The future of AIDS tied up with drug use

JAKARTA (JP): I'm angry! For those who know me, that's not unusual, but this time I'm really angry! Why? I've just come from sitting with four young people who have recently found out that they are HIV positive. That means that the virus which causes AIDS is now multiplying in their blood stream, and some time in the future, maybe in ten years time, they'll fall sick.

There's no cure for them, just hope.

So why am I angry? All of these four young men, two of them brothers both still in high school, became infected by injecting themselves with drugs, using needles that had previously been used by someone else who was already HIV positive. This is the most efficient way of transmitting this virus from one person to another. In many parts of the world, as many as 70 percent of injecting drug users are HIV positive. We don't know what the rate is for Indonesia -- no one is checking -- but we suspect that it's already well above 10 percent.

But why should I be angry? Surely it's their own fault! After all, they're only addicts, junkies. The world is better off without them! I hope I don't hear you saying this. Because in Jakarta now, there are probably over 100,000 junkies injecting themselves three times each day with heroin. Mostly young people under the age of 20 -- just like my four friends. Most of them are not bad, just misled. Misinformed.

Misdirected. They didn't set out to become addicts, let alone to become infected with HIV. Led astray by their friends -- did it never happen to us when we were their age? We were lucky! Hard drugs like heroin were not common then, and AIDS had not been heard of.

What makes me angry is our response to this terrible dual plague. As I travel around Jakarta, everywhere I see banners proclaiming this district "free of drugs", encouraging the residents of another to declare war on drugs, to get rid of drug users. Would that it was that easy! Many of us know how difficult it is to stop smoking -- we've tried for years, become expert -- but we expect our kids to just say no to the much more addictive substances which we've allowed them to get hooked on. It just ain't realistic! OK, it'll work for some kids who have yet to try them. But what are we doing for those who can't say no? Do we offer them treatment, rehabilitation, help to clean themselves up? With probably less than a thousand places in treatment centers in Jakarta, clearly that's not an option for many. And most of the centers are there to make a profit, and so charge high prices, far beyond the pocket of addicts from the lower layers of society.

So we allow the police to hassle them, to make life even more difficult for them. Lock 'em up? How does that help? Even if there were enough places in the prisons, is that really what we want to do with 16-year-old kids? Send them to the one institution that will really turn them bad? Sounds like a lousy idea to me.

You may say my four young friends are lucky. They'll probably get to live for at least another 12 years -- if they stay clean. But every day, one or two of their mates die in Jakarta of an overdose. Hospital emergency rooms don't know how to treat overdoses; they don't have the time or the medicines to save them. Many die at home, because no one knows how to give first aid, and the ambulance service -- well let's forget the ambulance service, you're better off waiting for a taxi in a thunderstorm.

It's time that we realized that these kids are not just going to say no, they are not going to give up their habits. Lecturing them, holding seminars, putting up banners, none of these are helping these kids.

What we need to do is to help them to get through this phase, even though it be a long phase, while limiting the harm they do to themselves -- and to others.

What types of harm are they? How can we reduce them? Perhaps the first thing is to reach out to them, not just ostracize them. We must offer them the means to continue their habits, bad though those may be, in greater safety. We must reduce the likelihood that they will become infected with HIV -- and then pass this on to their sexual partners and thence to their own children. We must recognize that our community is harmed by the approach that only considers law enforcement, and does not recognize that drug use is also a public health matter -- one that can be addressed by relatively simple, if certainly controversial means.

Thus far, there has been no sign that we are even ready to start a dialog about harm reduction. There is little evidence that we really give a damn about these kids. And that's what makes me angry!

As we approach World AIDS Day, let us be fully aware that the future of AIDS in Indonesia is inextricably tied up with drug use. Unless we take action today, unless we start to think about the options today, Indonesia will go the way of Thailand, of Vietnam, even of Myanmar. We cannot wait for eradication of drugs, even if we foolishly hope that this multimillion dollar business will go away just like that. Our kids will continue to be tempted by drugs, and some -- too many -- will succumb. We must provide an environment in which they can come out from behind this terrible shadow without having their lives permanently blighted.(Chris W. Green)