HIV spreads among IDUs despite campaigns

Tanjung Priok District, where the port is located in Jakarta, capital of Indonesia, is said to have three suns above it instead of one because of its extreme heat in an already hot city. Aside from the climate, the district is also known for its high levels of crime, especially drug dealing.

Eep*, 24, started using heroin when he was in junior high school while Fendi*, 21, had easy access to drugs because his uncle was a dealer and used drugs in his parents' living room. Similar stories are plentiful here.

There used to be few programmes for drug users in Tanjung Priok with activists often describing the District as too dangerous to operate in, but in the past few years clean needle programmes have been introduced, and a methadone [drug substitute used for treating heroin addicts] clinic opened in 2007.

Drugs are a major problem in Indonesia and injecting drug use is particularly rampant. In 2006 the Ministry of Health estimated the number of injecting drug users (IDUs) at between 190,000 and 247,000.

Injecting drug use is also the primary cause of HIV infection: the health ministry estimated that nearly half the 10,384 HIV/AIDS cases reported by September 2007 were IDUs. In "hot spots", like the capital, 72 percent of HIV/AIDS patients are IDUs; in West Java that number climbs to 80 percent.

Inang Winarso of the National AIDS Commission (NAC) said the government had scaled up efforts to prevent HIV infection among IDUs, mainly by adopting a 'harm reduction' strategy.

Harm reduction can be broadly interpreted to mean anything from safer sex counselling to condom distribution, but in the Asian context it usually means programmes providing clean needles and substitute drugs.

Clean needle programmes only reached 20 percent of IDUs in 2004, but according to the NAC they now reach 80 percent. There are 24 clinics providing methadone maintenance therapy (MMT) at hospitals, community health centres and prisons around the country, with plans to open more in the near future.

A study by the University of Padjadjaran in Bandung, about 100km southwest of Jakarta in West Java, found methadone effective in keeping drug users away from heroin and crime.

Despite the scaled-up efforts, the number of HIV infections among IDUs continues to rise. Recent research found HIV prevalence among Indonesian IDUs ranged between 40 and 90 percent, depending on the area. A study of teenage IDUs by the University of Indonesia's Public Health Faculty revealed that 62 percent of the teenagers reused needles, with one needle being shared by up to 18 people.

Winarso admitted that current efforts were not sufficient: limited facilities, human resources and supplies of methadone, which has to be imported, meant one MMT clinic could only serve up to 150 clients. Another challenge was the lack of available treatment for HIV-positive IDUs. He said many doctors refused to treat IDUs who kept on injecting.

However, Joyce Djaelani Gordon, an activist with the Harapan Permata Hati Kita Foundation, which runs programmes for drug users, said only a few doctors refused to treat HIV-positive IDUs.

"The problem with doctors is an old story," she said. "The [bigger] problem is the IDUs who continue to inject drugs with dirty needles, in dirty places ... so they are easily exposed to infections and other diseases, like Hepatitis C. That's why the progress to AIDS is fast."

Djaelani Gordon said there was an urgent need to scale up clean needle programmes and to provide IDUs with information about how to avoid sexual transmission. "We face an alarming fact, as the IDUs are young and sexually active, and even having kids, so we cannot just talk or focus on clean needles or methadone."

UNICEF estimates that thousands of Indonesian women have been infected with HIV through sexual contact with men who inject drugs.

Sekar Wulan Sari, from the Stigma Foundation, a community-based organisation set up to empower drug users and combat stigma and discrimination, slammed the government's focus on drug users rather than drug dealers. "There have been programmes and campaigns, but the HIV infection rate among IDUs continues to increase because the programmes started late and have been sporadic."

She said the harm reduction policy had been introduced without first conducting a proper assessment to ascertain the different rates of infection in different places, and suggested that "There should be good assessment and regulation before we continue with all the programmes and campaigns."

*Not their real names

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