Indonesia: The Jakarta Post (Indonesia), 13 October 2004

A developing crisis in Indonesia

By Meiwita Budiharsana, Ford Foundation. David & Joyce Djaelani Gordon, YaKita

HIV/AIDS is growing at an alarming rate in Indonesia. One of the main ways in
which it is spread is through the sharing of infected syringes by injecting drug
users (IDUs).

In these three related articles the spread of HIV/AIDS is examined, as well as
the role of the police and of corrupt officials in the distribution and
circulation of illegal drugs in the country.

HIV/AIDS now infects one new person every 15 minutes, of every day, somewhere in
Indonesia.

This means there are some 96 new cases per day, 672 per week, 34,944 per year.
These figures are growing daily.

New infections are documented daily in Jabotabek, Bandung, Yogyakarta, Surabaya,
Bali, Makassar, Medan, Bantam, Papua, from Sabang to Merauke.

HIV/AIDS has crashed through the entire governmental protective structure, the
defense line of health, welfare, medical institutions and organizations has
breached the security of both the police and military, and casts aside beliefs
and values of the religious community.

It now threatens the social system from palace to kampung, a foreseeable portion
of economic development and stability is in jeopardy, has given rise to another
meaning for malu -- a destructive attitude of guilt and shame within the
Indonesian culture, and has witnessed "damage" to the heart of many families.

The main "target" of HIV/AIDS is young males and females, sex workers and those
having random and unprotected sex, drug abusers and addicts, those in jail and
large quantities of those employed in large-scale industrialized businesses and
migrants/transients.

That means millions are in jeopardy, as they are open and vulnerable targets to
HIV/AIDS. And from those who are highly at risk, and become infected, they are
the ones that most often pass the virus to the unsuspecting multitudes of
others.

These include wives and lovers, boyfriends and girlfriends, and those in casual
and sexual relationships.

If the government is unprepared to produce a workable defense against HIV/AIDS,
it means the entire medical community is unprepared to meet the needs and
treatment of those stricken with HIV and AIDS, and related illnesses and
problems.

In turn, that means the entire "school system" is without proper or adequate
educational instruction, data, materials and instruction.

Taking all this into account, it means "much" of the entire Indonesian
population is wide open, nearly defenseless, against the spreading HIV/AIDS
pandemic.

In the mid-1990s only a few thousand were recorded as infected with the virus;
by 2000 it was tens of thousands; today, hundreds of thousands.

"Education" must be targeted at the general population, families, the most
reasonable and responsible lines of defense.

Fathers and mothers must lay aside their embarrassment and fear of the unknown,
stop stigmatizing and discriminating, learn the truth between fact and fiction,
and realize that HIV/AIDS must be declared a family and community issue.

Putaw (low-grade heroin) and shabu-shabu (methamphetamine) are presently the two
main choices for drug abusers and addicts, throughout most populated areas,
across the nation.

Both are injectable. Injecting is the most efficient way to transfer the virus.
Unprotected sexual intercourse is the second-most effective way to transmit the
virus. Young people are attracted to drugs and drug culture because of fun and
the thrills.

Sex is part of the fun, excitement and thrill, and is in large part why the
young are attracted to drugs.

Only a few short years ago, we, as a nation, ignored the possibility of HIV/AIDS
being harmful to our population. Then, as we began counting the infected, we
thought it would only infect and affect "gays, the unclean and outsiders".

Then, as it spiraled rapidly upward, we thought it would mostly infect drug
addicts, prostitutes and those at the bottom of the economic ladder.

Today, as a horrible homage to the reality we are praying that we lose only one
generation of young people, not two (or more).

The discovery of students, young women and men in the universities infected with
HIV/AIDS has been shocking and has brought rapid attention to parents and the
parental community -- parents who only a few years ago did not even know what
HIV/AIDS was.

Parents, multitudes of parents, from Sabang to Merauke, are now seeking help and
advice on HIV/AIDS. Yet reliable and definitive advice remains elusive for most
of the nation; doctors, hospitals, specialists, experts and medication are all
still haphazardly scarce.

