The document discusses the HIV/AIDS epidemic among injecting drug users in Indonesia and internationally. It provides three core interventions that can impact the epidemic: needle and syringe exchange, treatment for drug-related problems, and care, support and treatment for injecting drug users. The document also summarizes international experiences with harm reduction programs in Iran, China, and Brazil, noting their public health approaches, investments in addressing HIV/AIDS, and availability of antiretroviral therapy. Adherence to antiretroviral therapy among injecting drug users in Brazil was found to be similar to other international studies.

1. The Indonesian response for the HIV/AIDS Epidemic among and from Injecting Drug Users and its relation with the International response Fifth PCC Meeting in Bandung - 2005 I

2. Injecting Drug Users

4. Adults and children estimated to be living with HIV as of end 2003 Total: 37.8 (34.6 – 42.3) million Western Europe 580 000 [460 000 – 730 000] North Africa & Middle East 480 000 [200 000 – 1.4 million] Sub-Saharan Africa 25.0 million [23.1 – 27.9 million] Eastern Europe & Central Asia 1.3 million [860 000 – 1.9 million] South & South-East Asia 6.5 million [4.1 – 9.6 million] Oceania 32 000 [21 000 – 46 000] North America 1.0 million [520 000 – 1.6 million] Caribbean 430 000 [270 000 – 760 000] Latin America 1.6 million [1.2 – 2.1 million] East Asia 900 000 [450 000 – 1.5 million]

6. The governing body of UNAIDS has agreed a new policy on preventing HIV/AIDS, following tense negotiations in the weeks leading up to the meeting of the UNAIDS board, and at the board meeting itself, 27-29 June: International Support

7. ‘ Regarding preventing transmission of HIV through injecting drug use – the policy calls for ‘comprehensive, integrated and effective system of measures that consists of the full range of treatment options, (notably drug substitution treatment) and the implementation of harm reduction measures (through, among others, peer outreach to injecting drug users, and sterile needle and syringe programmes), voluntary confidential HIV counseling and testing, prevention of sexual transmission of HIV among drug users (including condoms and prevention and treatment for sexually transmitted infections), access to primary healthcare, and access to antiretroviral therapy. Such an approach must be based on promoting, protecting and respecting the human rights of drug users.’ International Support II

8. Needle Exchange in the streets of Jakarta

9. Outreach Work in the streets of Jakarta Conducted by LSM Stigma

10. Puskesmas in South Sulawesi linked to the Harm Reduction Project

11. Methadone Clinic in Bali

12. President Susilo Bambang Yudhoyono on 26/06/2005 supporting methadone expansion

13. Methadone (and buprenorphine as a medicine with a similar clinical performance) are now from July of 2005, on the WHO Model (Complementary) List of Essential Medicines Treatment for Drug Usage

14. HIV SUPPORT, CARE AND TREATMENT FOR IDUs

15. Hospital in South Sulawesi where VCT and ARV are offered

16. Training for Health Professionals is crucial for adherence of IDUs

17. Prison in Bali with the offer of Condons, Bleach and Methadone

18. Working with Police can be crucial for the public health staff reaching drug users

20. International Experience I Iran IRAN

21. Iran has a big land border with Afghanistan one of the biggest heroin productors of the world. In 2000 in the South West part of Iran inmates as well as their families in the community where found out to be HIV positive . Iran

22. A courageous group of doctors started advocacy for politicians and religious authorities that the only hope would be Harm Reduction approach. They got support to implemente NEPs, drop in centers and methadone clinics all over the country and are being respected as a model. Iran

23. Their decision, was followed and coordinated by all levels of Government commitment, including the Legislative and Judiciary Power. Recently the head of the Supreme Court of Ira, sent a letter to all his fellows requesting them to support Harm Reduction (peer education) Iran

24. Iran

25. International Experience II China

26. HIV/AIDS cases repoted in China 1985 - 2002

27. Law Enforcement in China There are severe punishments for the manufacturing, trafficking and supply of illicit drugs, with the overall position of Chinese law enforcement being one of zero tolerance. According to Chinese law drug users must be rehabilitated and consequently the country has adopted compulsory measures as the main approach, with drug users being sent to compulsory rehabilitation centres (CRCs)

28. Public Health Approach Needle and syringe programs are not in operation nationally but as the seriousness of the HIV/AIDS epidemic has become clearer, so the acceptance of harm reduction measures has increased. There has been a shift from describing illicit drug users as "illegal persons" to "illegal patients", demonstrating that there is an emerging understanding that illicit drug use is at least partly a health issue. From 2003, NEPs are being stablished as pilot projects.

29. Public Health Approach The main advance in the Harm Reduction approach is related to the expansion of Methadone avaiability. China decided in 2004 by their Ministry of Health to build one thousand (1000) methadone clinics in the next 5 years.

30. Investments from Government of China to confront HIV/AIDS epidemic

31. International Experience III Brazil BRASIL

33. ARV availability in low and middle income countries, according to geographical region. June, 2005* Source: “Progress on Global Access to HIV Antiretroviral Therapy, June 2005 update, World Health Organization Region Number of people receiving ARVs Estimated need Coverage Sub-Saharan Africa 500,000 4,700,000 11% East, South and South-East Asia 155,000 1,100,000 14% North Africa and Middle East 4,000 75,000 5% Eastern Europe and Central Asia Central 20,000 160,000 13% Latin America and the Caribbean 290,000 465,000 62% Total 970,000 6,500,000 15% (Average) *Adults only, average figures

34. 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 jan/97 abr/97 jul/97 out/97 jan/98 abr/98 jul/98 out/98 jan/99 abr/99 jul/99 out/99 jan/00 abr/00 jul/00 out/00 jan/01 abr/01 jul/01 out/01 jan/02 abr/02 jul/02 out/02 jan/03 abr/03 jul/03 out/03 jan/04 abr/04 jul/04 out/04 jan/05 abr/05 jul/05 out/05 170.000 * Dados preliminares Projected Number of patients receiving ARV therapy. Brazil, 1997 – 2005

35. AIDS cases distribution (%) according to exposure category. Brazil, 1980-2003 * Cases reported up to December, 2003; Source: National STD and AIDS Program/MoH. MSM Hetero IDU Hemo/transf. MTCT 2.4 0.1 25 12.5 66.1 19.0 80 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 0 20 40 60 80 100 12.8 34.2 (%)

37. What we can learn from the International Experience Political will, leadership and coordinated decisions are crucial to face the epidemic