Harm reduction: Confronting HIV/AIDS/hepatitis

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.

Untuk ibox
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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
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