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.