future of AIDS in Indonesia is tied up with
drug use. That was the headline of my World AIDS Day article in
The Jakarta Post this time last year. Sadly, the last few months
have proved this prophecy correct. Almost 80 percent of new cases
of HIV/AIDS identified over the last few months have resulted
from injecting drug use.

The theme for World AIDS Day 2000 is men. This is recognized
in the slogan AIDS: Men Make a Difference. Some may ask what has
this to do with drugs?

Sharing needles while injecting drugs is the most efficient
way of transmitting HIV, the virus which causes AIDS. If one
person in a needle-sharing group of injecting drug users (IDUs)
becomes infected with HIV, the rest will likely become infected
within weeks. And once the HIV prevalence among any population of
IDUs exceeds 10 percent, experience in many parts of the world
has shown that this can rise to 50 percent, 70 percent or even
higher within one to two years -- unless very effective action is
taken to stem this.

Not only does the virus spread among IDUs who share needles,
but it will spread from them to their sexual partners (including
sex workers) and onward to their children during birth or
breastfeeding. Thus an epidemic of HIV among IDUs can also
quickly spread into the general population.

We can only guess at the current situation regarding HIV among
IDUs in Indonesia. One recent estimate is that there are 3.1
million drug users in the country, but probably a large
proportion of these are using "soft" drugs such as marijuana.

Perhaps half are using the two main injected drugs, heroin
(putauw) or methamphetamine (shabu-shabu). Surveys around the
country have shown that 70 percent of such "hard" drug users are
injecting -- and the vast majority of these are sharing needles,
at least occasionally.

Thus a conservative estimate would suggest perhaps as many as
one million drug users in Indonesia are currently at risk of HIV
infection -- and at even greater risk of infection with hepatitis
C, which is almost as nasty as HIV.

What little data we have on HIV infection rates among IDUs in
Indonesia suggest that the 10 percent threshold has been
breached, certainly in Jakarta.

Here, at least two surveys have indicated HIV infection rates
among IDUs of 15 percent or more. If this reflects a wider
situation, that could mean that at least 10 percent of the one
million IDUs are infected with HIV -- a total of 100,000. And not
only is prevalence rising; so is the number of IDUs. It is not
unlikely that by this time next year, we will be looking at 30
percent HIV prevalence among 1.5 million IDUs, i.e. close to half
a million infections. That is more than a disaster; it is a
threat to the whole future of the country.

What other data do we have to support this dire estimate? The
reports of HIV infection submitted to the Department of Health
are known to represent the very tip of the iceberg -- the total
number of cases reported at the end of October was 1,521 --
against an official UN estimate of 52,000 cases. Thus a rise in
reported cases of HIV infection due to injecting drug use from
six in June 1999 to 212 this October, while not appearing to be
too large, represents a very frightening situation.

In this case, do men make a difference, as the slogan says?
Indeed they do, in a number of ways. First, although we know that
the number of women injecting drugs is consistently
underestimated -- they are a hidden group within an already
hidden population -- there is little doubt that in general many
more men inject drugs than women.

It is often men who introduce women to injecting. And as with
many activities in life, women are served after the men are
satisfied -- which in the case of injecting drug use means that
women get to use the syringe after the men have had their fill,
increasing the risk that it will be contaminated with dangerous
viruses. In this way, it is men who are putting women at greater
risk. Further, male drug users are much more likely to have
noninjecting sexual partners -- and are even less likely than
other men to use condoms.

If the threat is becoming clearer, the solution has long been
clear. We need to bring the problem into the open, not drive it
underground through law enforcement activities. If the result of
such activities is to put drug users in jail, the result is even
worse, since drugs are widely available in prison and HIV
prevalence is probably even higher, while a lack of clean needles
increases the risk. We need to find effective approaches to
reducing the harmful effects of drug use, being aware that few
drug users are willing or able to stop their habit in the short
term.

We need to involve current and former drug users in the
solution -- they understand the problem much better than most of
us who talk knowledgeably about drug use.

We have a very brief window of opportunity to start taking
real action. If we neglect this, the AIDS-related problems
resulting from drug use will take years and huge sums of money to
address.