Supporting people who inject drugs in Indonesia
If you inject drugs and are living with HIV, then you will need some kind of care and support to stay healthy and safe and not spread HIV to others. In Bandung, Java in Indonesia, our partner, a community-based organisation called Rumah Cemara, is providing just that kind of support. Among other things, it works in prisons with inmates who are HIV positive, and also runs a methodone support programme for other people who use drugs in the community.
It is part of the Community Action on Harm Reduction project; an ambitious five-country programme to provide HIV prevention and care services to people who use drugs. We focus on building the capacity of local community-based organisations and sharing knowledge about what works.
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 to provide 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.
Support provides individuals with life skills and includes building their ability to manage their dependence on drugs and their HIV status. 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 treatment has been proven over and over to prevent HIV transmission.
Methadone Therapy for people who use drugs
Local authorities introduced Methadone Maintenance Therapy (MMT) in Bandung in 2007 to reduce the dangers associated with injecting drugs. The greatest harm that comes from injecting drugs in Indonesia is HIV transmission. Methadone treatment replaces the need for opiates, and so people stop or reduce using drugs. This means they stop or reduce injecting. Methadone treatment has been proven over and over to prevent HIV transmission, and it also improves health in other ways as people stop injecting themselves. Neither do people need to find money to buy drugs.
The methadone clinic is located in Bandung at the Hasan Sadikin hospital, near the ART clinic. This helps to provide integrated services, which is important as one of the main drivers of the HIV epidemic in Indonesia is injecting drug use. Of the 210 people who have received services from the clinic, 78 active clients come on a regular basis.
Many reasons contribute to this high dropout rate. For example, some clients taking methadone experience very little change to their lives as they continue to take drugs. Some people 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. The police target the area knowing they will find people with drugs on them and 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.