The Community Action on Harm Reduction project is an ambitious five-country programme to provide HIV prevention and care services to people who use drugs. There is a strong focus on building the capacity of local community based organisations and sharing knowledge about what works.
Indonesia is one of the countries in which CAHR operates, through partner Rumah Cemara - a community based organisation based in Bandung, Java in Indonesia. They work with people who use drugs and people who are living with HIV.
There are a number of different programmes Rumah Cemara runs that are supported by the CAHR project. Two of these are highlighted below.
PRISON PRE-RELEASE PROGRAMME
Banceuy prison in Bandung is one of only a few prisons in Indonesia that detains prisoners with drug related convictions. Rumah Cemara has been working in Banceuy since 2004 and set up a peer support group in 2007 for HIV positive inmates.
The CAHR project specifically focuses on a pre-release programme which provides support to inmates who are in their last month before being released. Rumah Cemara works with the prison’s counselling department to provide HIV prevention information, advice and guidance for inmates who are leaving prison.
The support includes building individuals capacity to manage their dependence on drugs, their HIV status and it provides them with life skills. They are also given information about local HIV prevention and care services and support group details. Rumah Cemara works with prison staff to educate them about HIV prevention, HIV treatment and a harm reduction approach to drug use.
METHADONE THERAPY FOR PEOPLE WHO USE DRUGS
Methadone Maintenance Therapy (MMT) was introduced by the local authorities in Bandung in 2007 with the aim of reducing the harms associated with injecting drugs. The greatest harm that comes from injecting drugs in Indonesia is HIV transmission. Methadone treatment, as a substitution treatment, replaces the need for opiates, and so people who are dependent on opiates stop or reduce using drugs. This means they stop or reduce injecting. Methadone treatment has been proven over and over to prevent HIV transmission, but also to improve health in other ways as people step outside of cycles of unsafe injecting and needing to find money to buy drugs.
The methadone clinic is located in Bandung at the Hasan Sadikin hospital, near the ART clinic which helps to provide integrated services. This is important as one of the main drivers of the HIV epidemic in Indonesia is injecting drug use. However, while there are around 210 people who have received services from the clinic, only 78 active clients come on a regular basis.
Many reasons contribute to this high drop out rate. For example, some clients taking methadone experience very little change to their lives as they continue to take drugs. For some it’s that they have to make the journey every day to the clinic to take their medication and this may require them to travel long distances and pay for transport they cannot afford. For others, they meet people who are still using drugs in the vicinity of the clinic and the police target the area knowing they will find people with drugs on them. This instils enough fear that they stay away.
MMT can help people improve their quality of life but without proper support the chances are limited.
Rumah Cemara through the CAHR project is providing this support for people on MMT. At their offices there are rooms for people to rest after taking their dose at the clinic. They can meet up and get peer-to-peer support. They can hear talks on motivation, self acceptance, health and addiction.
With motivation and confidence MMT clients are showing that they can become role models for other clients. Some of the clients have made considerable progress: moving on in their lives, getting a job and enjoying a stable life.