HIV upsurge among Indonesian drug-users

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.