Drug addicts vulnerable to HIV infection

By Stevie Emilia

JAKARTA (JP): Both the Acquired Immune Deficiency Syndrome (AIDS) and drug addiction can lead to fatalities. But while AIDS is still incurable, drug addiction can be treated -- if the addict kicks the habit before it is too late.

Unfortunately, there are not many drug addicts who can give up their habit, which makes them -- especially intravenous drug users -- vulnerable to HIV infection through contaminated needles.

Zubairi Djoerban of the Pelita Ilmu Foundation revealed that last month four people with AIDS, who the foundation had been caring for, died. One of them, less than 20 years of age, used to be an intravenous drug user, and was the third drug addict in Jakarta to contract the virus from sharing contaminated needles with other addicts.

Sharing needles, he said, was a long time habit of intravenous drug users, not only here in Jakarta but also worldwide.

"But the death stunned us, because so far there's a strong denial of the existence of IV drug users here," Zubairy, who also chairs the Indonesian AIDS Society, told participants at a recent seminar, AIDS and Narcotics on Young People, which was held to commemorate World AIDS Day.

According to Zubairy, a 1998 report from the Cipto Mangunkusumo Public Hospital recorded 134 overdoses in the hospital's emergency room between 1996 to 1997. The victims were teenagers and adults between 16 and 30 years of age.

More than 20 percent of the cases were caused by the recreational drug Ecstasy, 6 percent by opiates and 3.7 percent by barbiturate pills.

Zubairi said that the relationship between narcotics and HIV/AIDS has been recognized in the United States since the beginning of the AIDS epidemic.

As of January 1996, the United States listed 183,359 people with AIDS, or 36 percent of all AIDS cases in the country, who contracted the virus through intravenous drug use.

However, it is not only the drug addicts who are infected with the virus, but also their partners and children. Of the 183,359 intravenous drug use AIDS cases in the United States, 161,891 of the people were drug addicts, 18,710 were their partners and 3,758 were their children, he said.

In Asia, he added, there was also an increase in drug addicts being infected with HIV.

Bangkok, which had an almost zero prevalence -- one percent -- of HIV infection among drug addicts at the end of 1987, has recorded a rapid increase in such cases. In March 1988, the percentage rose to 15 percent and then 43 percent by the end of 1988.

But in Indonesia, the problem is not yet widely recognized. Most people still relate HIV/AIDS with sexual relations.

And the government's so-called monthly surveillance system cannot provide a clear picture of drug-related HIV/AIDS cases here.

Out of 815 HIV/AIDS cases reported up to November of this year -- 39 of which were reported in November alone -- only six of the cases involve intravenous drug users. Three of these people were HIV-positive and the other three already have full-blown AIDS.

No one, however, really knows the real number of people living with HIV/AIDS in Indonesia. The same is true of drug addicts, though official figures put the number at around 150,000 people across the country.

Experts believe that the real numbers of people living with HIV/AIDS and drug addicts are far higher than those being reported.

"Even though there are no real figures, we can't dismiss the threat of HIV infection on drug addicts," Zubairi said.

With continuous reports of the confiscation of narcotics and the arrests of drug traffickers in the media, the threat is obviously real.

David Djaelani Gordon, who, along with his wife Joyce, works as a consultant on HIV/AIDS and addiction, referred to HIV infection and drug addiction as a 'real nightmare'.

"Both of them (HIV/AIDS and drug addiction) are already found here in Indonesia ... and if we want to be real honest to ourselves, we're not ready to face them...," he told the seminar's participants.

In his 42-years of experience working with drug addicts, he has noticed that many drug addicts often share needles with other addicts.

"None of them care about the cleanliness of the needles and almost none of them know how to clean needles properly," said Gordon, who was a drug addict himself for 15 years.

In his paper, he cited the confessions of a drug addict under his treatment:

"I usually clean it (the needle) with water. What's wrong with it? If it's dirty, it will only cause a bit of swelling. With sakaw (pain) and pakaw (wanting) to use the drug, I don't have time to think. The most important is, pakaw... in keeping the needles clean, I don't do much. Sometimes, I just put it on the dashboard without a plastic cover. While with friends, we use it (the needle) together. The most important thing is, I have the needle and it's not blunt..."

Although it is difficult and takes time, drug addiction can be treated. The detoxification process to cleanup addicts takes around six to 10 days. Then, it is up to the addicts themselves, whether they want to stop or continue with their habits.

"But the key to success, to completely stop addiction is: ongoing counseling...," said David.

Unfortunately, he said, there were only a small number of rehabilitation centers to treat drug addiction here. Also, there are no needle-exchange programs here, he added.

According to HindarAIDS bulletin, in the United States, after long debate, the government finally gave official support in April of this year to sponsor needle-exchange programs. These programs distribute free needles to intravenous drug users to prevent the spread of HIV and other infections through contaminated needles.

He also pointed out the absence of any survey of drug addicts. A survey's results would provide a clear picture of drug abuse here and the real number of drug addicts, he added.

"We in Indonesia never perform a study of HIV and drug addicts, because just like HIV/AIDS, addiction in Indonesia is still considered to be nonexistent," David said.

However, such surveys and programs, along with skilled experts, are important factors in dealing with drug-related HIV infections in the future, he said.