Harm reduction: Confronting HIV/AIDS/hepatitis
David Djaelani Gordon, The Jakarta Post, Contributor, Jakarta
By the latter part of the 1980s an increasing number of virologists and medical experts, along with a rapidly expanding number of anxious governmental agencies, were alarmingly waking up to the fact that HIV/AIDS had, in only a few short years, spread across most of world. Contrasting, yet hardening information and evidence were already very clear on the worldwide virus catastrophe that was developing.
Particular groups at risk included gay communities -- and large numbers of people who were actively engaged in casual and open exchanges of sex, the prostitution industry (both females and males), drug users and abusers (especially IDUs -- Injecting Drug Users).
Also at risk were "ordinary" people (those in the heterosexual community) who had received "tainted blood" in hospitals and institutions for operations and other applications where blood was transferred, and dentists' practices, where unsterilized instruments were being used with patients.
By the latter half of the 1980's these groups were being mass- infected with HIV/AIDS.
Also, by the beginning of the 1970's much of the world, including Indonesia, had already witnessed an astounding rise in drug abuse and addiction. In 1987 (officially) the first death from AIDS was documented here in Indonesia.
By 1991 the tentacles of a drug culture had opened a wide gateway throughout the nation, spurred on by marijuana, ecstasy and putaw (low-grade heroin). Shabu-shabu became popular in the mid 1990s.
In 1994 the beginnings of a National policy on HIV/AIDS had been organized, and in 1995 the AIDS Commission was established. By 1996 drug addiction was declared to be of epidemic proportions in our country! Yet, as of now, little has been accomplished to intervene in and defend our nation against HIV/AIDS and Hepatitis C, drug abuse and addiction.
For many reasons, some credible and some not, harm reduction methods were not initiated, and today we lag far behind in the race to ward off the devastating effects that HIV/AIDS and hepatitis C, drug abuse and addiction are having upon the nation.
Please note that wherever you find drug addiction you always find coexisting sexually transmitted diseases -- HIV/AIDS and hepatitis -- plus associated money problems, crime and violence. Harm reduction strategies attempt to tackle all of these issues.
According to the most reliable data being received from across the nation, the number one hot-spot is the Jabotabek area (Greater Jakarta), while a "wildfire and crisis" now exists, with HIV/AIDS and hepatitis C as well as drug addiction prevalent throughout the archipelago.
There are today an estimated 4 million-plus active drug abusers and addicts throughout Indonesia. Needle-use and needle- sharing increase on a daily basis.
In the Jabotabek Area, over 20 percent of IDUs are now continuously testing positive for HIV/AIDS and over 85 percent of IDUs in the Jabotabek area are testing positive for Hepatitis C.
These numbers and statistics will continue to increase, and spread, throughout the nation!
The most recent statistics indicate there are now over 20,000 drug abusers and addicts already infected with HIV/AIDS within the Jabotabek area alone at present. In addition, well over 100,000 are infected with hepatitis C at present.
Harm reduction methods are regarded as some of the most respected and successful modes of intervention, education, programming, and action -- which create a shield, an intelligent and sustainable line of defense against viruses and drug abuse. Harm reduction methods within our sex worker communities are proving to reduce HIV/AIDS infection and transmission, and are helping scores of drug abusers curb many of their most harmful modes of behavior.
Presently the Asian Harm Reduction Network based in Thailand, along with several Indonesian partners, is pioneering efforts to construct an "Asian collective" that will contribute to opening doorways to directly assist Indonesia in developing plans and programs that can successfully face these fateful issues.
Government, NGOs, the medical, therapeutic and welfare communities, along with the drug recovery community are intending to unite in identifying harm reduction methodologies and strategies.
Harm reduction -- both methods and programs -- builds a strong bridge in shifting attitudes to unite people and organizations in far more positive and effective ways to challenge drug addiction, HIV/AIDS and hepatitis. This then increases awareness surrounding these issues, which, in turn, increases the response to these issues.
2002 and 2003 will prove to be a major pivotal point in the battle to take a stand against drug abuse and the viruses. We must work together to assemble a pragmatic multi-level program to confront these issues.
Confrontation -- in the genuine sense of harm reduction -- means government, NGOs, the recovery community, the Ministry of Health, the religious community, the educational community and the general population must all work together.
By concentrating our attention on applying harm reduction methods we will be able to slow down the rampage that addiction and the viruses are having within our country. If we do not slow down the rampant spread of drug abuse and addiction and contain the spread of the viruses over these next two years by means of strong harm reduction strategies and programs, the losses will be even more unimaginable than they are today.
Today the losses we are facing are already unimaginable.
Harm reduction must become a top priority in 2002.
The writer is Director of Yayasan Harapan Permata Hati Kita - Bogor.
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Harm reduction strategies can take the following forms: * Policy and advocacy direction and leadership * Dissemination of information through the educational system * Hospitals and clinics, designated to assist and support those infected with the viruses, and needing medical treatment and attention * Rehabilitation and recovery centers, and aftercare programs for drug abusers * Testing and counseling facilities for those wanting/needing to find out if they are infected with a virus, and needing ongoing supportive counseling * Community outreach service centers * Self-help programs and support groups * Therapeutic communities * Condom-use education and community outreach programs supporting condom usage * Needle exchange and drug substitution programs ----------------------------------------------------------------