Youths exposed to HIV/AIDS through intravenous drug use

By I Wayan Juniarta

DENPASAR, Bali (JP): On Tuesday morning David was informed that once again a young drug-user had died of an overdose, while another young user was dying in a hospital bed after shooting up low-quality heroine.

"This job is not getting any easier by the day. We keep witnessing young guys we know fall prey to a painful death caused by drug addiction. And, I mean, those deaths really ate a big portion of my heart, and made me think a lot," David said sadly.

A field-worker for the Denpasar-based Yayasan Hati-hati Foundation, a non-government organization active in raising awareness among Intravenous Drug Users (IDU) about HIV/AIDS issues, David has witnessed the pain and suffering IDUs have to endure. Yet, nothing had prepared him to face the series of drug- related deaths like the ones that occurred over the last few weeks.

There are no precise details available on the number or the precise causes of death. But David recalls the way three users died in Buleleng regency, North Bali last week. They injected the drug at the same time and three days later they died of an overdose also at the same time.

Low-quality heroine is responsible for most casualties. Drug producers reportedly mixed the drug with other substances so they can sell it at lower prices to cater to the low-income users.

"Most of the IDUs do not come from wealthy families, so the economic crisis really affects their buying power," the foundation chairwoman Yacintha EM Desembriartista said.

Low-quality drugs are not the only threats the IDUs must face. Even more dangerous is the transmission of HIV/AIDS from used and shared needles.

"Users' bad habits such as sharing needles will likely result in HIV/AIDS transmission," Yacintha said.

Data from the Ministry of Health showed that in November 2000 the number of IDUs who contracted HIV/AIDS had reached 238 out of the total 1,559 HIV/AIDS cases recorded in that month.

"We believe that the number will increase and multiply very rapidly unless we succeed in raising the awareness among the IDU community, and also provide them with tools and methods to prevent transmission," Yacintha said.

A 1998 survey conducted in Bali showed that 73.3 percent of users always shared needles with other users and only 13.3 percent of the users did not practice such a habit.

Moreover, although 83.3 percent of them claimed that they knew how to clean a syringe, it turned out that 70 percent cleaned the syringe with water only.

Shockingly, zero percent of users used new needles every time they injected drugs.

The survey was conducted in Denpasar and Kuta by a number of concerned young people including I Made Setiawan, Jane Patten, Agus Triadi, Steve Yulianto, IPG Terryl Adnyana, and M Arief. And, the survey was later published in The 1999 International Journal of Drug Policy.

"Made Setiawan with several other friends afterward established this foundation to specifically address the issue of HIV/AIDS and the IDU's community," Yacintha explained.

The foundation has already launched a number of awareness campaigns and programs on the danger of the HIV/AIDS targeting drug users.

Most of the programs focused on harm reduction efforts, such as introducing the users to the correct and effective way to clean needles and syringes.

There were times when the foundation also distributed free needles, cleaning substance, and condoms, of course, to the IDUs.

"It is not an easy job. The IDU communities are very closed; they do not trust people easily. So you have to win their trust, which usually takes a lot of time, before you can introduce new things and methods to them," David said.

The foundation's compassionate approach toward the IDUs, has often put the foundation in a risky position. It has endured the misperception, suspicion, and prejudice of the local community and the local government, not to mention, the local police.

"One of our volunteer got busted when the police raided an IDUs hide out. There were and are still rumors that young people use the foundation's office as a place to get 'high'," Yacintha said.

Yacintha explained that many people perceived the foundation as a bunch of young people who condone drug using activities. Those people, she said, have ignored the fact that the foundation also provides comprehensive counseling programs to help users discard the dangerous habit.

"Our ultimate aim is to free them from the claws of narcotics and, during the process, we also inform about how to protect themselves from the danger of HIV/AIDS," Yacintha said.

Up to now more than 300 drug users, 176 of them IDUs, have been touched and reached by this foundation's programs. There are approximately 5,000 IDUs in Bali today according to estimates of local police.

Yet, this 27-year-old activist admitted that things are getting better these days, with the police finally acknowledging the foundation's efforts. And the local community leaders now deliberately ignore the rumors and gossip that are frequently targeted toward the foundation.

But, Yacintha also admitted that two years after the 1998 survey the dangerous habit of needle sharing is still widely practiced in IDU communities. The expensive price of needles, and the reluctance of certain pharmacists to sell needles to users are the reasons behind this sad phenomenon.

"I know a user who kept using the same needle until it was worn out, rusty, and, finally broke inside his arm. His arm swelled badly and the needle had to be surgically removed from his arm," she said.

She also described that nowadays drug problems occur both in major cities such as Denpasar, Kuta, and in small villages in Ubud, Singapadu, Celuk, Tabanan, and Negara as well.

"We must act quickly otherwise the habit will claim more of our younger generation in the future," she stated.