HIV upsurge among Indonesian drug-users
Viva Goldner, The Jakarta Post, Jakarta
With the number of injecting drug users (IDUs) on the rise, Indonesians must prepare themselves to accept the realities of HIV/AIDS or face an imminent AIDS epidemic in the coming years.
A recent report by the Australian Centre for Harm Reduction (CHR) titled Revisiting the Hidden Epidemic revealed that half of Indonesia's estimated 1.3 million to 2 million drug users regularly inject, with 60 to 80 percent of IDUs aged between 16 to 25 years.
By September 2001, 19 percent of the 2,313 reported cases of HIV/AIDS in Indonesia were transmitted via injecting drug use, compared with less than one percent of reported cases prior to 2000, according to the Ministry of Health.
However, non-governmental organizations estimate the actual rate of HIV/AIDS in Indonesia to be between 80,000 and 120,000 cases, with an estimated 3,000 deaths from AIDS-related diseases in 2000 alone.
Jakarta-based AIDS activist Chris Green said HIV infection was widespread in certain geographical areas and among certain sections of the Indonesian population, in particular among IDUs.
"One expert predicted that it was too late to stop more than one million cases of HIV/AIDS from injecting drug use within the next two years, although if we move fast with intervention, we have the potential to stop the next two to three million cases," Green said.
In Indonesia, drugs are readily available from food stalls, shopping malls, beauty salons and university campuses in many parts of the country.
Green said harm reduction programs, which include providing users with clean needles or substitute drugs, were urgently required to stem risk-taking behavior among IDUs, such as sharing syringes and failing to sterilize injecting equipment.
He said an essential part of harm reduction was reaching out to users, who are often socially isolated and therefore excluded from the support needed to overcome their addiction.
"There is discrimination within the medical environment, but also within families, who are often poorly informed of the risks because they are led to understand, by the medical profession, that people with HIV/AIDS should be isolated, and use separate utensils," Green said.
Daisy Egamadona, of Yayasan Hati-Hati, said the stigma attached to drug use often prevented those most at risk from obtaining information and accessing services needed to prevent HIV infection.
"We are running a peer support program for people who want to stop using drugs, but we are also doing more harm reduction programs to teach people how to use drugs safely and provide medical support," Daisy said.
She said education and outreach initiatives were proving successful, with more parents becoming involved in helping their children beat addiction.
Djoko Suharno of the National AIDS Commission said there was no specific mention of any drug use policy in the Ministry of Health's 1994 Indonesian National AIDS Strategy.
After the UN General Assembly Special Session on HIV/AIDS in July 2001, an ad hoc committee was formed under the direction of the Minister of Health to revise the strategy to reflect Indonesia's endorsement of the UN Declaration of Commitment.
"The government of Indonesia recognizes that injecting drug use is increasing rapidly and that it has contributed significantly to the spread of HIV in some places in Indonesia," Djoko said.
Recognizing that this was a very sensitive and complex social issue, the Indonesian government has been careful to try to slowly integrate harm reduction approaches through pilot activities that will demonstrate how these can be most appropriately developed in an Indonesian context.
For example, the Ministry of Health last September announced a trial program at the Fatmawati Drug Dependency Hospital in Jakarta, in which the less-harmful heroin substitute, methadone -- taken orally -- would be administered to IDUs.