Harm Reduction: A Public Health Response to HIV Epidemic among Injecting Drug Users in Indonesia

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Harm Reduction: A Public Health Response to HIV Epidemic among Injecting Drug Users in Indonesia

  1. 1. Harm Reduction: A Public Health Response to HIV Epidemic among Injecting Drug Users in Indonesia Patri Handoyo Indonesia HIV Prevention and Care Project – Australia Indonesia Partnership
  2. 2. Source: MoH RI, 2006
  3. 3. HIV Prevention and Care to IDU <ul><li>Needle and Syringe Program (NSP) </li></ul><ul><li>Methadone Maintenance Treatment (MMT) </li></ul><ul><li>HIV Care, Support, and Treatment (CST) </li></ul>
  4. 4. No. of article found: Google Scholar
  5. 5. First NSP in Indonesia <ul><li>1999, by an NGO in Bali </li></ul><ul><li>Encountered by law enforcement (police) </li></ul><ul><li>Project based program </li></ul>
  6. 6. First MMT in Indonesia <ul><li>Jakarta and Bali, 2003 </li></ul><ul><li>Two hospitals </li></ul><ul><li>Evaluation result: decrease in criminal activity and drug injecting behavior </li></ul>
  7. 7. CST for IDU <ul><li>Stigmatization for ART adherence </li></ul><ul><li>Adherence can be improved by access and integrating it with prevention program </li></ul>
  8. 8. Considerations to Scale up Program <ul><li>To cover as many IDU as possible </li></ul><ul><li>Cost </li></ul><ul><li>Sustainability </li></ul><ul><li>Legitimacy </li></ul>
  9. 9. Primary Health Center <ul><li>At least one in each sub-district </li></ul><ul><li>Health workers </li></ul><ul><li>Well known health institutions in community </li></ul><ul><li>Part of public health system </li></ul>
  10. 10. What We Have Done <ul><li>Capacity building of health workers for program implementation </li></ul><ul><li>Hospital as primary health center and prison’s program supervisor </li></ul><ul><li>Local and national authorities involvement for the integration to existing health system </li></ul><ul><li>Clients and community involvement to HIV prevention and care program </li></ul><ul><li>Establishing national policy for production, distribution, dispensing, and monitoring </li></ul>
  11. 11. NSP Indonesia, 2007 <ul><li>65 primary health centers, incl. CST for IDU </li></ul><ul><li>1 hospital </li></ul>
  12. 12. MMT Indonesia, 2007 <ul><li>7 hospitals </li></ul><ul><li>9 primary health centers </li></ul><ul><li>3 prisons </li></ul>
  13. 13. Lesson Learnt <ul><li>Program should integrate to existing public health system </li></ul><ul><li>National policy should be made </li></ul><ul><li>Involvement of local and national authorities </li></ul><ul><li>Involvement of client and community to the program </li></ul>

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