Parents and those in authority, religions, educators and the War on Drugs all
say "Don't use drugs!" yet multitudes of people around the world still use
drugs, while the War on Drugs lost position and respect a decade ago.

The supply reduction approach says "stop trafficking, dealers and production,
destroy crops and laboratories that produce the drugs, and put the dealers in
prison or execute them, enact more reliable legislation".

Demand reduction says "produce more information, education, communication,
hotlines, peer programs, counseling, outreach, treatment, 12-step programs,
advocacy".

Harm reduction says, "teach people about the effects of drug abuse and people
will be more sensible about how they use them, what they use, and with whom they
use them.

"They will adopt a common sense attitude ... Establish more risk reduction
programs, testing & counseling, treatment & clinics, hospitalization,
therapeutic communities, HIV/AIDS education, hospices, family aftercare".

All the reduction programs are sensible, well-structured, wizened by time and
experience, and well-known worldwide, yet ... while each "reduction" approach
has achieved some success, in reality the success is found to be minimal.

Afghanistan and Myanmar (and Colombia and Mexico) are growing more
heroin-producing poppies than ever before. Putaw is easily located and purchased
(because of well-developed trafficking routes and systems) in most densely
populated areas of Indonesia.

Use of ecstasy and shabu-shabu is rapidly increasing with young people. (Both
ecstasy and shabu-shabu are now being produced, in large quantities in
Indonesia.)

More and more (mostly young) people are becoming drug users, as growing numbers
of young people, from junior high school age, are turning to drugs for fun and
excitement.

More marijuana and alcohol is being used than ever before across the nation.

More outreach, recovery, treatment and aftercare programs are available than
ever before, yet residencies are declining in many treatment centers and
facilities due to high costs, relapse and lack of aftercare plans & programs.

More individuals are being convicted of crimes, directly related to drugs and
being sentenced to prison than ever before.

Low awareness among medical professionals is obviously shown by their limited
knowledge of the meaning of terms like "user", "abuser", "junkie", "IDU", "CD 4
count", "antiretrovirals", "detoxification", etc.

All these are "words" that need definition, education and training to realize
and understand when confronting HIV/AIDS and issues related to the virus.

Many opportunities are missed when some clients and/or IDUs who are
HIV-positive, are not informed of their status and are sent home without any
counseling or adequate information regarding testing and treatment alternatives.

A few weeks ago a 28-year-old man died of cancer, caused by AIDS-related
complications.

A few weeks ago a 24-year-old woman, who was six months pregnant, died of AIDS,
so did the unborn child.

A couple days ago a young man of 21 years died of AIDS.

A month ago, a couple, both with HIV, and both taking antiretrovirals, gave
birth to a child. Now is the waiting time to see if the baby will be infected
with the virus.

Young people with HIV and AIDS are getting married ... Some of the partners know
their partner is infected with HIV, and marry for love and wanting to be with
the partner under any and all circumstances.

Others marry, yet do not know their partner is infected with the virus (often
the parent knows, but ... does not say anything to the partner or the partner's
parents).

At present there is no hospital in Indonesia directly devoted to work with those
infected with HIV/AIDS (or Hepatitis).

Testing sites for HIV/AIDS remain limited across the nation.

Confidentially remains an issue of anxiety and significance.

The spread of tuberculosis (TB), as a result of AIDS is increasing rapidly. TB
is airborne, which means anyone can become infected. TB is transmitted like a
cold or flu.

Each of us must do our part, learn about HIV/AIDS, confront the issue and
related issues at home, and in our own communities.

Yayasan Harapan Permata Hati (Yakita) is a non-governmental organization
involved in drug prevention and the rehabilitation of drug addicts.

It can be contacted at: Villa Pandawa YAKITA, Jl. Ciasin No. 21, Desa Bendungan,
Ciawi, Bogor, Jawa Barat, (PO Box 126, Bogor) tel. (251) 243069/243077
wisma_srikandi@h... http://www.yakita.or.id
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A posting from HIV-News-AsiaPacific