Drug recovery centers: Solution or problem?

By David and Joyce Djaelani Gordon

JAKARTA (JP): Recently, there was an article on page 2 of The Jakarta Post. The bold black letters read: "Government to boost campaign on HIV/AIDS".

Jakarta and Irian Jaya were reported, and continue, to have the highest number of new cases of HIV and AIDS now on a regular basis.

Many of the newly infected in and around Jakarta are drug abusers and addicts. If these "reported cases" were more closely examined, you would find many of those infected with HIV/AIDS were also co-infected with hepatitis C.

We are not just facing one virus and one pandemic. The threat to Indonesians -- mostly drug users and abusers -- nationwide are two viruses and two pandemics of HIV/AIDS and hepatitis C.

Possibly two generations of young Indonesians will be devastated by these viruses in which hundreds of thousands, or more, will die over the next two decades.

A worldwide warning has been issued in the last few years stating that, when the level of HIV/AIDS positive cases reaches and exceeds 10 percent among drug abusers, the virus then spreads as an unstoppable force.

At Yayasan Kita Recovery Center and Community, our test results indicate that, among the drug abusers and addicts in the Greater Jakarta area seeking treatment at our center, over 20 percent are HIV/AIDS positive and 90 percent have hepatitis C.

Another accepted assessment is: the drug abuse and drug addicted communities, especially the injecting drug users (IDUS), are the number one group (ultra-high risk) for the infection and spread of both the HIV/AIDS and hepatitis C viruses today.

*Fact: Sharing needles is the easiest way to transmit and contract either virus!

Then, in the Post's July 15 edition, the headlines read as "Rehab centers help local drug addicts". This is true as the centers absolutely do help drug addicts, but most of them are not testing for the viruses. This is not because they have never heard about the HIV/AIDS and hepatitis C viruses, but the centers have no idea about what to do if they have an addict who tests positive for HIV/AIDS or hepatitis C.

*Documented Note: Yayasan Kita has verified that the most prominent drug rehabilitation centers have yet to provide counseling and testing for their residents. Sometimes they do, but they don't hold the tests properly or they minimize, miscommunicate or mask facts and results regarding HIV/AIDS or hepatitis C.

Nine treatment and recovery centers -- which all are working with addicts and well known to the public -- were all confidentially asked, "if they provided counseling and testing for HIV/AIDS and hepatitis C".

The responses varied from "no", "providing testing and some counseling only when asked" to "HIV/AIDS can be cured and will come out in the urine if one has better faith". Some centers even bar addicts with HIV, AIDS and hepatitis from ever entering their Center.

The interesting thing about the last comment is: how would this center even confirm if anyone is HIV or hepatitis C positive without a test?

Most centers are also not informing or counseling addicts who come into their centers about how to reduce the risks of contracting HIV and hepatitis. Should you have doubts about what we are sharing, we encourage you to call some of the rehabilitation and recovery centers yourself.

Do these centers -- along with their owners, executive boards, management and staff -- have only the vaguest idea about drug abusers and addicts, the recovery process or what the world of drug addiction actually represents?

They don't understand how the HIV/AIDS or hepatitis C viruses will negatively affect any addicts or those in the initial stages of rehabilitation, or provide critical causes for a relapse.

Proper info

Without providing proper information and harm reduction counseling, and being mindful of the high probability of relapse, these centers and their entire management team and staff are guilty of absolute and lethal negligence, not to mention naivete!

Any organization, group or individual that has opened, or is considering opening any type of recovery or rehabilitation center, drop-in or outreach center, drug detoxification center, recovery aftercare community, or a facility dealing with any form of drug abuse -- dealing with drug awareness, information, education and outreach -- must realize that it is impossible today to speak about the dangers and risks of drug use, abuse, addiction or the process of recovery, without speaking about the HIV/AIDS and hepatitis C viruses.

One of the centers, chaired by a medical doctor, confidentially said that they "would bar anyone with hepatitis B, hepatitis C or HIV from their center".

Another doctor who owns a center said, "we wait for 6 months, while the addict does our recovery program, before any talk or counseling about HIV even begins."

This same doctor also admitted, "that only a few addicts, or their parents, even asked for a test while the addict was in treatment, or after the six months".

Some centers are pretending or denying that these viruses are a secondary issue within the recovery process, just like any infected addict who tries to pretend or deny that education is unimportant to one's intelligence.

The process of working with drug abusers and addicts is difficult enough just to begin with, but the process of working with a drug abuser or addict with HIV/AIDS or hepatitis C is far more demanding and exceptionally more intense.

Harm reduction strategies and networks recognize the ultra- importance today of being able to 'test high risk groups, and high risk individuals with confidentiality'. Harm reduction peer counselors are qualified to give pre and post-test counseling for those infected and their families.

Our rehabilitation and recovery centers are harm reduction networks just by the nature of what they do and should, in the near future, become one of our first lines of defense against the spread of HIV/AIDS and hepatitis C.

If any recovery center or organization admits a drug abuser for detoxification, treatment, rehabilitation and recovery (all of which are expensive services) but does not counsel and test for the viruses, even though the center knows how embedded the viruses are within the drug abusing community today, it must be considered and held morally and ethically negligent.

What will happen if an individual relapses and then shares needles or has unprotected sex after treatment, without ever knowing if he or she is infected with HIV/AIDS or hepatitis C, and infects others like your very own son or daughter?

Who must be responsible morally and ethically for the new infections? Who will be responsible for spreading the viruses further and faster among unsuspecting individuals and our nation?

There is no cure for HIV/AIDS or hepatitis C.

We have little choice left other than to face the truism that the drug abuse and addicted community is openly exposed to a full blown wildfire situation.

As the heartbreaking impact of the marriage between drug abuse and HIV/AIDS and hepatitis C dawns on Indonesians, the fatalities among our young people will accumulate at a rate never seen in this nation before.

Detoxification, rehabilitation, treatment and recovery centers, plus their support and aftercare communities, must assume the responsibility for counseling and testing drug abusers and addicts (and their friends and families, if needed) for HIV/AIDS and hepatitis C, and provide the necessary support system(s) early in the recovery process. The recovery community has the best and most direct chance to work with those infected, and their families.

If our recovery centers and recovery community fail to work with drug abusers and addicts who have HIV/AIDS or hepatitis C for whatever reasons, these centers become part of the problem, rather than part of the solution.

-- The writers are directors of Yayasan Hati Kita.