Harm reduction, a work in progress in Kampung Bali

Harm reduction, a work in progress in Kampung Bali

Leony Aurora, Jakarta

Indra, 24, went to the public health center in Kampung Bali,
Central Jakarta on Thursday for one reason: free hypodermic
needles.

He went to Iboy, a health worker for the Pelita Ilmu
Foundation, which runs the harm reduction program, and took out a
small package from a crumpled brown paper bag.

Iboy took it and gave him a fresh bag, with two disposable
hypodermic needles and two small bottles of bleaching solution to
sterilize used needles. On the back of the bag, a warning is
printed that explains the various ways HIV can be transmitted.

"Many people perceive this harm reduction project as something
that condones drug abuse," said Pungky Djoko, the foundation's
program manager. Such a scheme provides injecting drug users
(IDUs) with alternatives like methadone treatment and clean
needles. "Actually, it (harm reduction) is the last resort."

Indra has been addicted to putauw (low-grade heroin) since
1996 after three years of being a regular marijuana smoker.

"In 1999, when putauw was more difficult to find, I changed
methods from free-basing to injecting," he added. Taken
intravenously, he only needed a small amount of the drug to get
his "fix".

He found out that he had contracted HIV after taking a
voluntary test last year. "Thank God, my wife is negative so
far," said the father of a one-year-old baby, who has been found
negative as well.

HIV is one of the concerns the foundation takes into account
to determine who is eligible for the needle exchange program.

"They (drug users) must also go through detoxification and
counseling first," said Pungky. "We need to establish their
levels of addiction and their eagerness to stop, or at least
reduce their usage."

Since the program started two years ago, 190 people living in
the area, notorious for its drug activities, have been put on the
list of those who are eligible for clean needles twice a week.

"But only about 15 people are active at this time," said Iboy.
There were 13 clients in his book -- aged between 22 and 31. Next
to the names, Iboy marks how many times a day his clients use
drugs, based on their own admission.

"If the frequency doesn't decrease within two months, we stop
giving them needles," he said.

Iboy, who himself used to be addicted to drugs, did not deny
that most clients drop out after some time. "Some just
disappeared, but some return."

The door to a legal harm reduction program was opened last
December with the signing of a memorandum of understanding
between the National Narcotics Body (BNN) and the government
after a rise of HIV among injecting drug users in the last couple
of years.

Before that agreement is signed, a needle on anyone could be
used as evidence against them in the court. Indonesian law
punishes not only drug dealers but also users.

BNN, working with several non-governmental organizations, has
said that it is trying out the program to find an applicable
model in the country.

"Needle exchange works here because it's a small-scale program
and therefore can be monitored," said Pungky. "But I don't think
such a program is ready to be applied nationwide."