Harm Reduction in Indonesia Challenges and Opportunities

HIV and Drug Situation

220,000 52%

Stigma Discrimination

Drug Policy

Drug Treatment

HIV care

Harm Reduction Program

Outreach

NSP

IEC

Risk Reduction Counseling

Oral Subtitution

Therapy VCT

CST

Drug Treatment

Harm Reduction Policy

2001 - 2003

• Harm Reduction Projects: Jakarta, West Java, East Java, Central Java, North Sumatera, South Sumatera, South Sulawesi (ASA/FHI)

• MoU between NAC and National Narcotic Board

2003 - 2005

• IHPCP - AusAID

• National Strategy on AIDS, included Harm Reduction

• National Strategy for HIV prevention and care in prison

2006 - 2009

• MoH policy on NSP

• National Harm Reduction Policy (NAC): Tergeting 80% coverage in 2015

• Global Fund R 8 and 9

0

10.000

20.000

30.000

40.000

50.000

2006 2007 2008 2009

IDU Sexual Partner

Cumulative number of IDUs and IDU sexual partners reached

Coverage of Needle-Syringe Program IBBS, MoH 2007

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

Medan Jakarta Bandung Semarang Malang Surabaya National

Perc

en

t (%

)

City

Proportion of IDU receiving Needles and sharing Needles in the past week, by city 2004 and 2007

HIV prevalence among IDUs IBBS, MoH 2007

56

27

56

41

55

37

43

10

0

10

20

30

40

50

60

70

80

90

100

Surabaya Medan Jakarta Bandung

HIV prevalence among IDUs HIV prevalence among new injectors (injecting less than 2 years)

Potencies of Regression

Despite of the acknowledgment as one of the developing

country with progressive Harm Reduction (HR) programming, Indonesia is facing challenges that could

lead to regression.

Challenges for future Harm Reduction Programming

• Sustainability

• Coordination & Transparency

• Conflict of Interest among Civil Society Organization

• Human Right Violation

• Ignorance of existing evidence

• Lack of technical and Managerial Capacity

NSP model accesed by IDU IBBS, MoH 2007

0,0

1,0

2,0

3,0

4,0

5,0

6,0

Medan Jakarta Bandung Semarang Malang Surabaya National

Nu

mb

er

of

Ne

ed

les

City

CHC NGO DIC NGO Outreach Satelite Others

Program quality

• Limited access to drug treatment

• Insufficient number of needle-syringes distributed to IDU

• Issues within MMT

• Quality of counseling within HIV test and counseling for IDU

• Issues within ART

Opportunities

• Stronger Political commitment to HIV/AIDS program from government

• There is enough time to advocate to national and sub-national

government to take over the program funding after 2014 • “Best practice” of the implementation of the program are available

from previous interventions in Indonesia • Increasing commitment of some CSOs to be “watch dog” of the

HIV/AIDS related policies and implementation • Increasing number of CSO which concern on drug policy and

advocacy for drug user rights

Recommendations

• AIDS commission at national and sub-national should focus more on developing coordinating mechanism for multi sectoral players and advocacy of HIV/AIDS budgeting to legislators than on the implementation of projects

• Representative of CSOs in NAC and CCM should be more

responsive to aspirations of civil society • Program coverage is important to be achieved, but the current

program should consider quality of services provided by the implementing agencies

• It is imperative to have a strong CSO network to be able to function

significantly in the course of the program

Thank you