Turning strategy into concrete action

Turning strategy into concrete action

Drug use, including drugs that are injected, is rampant among
youths in Bali, Bali Provincial Narcotics Agency Rehabilitation
and Treatment Center head Dr Made Molin Yudiasa says.

"A study in late 2002 showed that 35 percent of the Injecting
Drug Users in Bali were HIV positive," Molin said.

The harm reduction approach incorporates a number of
activities, the first of which is counseling.

Dr Satya said people were basically advised not to start
using, but "if they have to, we tell them not to inject but to
use a substitute, namely methadone, which is taken orally so it
reduces the risk of HIV, Hepatitis A and B".

Dr Hanati of the methadone clinic at Sanglah Hospital said
that of all the treatments he had used "this is the one that
clients say is the most effective".

"What we are seeking is behavioral change," she said. "We want
them to be disciplined enough to come to the clinic for their
daily supply of methadone everyday, to refrain from injecting and
to eventually stop using drugs altogether."

So far, the results appear promising. Some clients who worked
in the past have returned to work because they no longer have to
think, "what can I steal this morning in order to get my fix?" Dr
Hanati said.

Dr Amaya Maw-Naing of WHO Indonesia agreed the methadone
projects aimed to provide stability for addicts so they had time
for behavioral changes.

Addicts became stable, less restless, could think better,
could return to school or work, did not need to commit crime for
drug money and family relations usually improved, she said.

Molin said recent commitments by the local government to
support the HRT did not yet include financial assistance. "What
financial support there is is usually given to the preventative
approaches. It is not enough for rehabilitation," he said.

He said a rehabilitation program for one drug user cost Rp 6
million a month whereas the government had decided this year to
allocate only Rp 180 million to support the work of 5 addict
support organizations, namely Kesehatan Bali Foundation, Hati-
hati Foundation, Trijata Polri Hospital, Bangli Mental Hospital
and the Putra Kusuma Foundation.

Two weeks after the introduction of a methadone treatment
project in March, 14 drug users have enrolled in Denpasar, and 30
in Jakarta, lending a cause for optimism on the part of the
experts and health workers. But the question of funding remains
critical, for both the health workers and the clients.

"What happens after this pilot project ends?" said a client.
"What if I became dependent on Methadone, the way I was once
dependent on heroin, and the project is then finished?"

Maw-Naing said the project was a shared responsibility for
many parties, most notably the central and local governments.

UNAIDS assisted in the funding of the methadone project in
Bali and Jakarta, which started three years ago and is expected
to involve some 500 patients before it ends in two years.

"Funds will end eventually," she conceded. "WHO can assist in
the purchase of cheap methadone but WHO wishes to see that (the
government) allocates funds for that purpose."

However, "we'll find ways to continue our support in technical
capacity building."

How long do addicts take to wean themselves off substitute
heroin? "Until they finally decide they have enough strength to
let go of the drug -- this can take two to six months or two
years or even longer," Maw-Naing said.

Dr Wirawan of Udayana University said: "It is our hope that
within 6 months, clients will have the discipline to quit. They
must not think that methadone will always be provided for them.
They have to think when and how they can stop using drugs."

There are criticisms of the programs, including resistance
from some community leaders in Bali who thought the health
workers were basically pushing drugs on the clients, and those
who believed the project was a waste of good money because it
"spoon-fed" drugs to the addicts.

Dr Georg Petersen of WHO Indonesia, however, insisted that
"the cost of methadone is much smaller than the price we'd have
to pay to allow heroin dependence to continue, the social costs
as well because drug abusers steal and do other things to support
their habit."

How necessary is it in Indonesia where the HIV/AIDS
prevalence, at 0.1 percent, is relatively low?

Joint U.N. Program on HIV/AIDS Director Peter Piot recently
warned in Jakarta that the low rate of the disease could also
mask the growing risk of HIV spreading in the country.

Speaking recently at the launch of Indonesia's National
HIV/AIDS Strategy through 2007, Piot said urgent action was
needed to slow the spread of the disease.

"The current low levels of condom use and widespread sharing
of unsterilized needles among injecting drug users can be a
lethal mix for the spread of HIV in the country," Piot said.

According to UNAIDS, the majority of the estimated 90,000 to
130,000 HIV/AIDS cases in the country were concentrated in high-
risk groups, including drug users and sex workers.

"Indonesia must urgently scale up prevention interventions
targeting sex workers and their clients, and injecting drug
users, if it is going to succeed in slowing the spread of the
epidemic," Piot said. "Young people must also be given the life
skills to protect themselves from HIV infection."

Indonesia's National AIDS Commission decided to revise the
National HIV/AIDS Strategy because of an increase in HIV
infections in recent years and to respond to commitments made at
the 2001 U.N. General Assembly Special Session on HIV/AIDS. The
new national strategy outlines six priority areas -- surveillance
of the epidemic; prevention; treatment, care and support of
people living with HIV/AIDS; human rights of people living with
HIV/AIDS; research; and government coordination at all levels.

"AIDS cannot be fought by one sector alone, every part of the
government and every force in society must be harnessed in a
common fight," Piot said. "The challenge now is to implement the
national strategy and to ensure that resources and capacity are
in place so that it can be translated into action." -- Santi W.E.
Soekanto