Twin threat of AIDS and drug abuse

Sudirman Nasir, Melbourne

HIV/AIDS and drug use, injecting drug use in particular, are twin epidemics and explosive combinations in many countries in South and Southeast Asia, including Indonesia. Injecting drug use fuels the spread of HIV and other blood-borne viral infections such as Hepatitis C. Risky injecting practices among injecting drug users (IDUs) such as sharing needles and syringes as well as risky sexual behavior, i.e. multiple sex partners and a low level of condom use, are the reasons for the rapid spread of HIV among this group.

Currently, injecting drug use is the major route of HIV infection in South and Southeast Asia, alongside heterosexual transmission. Therefore, UNODC and UNAIDS, bodies within the United Nations to prevent and overcome drugs and HIV/AIDS, decided on "value yourself, make healthy choices" as the theme for the June 26 International Day Against Drug Abuse and Drug Trafficking. Both organizations address the urgency of sustainable education, prevention and care programs for young people, since youth between the ages of 14 and 28 are the most vulnerable to these twin epidemics.

UNODC (2004) estimates there are 14 million to 16 million regular drug users in Asia and at least 6.5 million of them are IDUs. There are 4.5 million IDUs in three countries alone, i.e. India, China and Indonesia. There are millions of people living with HIV/AIDS in South and Southeast Asia and these regions will be the next epicenter of the pandemic unless more serious action is taken.

The Indonesian Ministry of Health stated there were 3,368 HIV- positive cases and 2,682 AIDS cases in the country. Nevertheless, due to poor surveillance in Indonesia, those numbers are merely the tip of the iceberg. WHO and UNAIDS (2004) estimated that in 2003 there were 53,000 to 180,000 people living with HIV/AIDS in the archipelago.

Since 2001 Indonesia's classification has been shifted from "low prevalence" to "concentrated prevalence", meaning that HIV is present in over 5 percent of members of vulnerable groups. Riau, Jakarta, West Java, East Java, Bali and West Papua are provinces with the highest number of HIV/AIDS cases in the country. The Indonesian National AIDS Commission estimates that there are 12 million to 19 million people at risk of HIV infection. This is reasonable since many of the factors responsible for the spread of HIV are present here, such as poverty, unemployment, gender inequality, social disconnectedness, large scale prostitution and drug use.

Accurate data on the number of drug users and IDUs in Indonesia is hard to obtain due to its clandestine and illegal nature.

In the meantime, USAID (2003) reports that HIV prevalence rates among young urban IDUs are critical, particularly in Jakarta (45 percent), West Java (45 percent) and Bali (53 percent). These circumstances need to be seriously addressed since once HIV infection comes into the IDUs population, infection rates can rise exponentially, up to 40 percent, in one year.

For biological reasons, women are approximately four times more susceptible to HIV than men. Women also generally have less power and status than men, which facilitate higher-risk situations for the spread of HIV.

Women's dependency on men economically and culturally means women have less ability to negotiate with men to guarantee safe sex encounters. Furthermore, many studies maintain that once drugs are established among women, sex work (exchanging sex for drugs or money) frequently becomes a means to sustain the habit, pushing many women to become trapped in a vicious cycle and making them more vulnerable to HIV infection.

It is such a truism in public health that once HIV and drug use affect women severely, it becomes a threat for the whole population due to women's crucial reproductive role. We cannot win the war against these twin epidemics without taking into consideration women's vulnerability.

Sudirman Nasir, a postgraduate student at the University of Melbourne, is writing a thesis on The drug subculture and the social context of HIV-risk behaviors among injecting drug users in Makassar.