Putaw and HIV/AIDS: The crisis worsens across the country
David and Joyce Djaelani Gordon, Contributors, Jakarta
Recently, four addicts, putaw (low-grade heroin) users, undergoing treatment for recovery from drug addiction in Makassar, South Sulawesi, were tested for HIV/AIDS. (The testing was consensual and was part of the program.)
Three of the four tested positive for the virus. In late 2004 another group of addicts in Makassar was tested for HIV/AIDS: The results were nine out of 12 tested positive.
While these sample tests are small the rate of infection is very high at 75 percent. In talking with the most recent group tested, each mentioned that they had friends that were also addicted, and all had been sharing needles together.
There is now ample reason to believe that as more individuals test, a continuing (high) rate of infection will be discovered. This data is extremely alarming, and these figures and facts foretell future trends.
In these current times it is both well-known and documented that when the "addicted population" of any country reaches the level of 10 percent HIV/AIDS positive, the virus "explodes" throughout the country.
This finding in Makassar represents hard data, and confirms that putaw addiction has now become a full-blown crisis, and that HIV/AIDS is now a full-blown-epidemic.
Whole nation affected
We believe that Makassar is not a unique example; it differs merely because people there can monitor what is happening, and report such findings. These findings, taken together, substantiate that both addiction to putaw and HIV/AIDS are spreading throughout other islands, and thereby, the nation.
Huge increases in drug use/abuse/addiction (especially the use of putaw and shabu shabu) and rapidly increasing rates of HIV/AIDS infection are now evident in Bantam, Medan, Bandung, Yogyakarta, Surabaya, Singaraja, Makassar and Merauke.
Taking South Sulawesi as an example, families are bringing in youth and family members from rural districts and small towns to provincial hospitals and recovery centers -- so we are able to verity that both addiction to putaw and HIV/AIDS are spreading outside of the main cities.
Trafficking routes for drugs and lines of progression for HIV/AIDS can now easily be defined and mapped across the nation.
This data also highlights another truth: If we are (currently) unable to contain and reduce the spread of drug abuse and addiction, and the increase in HIV/AIDS infections within the most densely populated (better educated) areas of the nation, how are we going to be able to thwart either in the smaller and more remotely populated (i.e., lesser educated) areas?
'Putaw' "culture"
Putaw is problematic: It takes away (dissipates) all forms of pain, anxiety and stress while, at the same time, gives one a sensation of euphoria -- of calm and relaxation, along with an enhanced feeling of well-being -- which lasts for several hours.
It is a drug that is most often used in the company of others. Putaw is most often used in small groups, in which individuals seek out the substance from dealers and share the drug with others within their group. Today, the majority of putaw users/addicts use needles, and they regularly share needles with one another.
Needle-sharing is, in itself, also an interesting feature because it is an inherent part of putaw "culture": Sharing needles strengthens bonds and emphasizes the rite of passage involved in the activity.
Injecting is also the most efficient way to become infected and transmit the HIV/AIDS virus.
Drug abuse and addiction to putaw has now spread to all sectors of the population, as has HIV/AIDS. Drug addicts, especially injecting drug users (IDUs), sex workers, those in prison and those referred to as transients and migrants remain at the top of the nation's list of "high-risk" groups.
Although each of the above groups includes both males and females, new data indicates that women in high-risk groups are highly susceptible to drug abuse/addiction and becoming infected by HIV/AIDS.
This drug and virus crisis might be better understood if it were perceived as a smaller, less visible form of earthquake or tsunami, yet it occurs far more frequently, and is much more powerful and destructive.
Each and every day, across the entire nation, destruction and death are a direct consequence of addiction to putaw, and of AIDS.
Putting crisis in its context
The number of people infected, and those who will become infected, those who have died, those who are dying and those who will die from drug abuse and the virus is far, far greater in totality than the deaths caused by earthquakes and the tsunami.
Drug abuse and addiction to putaw have steadily increased since the early 1990s, and presently rage, uncontrolled and uncontrollable, across the nation. Estimates of individual abuse and addiction to drugs (mainly putaw, shabu-shabu and alcohol, followed by ganja, ecstasy and tranquilizers/barbiturates) now total millions.
HIV/AIDS is increasing at a great rate across the country; estimates range from 150,000 to 500,000 infected people. While numbers vary of total individuals infected with the virus, it is generally agreed that by 2010 more than one million Indonesians will be infected with HIV/AIDS.
Even as some departments within government, non-governmental organizations, medical, health and welfare departments, education departments, religious communities and the private sector are evolving ideas, education and training and plans of action, and some are providing action & programs -- still the nation, as a whole, remains categorically weak and far behind in combating addiction and HIV/AIDS.
Importance of education
The only combative resources that have an opportunity to engage these massive destructive forces, face to face, are education, intervention and harm reduction.
Education is the most logical defense that can be used today when fighting the spread of HIV/AIDS. Education is the least costly, most effective, most intelligent and readily available weapon we maintain when addressing the issue of prevention.
There needs to be, as quickly as possible, an initiative that specifically provides direct, open and honest education on drug use, abuse and addiction, HIV/AIDS, hepatitis and tuberculosis.
There also needs to be education on sex, sexuality and welfare, and issues pertaining to gender as part of the curriculum in all junior and senior high schools and universities across the nation.
Trained facilitators and peer-educators should teach the teachers and educators, and then the teachers and educators should teach the students. This is the most pragmatic approach that can currently be developed.
With putaw users, abusers, addicts and other individuals already infected with HIV/AIDS direct intervention (outreach) and harm-reduction strategies, techniques or programs, along with aftercare services and programs, and self-help programs and curriculums, must be entirely utilized.
The connection between putaw and HIV/AIDS is no longer an academic concept: It has already become a harsh reality that demands appropriate action be taken immediately.
(The writers are directors of Yayasan Harapan Permata Hati Kita and can be contacted at Villa Pandawa YAKITA, Jl Ciasin No. 21, Desa Bendungan, Ciawi, Bogor, Jawa Barat, (PO Box 126, Bogor), tel. (0251) 243069/243077, e-mail: wisma_srikandi@hotmail.com, website: http://www.yakita.or.id)