Out of the cities: Working with injecting drug users in Indonesia
Most harm reduction programmes - including methadone therapy and needle exchange – focus on the major cities of Indonesia. However, not all injecting drug users live in cities. Reaching out to other more remote places is crucial, if we are to properly address the HIV/AIDS epidemic.
Community Action on Harm Reduction (CAHR) is an ambitious project that aims to expand harm reduction services to more than 180,000 injecting drug users, their partners and children in China, India, Indonesia, Kenya, and Malaysia. In Indonesia, community-based organisations have been implementing programmes in new geographical areas. Two community initiatives have been very effective in bringing harm reduction services to clients who are vitally in need.
PEKA is a community-based organisation based in Bogor city, which has been implementing CAHR since 2011. PEKA made an assessment of drug users’ needs in Bogor regency, the area outside the city. It found a very limited service existed for people who inject drugs, yet it is the biggest regency area in Indonesia with more than 40 sub-districts.
In 2009 an estimated 500 people who inject drugs were living in Bogor regency, particularly in Cibinong district. Cibinong is connected to Jakarta, Bogor city and Sukabumi through railways and other transportation systems, which increases the possibility of drug distribution to the district.
Services for drug users such as providing clean needles and syringes have been implemented effectively in big cities but these services are located very far from the regency area and are impossible for people in Bogor regency to use. Services in local clinics are not effective and the AIDS Commission and other stakeholders have not been very active here. The community in Bogor regency has therefore found it very difficult to access the services they require.
PEKA opened an office in Bogor regency to intervene and provide services for people who inject drugs. It has started to get more information on drug users’ needs and the availability of existing services. Staff interviewed individual drug users, and other stakeholders.
In January 2013, PEKA opened an office in Cibinong district and assigned an outreach officer and volunteers to provide a 24-hour service for clean needles and syringes. These were provided through the AIDS Commission and Rumah Cemara. The office also provides regular meetings for people who inject drugs, educational and information kits, and a drop-in centre service.
“They searched for used needles and syringes from hospitals and dumps.”
In Lombok, AKSI NTB is the only community-based organisation to implement a harm reduction programme. Since 2012, AKSI NTB started working with Rumah Cemara within the CAHR project.This work takes place in Mataram city and has so far reached 128 people who inject drugs.
While harm reduction programmes are of great benefit to people who inject drugs, the project faced a problem in East Lombok: people had to travel for at least two hours to get to Mataram city to access clean needles and syringes. An estimated 120 people inject drugs in East Lombok, ranging from heroin users to liquid diazepam and petidin users. But AKSI NTB found that they searched for used needles and syringes from hospitals and dumps and tried to clean them before they used them.
From early 2013, through the CAHR project, AKSI NTB supported PEDULI LOTIM, a community-based organisation of drug users in East Lombok. Through the CAHR project, East Lombok now has an outreach officer and a volunteer to provide clean needles and syringes. Psychosocial support and regular session meetings provide people with information about harm reduction, HIV/AIDS and drug addiction. Most of the meetings take place at someone’s house, who is a member of PEDULI LOTIM. Occasionally the meetings take place at local clinic in order to develop better relationships with health service providers.
AKSI NTB encourages PEDULI LOTIM to get involved in advocacy to increase services for injecting drug users since they know the community’s needs. AKSI NTB has been providing technical support for advocacy and working with stakeholders especially the AIDS Commission, Health Department, Police Department, Social Department, Hospital, local clinics, Voluntary Counselling and Testing clinic and others. The CAHR project has helped in the advocacy process, especially supporting the position of people who inject drugs to local stakeholders.