Nation takes solid step against HIV

Nation takes solid step against HIV

Urip Hudiono, The Jakarta Post, Jakarta

Daniel (not his real name), started using drugs when he was in
high school, frequently sharing needles with his friends to
inject the drugs to which he had grown addicted.

Little did he know that the habit exposed him to the dangers
of contracting the AIDS-causing Human Immunodeficiency Virus
(HIV) -- he was diagnosed as HIV-positive a year ago.

"I really didn't realize back then, I just thought of how I
could fulfill my cravings when they hit me, and sharing needles
was just the most practical way at the time," he said.

Daniel, now 23, "clean" and a volunteer at a drug
rehabilitation center, is just one of the many injecting drug
users (IDU) in the country who are vulnerable to HIV/AIDS and in
need of the benefits of a harm reduction program, which would
provide them with clean disposable needles and a methadone oral
substitution treatment to get them off drugs.

The health ministry data shows that from 1987 -- when the
first HIV/AIDS case was recorded in the country -- to December
2004, at least 6,050 people had contracted the virus, of whom
3,368 were diagnosed as HIV-positive and the remainder had
developed AIDS.

The government is aware that the figures reflect only recorded
cases, and agrees with the estimate from experts that the actual
number of people living with HIV/AIDS (PLWHA) is likely to be
much higher -- somewhere between 90,000 and 130,000.

More fortunately, having fully realized the scope of the
problem, the government has moved swiftly to address it -- most
recently, through the Indonesian National Harm Reduction
Conference from Feb. 14 through Feb. 17, which involved
government institutions, the National Police and non-governmental
organizations (NGOs).

The conference was the first of its kind to be held in
Indonesia, and also the first national conference on harm
reduction to be held in Asia.

Coordinating Minister for People's Welfare and National AIDS
Commission (KPA) chairman Alwi Shihab said at the conference that
the HIV/AIDS issue should not only be the concern of a particular
group, as it was a problem for the entire nation, if not the
whole of humanity.

"If we do not address this problem now, then what we will have
on our hands is a national catastrophe, perhaps greater than that
of the recent tsunami disaster in Aceh," he said.

Deputy minister for health affairs and KPA secretary Farid W.
Husain explained that the conference was held due to the
significant increase of HIV infection among IDUs.

"If previously HIV was mostly contracted through unsafe sex as
compared to unsafe injecting drug use, the tables have now
turned," he told The Jakarta Post. "We have to put a brake on it
now, before it is too late."

The conference, Farid said, was a forum for all stakeholders
in the country focusing on HIV/AIDS to share their knowledge and
experience, achieve a better understanding of one another's
activities and further cooperate in establishing a national harm
reduction strategy for IDUs.

For its part, the government has provided Rp 80 billion
(US$8.8 million) of the total Rp 200 billion various institutions
had donated to the program. The government has also allocated Rp
120 billion to execute its 2003-2007 strategy against HIV/AIDS,
which includes campaigns, public education, seminars, harm
reduction programs and the provision of antiretroviral drugs.

"The government has also established a cooperation with two
pharmaceutical companies in producing low-cost, disposable
syringes for harm reduction programs," Farid said.

Commenting on the government's policies in addressing
HIV/AIDS-related problems among IDUs, Palani Narayanan of the
Indonesian HIV/AIDS Prevention and Care Program (IHPCP), which
co-sponsored the conference, said compared to other affected
countries, the government had moved effectively and quickly.

"In many other countries in the world, in Asia, they are still
having problems doing that," Narayanan told the Post. "The
problem is that the drug people think it is a drug problem, while
the health people think it is a health problem, whereas HIV/AIDS
among IDUs is an issue for everybody. Everybody has to understand
each other's programs and find areas where can work together."

Narayanan pointed to the conference's significance, as its
main organizers were the country's two most prominent
institutions concerned with the issue -- the KPA and the National
Narcotics Agency (BNN).

"This shows that there is now a shift of paradigm at the
highest level of policy makers," he said. "I think more and more
now, all the government policy makers are realizing that they
have to work together."

Narayanan explained that in the past, NGOs had been conducting
their own activities, while the KPA, the BNN and the health
ministry pursued their own policies and strategies separately.
Furthermore, NGOs were worried that the police would arrest them
if they implemented needle exchange programs, because the needles
could be used as evidence for drug-related offenses.

"So if we look at the conference, we are very happy that there
are representatives from the BNN, the police, the KPA, the health
and social affairs ministries, universities and NGOs, as it
provides an opportunity for different policy makers -- and also
between policy makers and NGOs -- to come together." he said.

He hoped that a national policy would be drawn up allowing
NGOs to conduct more programs with greater national coverage.

"Coverage is really important if we are really serious about
preventing HIV/AIDS," he said. "The existing harm reduction
programs and pilot projects are good, but not enough, because we
have only been reaching 10,000, or less than 10 percent or so of
IDUs."

He added that many means for outreach expansion existed aside
from NGOs, such as community health centers and hospitals.

Elizabeth Pisani from Family Health International Stop AIDS
Act agreed, saying that pilot projects alone were not enough to
prevent the spread of HIV/AIDS among IDUs in Indonesia, and more
harm reduction projects should be set up in as many places as
possible.

"What we also need now is more commitment, compassion and
courage in carrying out the programs," she said.

Meanwhile, country director for the Joint United Nations
Program on HIV/AIDS (UNAIDS), Jane Wilson, said Indonesia was the
only country in Southeast Asia to have implemented comprehensive
pilot projects for IDUs and HIV, as well as being the only large-
population country globally that could prevent a generalized
epidemic of HIV/AIDS.

However, UNAIDS estimates that Indonesia has only three years
to make this happen, as it is among those countries seriously
affected by the global HIV epidemic, which has infected some 39.4
million people as of 2004.

The health ministry estimates that PLWHAs in the country will
number about one to five million people by 2010.

"Resources will double in 2005, but the question is how we can
make these funds work for the people," Wilson said, stressing the
importance of partnerships between stakeholders in conducting
needle exchange programs and methadone treatment, which have been
proven to minimize HIV infection among IDUs.