Win us to our harm

Are we winning the 'war on drugs'? "New HIV infections among drug addicts [in Indonesia] have dropped significantly in recent years," Ibu Nafsiah (National AIDS Commission secretary) is quoted as saying in an article (Indonesia's Uphill Fight Against Aids) in the Jakarta Globe. Ibu Naf partly puts this down to the success of the authorities in cracking down on heroin use, as well as the distribution of sterile needles, and increased use of methadone.

Let's start by examining the evidence for Ibu Naf's statement. The data from the MoH seems to support it.



However, we should bear in mind that less than 20% of the almost 400,000 people thought to be living with HIV in Indonesia actually know that they are infected. And reasonably reliable data is available only for the 26,483 who have been reported as diagnosed with AIDS. Can this be considered a representative sample from which we can draw accurate conclusions?

On the other hand, there is anecdotal evidence to support the statement. At a recent meeting Ibu Naf noted that outreach workers were finding it very difficult to find additional injecting drug users.  Yes, it is a 'hidden epidemic', but there has been considerable success in reaching these users in many parts of Java.

Further. we frequently hear that drug users are abandoning injected heroin. Some may indeed be migrating to methadone, although only 2548 clients are accessing this service according to the latest MoH report, More are probably using buprenorphine, which is reported to be quite freely available in many places.

But there is fear that more are probably switching to sabu (as crystal meth is known here). This may reduce the risk of HIV infection, but greatly increases the risk of an addled brain, and there is of course no effective substitution therapy for meth addicts.

So, although the evidence base may be limited, it does seem reasonable to infer less people are injecting heroin. But our ill-fated war on drugs just may be causing more collateral damage.

Babé