Harm reduction for drug users could save more lives: Former addict

Fina Pc., (not real name), A recovered drug addict and AIDS activist

I tested positive for both the human immunodeficiency virus (HIV) and Hepatitis C (HCV) because of my injecting drug use. If I had been taught to reduce the dangers of my drug use while still active, everything might be different. I would have tested negative for both HIV and HCV, and I would be able to say that harm reduction had saved my life.

Yet, sadly, this is not the case. I support harm reduction programs simply because I don't wish to see anyone else become HIV and HCV positive, like me, because of their ignorance of drug-related harm. I do not support people who are against harm reduction methods that could save lives, lives like mine and those similar to mine. People must begin to understand addicts, and how people like myself could have been spared from HIV and HCV.

People continue to misunderstand harm reduction programs. Harm reduction is not only about needle exchange programs and distributing clean needles and syringes.

If I had been taught about harm reduction before or when I began using and experimenting with drugs, and been made to feel that I was not impervious to HIV and HCV, I would have been more careful and gone to find help much earlier.

The simple fact is, if I had understood harm reduction back then, I would not be HIV positive now, and my life would be much easier than it is now. Yet, no one told me. No one reached out to me back then.

HIV and HCV, both incurable, are rampant among injecting drug users (IDUs) in the Greater Jakarta area. It is now estimated the area has about two million addicts. Around 40 percent of my IDU friends are now infected with HIV and about 80 percent have HCV.

When I was an IDU, I shared needles. There were many reasons why I shared needles with my friends; ignorance, unavailability of clean needles and laws that prevented me from getting clean needles.

I could not tell who was infected with the viruses since everyone looked healthy and clean. It never crossed my mind that my friends could be infected with those deadly viruses. No one told us a few simple facts. Most addicts share needles with their friends because they seem all right and healthy to them. I do not even know who gave me HIV and HCV.

Even now, all of my friends still look healthy. None of them was ever counseled or tested for viruses, even though they had had countless bouts of detoxification and rehabilitation attempts in the past, and also countless relapses into drug use. Most of them are still in relapse because they never had a good chance at real recovery due to the limited understanding among the well- intentioned helpers about the addiction recovery process, much less about harm reduction. The process takes time. Most of us don't get clean and recover at our first attempt to stop our addiction.

I have been through addiction treatments given by shamans (dukun), alternative therapists as well as doctors. Medical doctors and psychiatrists only provided me with medications of one sort to another that zonked me out cold, or left me in a temporary drug-induced psychosis, much to my parents' distress. I even tried rapid detox but relapsed after. All these medications have taken their toll on my liver, which was already infected with HCV to begin with.

The medical professionals also missed opportunities to provide me with real help because they did not give me the facts or counsel me properly when I showed up for detox.

The professionals were unable to relate to an addict like me, and reluctant to spend their precious time to counsel me and my family. And they did not even have the real facts about addicts and addiction -- much less about HIV and HCV.

When I was tested, the doctor gave my parents inaccurate information that made them hostile toward me when they found out I was positive for both HIV and HCV.

It was Yayasan Kita in Cipayung that finally gave me and my family the counseling we needed to deal with the pain and damage done by the inaccurate information provided to us by the earlier doctor.

Prevention is needed. However, prevention is only one part of the whole intervention process. Supply reduction, demand reduction and harm reduction have to go together, hand in hand.

Supply reduction is mainly up to the government and law enforcement authorities -- it is good if we can get support from the government to reduce the supply of illegal drugs to Indonesia. Yet demand reduction also plays a very important role. We must continue to educate people about the demand reduction process, especially in terms of prevention, counseling, and providing good recovery programs that are capable of providing real help, rather than quasi help for addicts who wish to stop using drugs.

Even with good supply and demand reduction in place, these two strategies do not reduce the spread of HIV and hepatitis C among IDUs, especially IDUs who are still in active addiction and will not listen to reason. What if these addicts cannot or will not stop using, and are actually infected with a virus and yet continue to share needles because they have not been informed of the dangers, and do not even know whether they have a virus in their system or not. And truthfully, they do not even know where to go to get tested, and they have a lot of fear about stigma and breaches of confidentiality.

I am now in recovery and have been clean for over a year. As an ex-user, I do know that the "culture of sharing needles" among addict friends is "normal". It was not easy for me to stop using. I tried to stop using drugs seven or eight times, through doctors, psychiatrists and alternative medicines. I went through so many detoxification programs, but none of them worked for me, and I kept using and abusing drugs.

I did not get good in-depth information about the viruses at all of the service points I went to for help. I did not even know how to clean needles properly, or why I should even clean needles; I did not know that using bleach was the right way to clean needles for HIV, and yet that bleach does not kill HCV. I did know that I could become infected with HIV from sharing needles or having unprotected sex. But I shared needles anyway because I had no access to clean needles and because I did not think anyone in my drug-injecting circle was positive for any viruses.

And even when I had money, enough for me to buy clean needles, I would rather save my money for my next package of drugs. If I was withdrawing {sakow} from drugs and needed a shot, I would not even bother to clean my needle and syringe. In these kinds of situations, I would just use anything that was available, rinse it with water several times and use it right away. Doing that, I thought, would kill any viruses. I was wrong! But there you go, no one told me these facts! And that kind of information would have saved my life!

Getting good quality information, counseling, outreach and community peer programs and needle and syringe exchange programs are all part of harm reduction programs. If I had been given this information, I might not have HIV and hepatitis C today. I know my mother and father would have much preferred just putting me in a recovery center to repair my physical, mental, emotional and spiritual condition without having to deal with these two viruses in my body.

If you have an addict in your family who is an IDU you will know how often they relapse and how hard you've tried to help her or him stay clean. Would you want them to recover without HIV and hepatitis C? Sure you would! So, teach him or her about these important facts on harm reduction and about drug abuse and the viruses. Other things you should know: total recovery is a process that takes time, and relapse is very common.

And, when they finally comes to their senses and see that drugs do not work anymore, I am sure, like my family, you would prefer your addict to recover without a lingering and deadly leftover effect of his or her drug injecting times, wouldn't you? Take me as an example. Yes, my family is very supportive and happy that I can stay off drugs now. I have changed and so has my family, but wouldn't they be happier if I did not have any viruses? Personally, I know you do not want your loved one to recover with deadly viruses.