While
drug abuse is a broad problem encompassing many
potential causes and consequences, both personal
and societal, the problem of associated HIV infection
is becoming one of the primary concerns due to
the rapidly rising proportion of HIV/AIDS cases
that are linked to injecting drug use. According
to a 2005 study by the National Narcotics Board
( BNN ) and the University of Indonesia, approximately
1.5 percent of Indonesia's population ( 3.2 million
people ) abuse drugs; 25 percent of them by injecting.
Furthermore, 60 percent of these injecting drug
users ( IDUs ) are estimated to be infected with
HIV. In the same study, the Communication and
Information Technology Ministry estimated that
15,000 people die each year in Indonesia due to
drug abuse, either from overdose or from AIDS.
In addition, according to an article on the BNN
website ( www.bnn.go.id ), 2006 saw more than
15,000 cases of secondary school students who
were "victims of illegal drugs", with
over 4,000 among junior hih school students and
over 11,000 among senior high school students.
The first case of HIV due to injecting drug use
( IDU ) was reported in 1993. According to the
Health Ministry, only 1.1 percent of all known
HIV/AIDS cases by December 1995 were due to IDU,
but by December 2000 this figure had risen to
6.4 percent; by December 2005, it reached 38.9
percent. In 2006, IDU surpassed heterosexual transmission
as the most common mode of transmission among
all cumulative reported cases of HIV/AIDS in Indonesia.
The latest data, compiled through September 2007,
indicates that 49.5 percent of the 10,384 known
AIDS cases in Indonesia ( cumulative, not including
HIV ) are due to IDU. Harm Reduction Harm reduction
has become quite a global buzzword in recent years.
It refers to interventions aimed at minimizing
the medical and social problems associated with
drug use, such as methadone maintenance and needle
exchange programs. It is not exclusively concerned
with IDUs or with HIV, but with all kinds of drug
use and all kinds of harmful consequences. In
other parts of the world, HR has become a major
thrust of government and community efforts to
combat the problems of drug abuse, within the
context of frustrated efforts at controlling drug
trafficking and dissuading people from using drugs.
Despite being recently embraced by the office
of the Coordinating Minister for People's Welfare,
HR remains somewhat controversial in Indonesia,
mainly due to its different approach from the
more popular demand reduction and supply reduction
programs ( see Part II-sidebar ). Octavery "Very"
Kamil is head of the Injecting Drug Users Intervention
Unit at the Aksi Stop AIDS! ( ASA ) project, run
by the Jakarta-based Family Health International
( FHI ). He has worked for ASA since its inception
in 2001. ASA is funded mainly by the U.S. Agency
for International Development ( USAID ), but also
by The Global Fund to fight AIDS, Tuberculosis
and Malaria and the HIV/AIDS Indonesian Partnership
Fund ( IPF ) of the UK Department for International
Development ( DFID ). The IDUs Intervention Unit
was created in 2005, and it manages 22 non-governmental
organizations ( NGOs ) and two Health Ministry
programs in six provinces -- the latter covering
40 districts and cities.
"The goal of ASA's IDUs unit is to reduce
the spread of HIV among IDUs," said Very,
"thus all of the unit's work is concerned
with harm reduction ( HR )."
The organizations and programs supported by ASA's
IDUs Intervention Unit work on preventing the
spread of HIV and sexually transmitted infections,
assisting with health issues related to HIV infection,
and assisting on addiction problems through rehabilitation
programs, counseling and family intervention.
HR programs include outreach work, needle and
syringe programs ( NSP ), counseling and testing
for HIV, case management and support groups.
Rise of Heroin in Indonesia Although Very's unit
deals mainly with HR among people already injecting
drugs, he and his team also make it their business,
he said, to learn about the drug problem in Indonesia
from every angle.
As Very explained, Indonesia's response to the
spread of HIV began in 1991, when the reported
cases of HIV or AIDS began reaching the double-digits,
but before the emergence of cases linked to IDU.
"Around 1995 to 2000, the availability and
use of heroin in Indonesia increased greatly,"
he said.
The monetary crisis in 1998, with its attendant
lawlessness and loosening of social controls at
the community level, exacerbated these already
growing problems. During this period, Very estimates
that about 70 percent of high school students
in major cities had access to heroin and other
drugs, regardless of social or economic status;
at the same time, the number of HIV/AIDS cases
linked to IDU began to increase dramatically.
But by 2001, Very continued, the country saw a
substantial restoration of law and order. "The
socio-economic profile of IDUs in Indonesia varies
from city to city," noted Very, "and
they come from widely varying backgrounds."
Initially, heroin users were from the upper classes,
but during the heroin boom throughout the 1990s,
its use spread toward greater variation among
users.
According to Very, many users from affluent families
were thrown out, and some middle-class families
were cast into poverty due to the heroin addiction
of a family member. In major cities like Jakarta,
Bandung and Surabaya, he said, many IDUs were
youth from middle- and lower-class families. According
to a survey in late 2006 among clients of the
Kios Atmajaya IDU program in Jakarta, 20 percent
of the sample group were below the age of 23,
and 38 percent had never reached high school.IDUs
who drop out of school due to drug use never complete
their education," said Very.
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