Adisti Sukma Sawitri and Anissa S. Febrina, The Jakarta Post, Jakarta
They say it is all downhill when drugs start to take hold, but ""Anton"" has come out the other side.
His eyes sparkle when he talks about his wife and 5-year-old son.
""My counselors said I could spend this Christmas with my family,"" said the former injecting drug user (IDU) with a big smile.
Anton has spent the past six months in a Drug Addiction Treatment hospital (RSKO) and Halmahera rehabilitation house in Cibubur, East Jakarta. At times his life has hung in the balance, due to drug addiction and AIDS.
He is among the 1,554 IDUs with AIDS in Jakarta, a population that makes up almost 70 percent of AIDS cases in the city.
According to the Jakarta chapter of the National AIDS Commission, there is an accumulative number of 1,500 cases of HIV infection and 2,206 of AIDS -- including the 1,554 IDUS -- in the city.
Of the total number, 369 have died.
Its latest estimation reveals there are between 190,000 and 247,000 IDUs in the country. The national prevalence of HIV among IDUs has climbed to 41.6 percent, a significant increase from 26.76 percent in 2002.
Jakarta, with some 27,000 IDUs, has the highest HIV prevalence at 51.71 percent.
Considering the sharp increase in prevalence, harm reduction efforts, including methadone treatment and clean syringe programs, are desperately needed to contain HIV/AIDS.
Methadone, a synthetic opiate developed as a painkiller by German scientists during World War II, is medically used as a legal substitute for heroin in treatment programs for drug dependency.
It mimics many of the effects of opiates such as heroin and its maintenance programs are intended to reduce the risks associated with heroin addicts who use illicit sources for their drugs.
It is presumed that these risks -- such as heroin overdose, HIV or hepatitis infection from shared syringes, and risks associated with the need for criminal activity to fund illicit drug use -- are reduced if addicts receive a daily supply of methadone as a substitute for illicit heroin.
Halmahera house program director Minardiantomo said that drug users with HIV were more fragile both physically and mentally, and often relapsed.
""Some of them lose their will to live. Others simply are not strong enough to follow the rehabilitation program since they have to stay in bed all day while we are lacking in people who can look after them carefully,"" he said.
As 60 percent of 31 patients treated at the house are HIV-positive, he hoped programs in rehabilitation centers could be combined with harm reduction programs so that patients could feel more comfortable.
Asliati Asril, the head of RSKO's methadone treatment center, said that once a person had tried heroin or opium they would crave it for a long time, even for the rest of their life.
""That is why methadone is important for HIV patients because they can concentrate on fighting the virus instead of craving drugs all the time,"" she said.
In Indonesia, methadone was first distributed legally in 2004 with the establishment of two treatment centers at RSKO in Fatmawati, South Jakarta, and at Sanglah hospital, Bali.
Despite the increasing number of injecting drugs users in the capital, it took almost three years to establish a second center in Tanjung Priok, North Jakarta, this year. The Health Ministry plans to build two more centers in Jatinegara, East Jakarta, and Gambir, Central Jakarta, in 2007.
Asliati acknowledged the government had been slow in providing these facilities in Indonesia.
""It takes 75 to 80 percent of IDUs who substitute drugs for methadone to curb the number of HIV patients in the city,"" Asliati said, adding that IDUs with the disease needed a special and integrated treatment program to help them combat their illness.
There are 79 recommended hospitals that provide HIV treatment, but little training is being given in home-based family care or there is no intermediary between hospital and home-based care .
In a newly drafted national policy on harm reduction for HIV/AIDS, the government has set the target of reaching 80 percent of IDUs by 2010.
""We are scaling up the provision of methadone and sterile needles to community health posts across the country. Next year's target is reaching out to 50,000 IDUs,"" National AIDS Commission harm reduction program officer Inang Winarso said.
With such a target, the government and donor bodies have set aside Rp 45 billion in 2007 alone for the provision of methadone, which is still imported from New Zealand and Switzerland.
The combination of methadone and needle syringe programs is hoped to save the economic cost of treating more HIV/ AIDS patients as well as more fatalities.
The National AIDS Commission estimates the country could save up to 150,000 lives threatened by the disease a year, as well as Rp 182.8 billion.
Methadone and needle provision is inarguably an effective method to prevent the spread of the virus among IDUs and the people close to them.
However, while methadone maintenance does represent a low-cost form of treatment for opiate addicts, it offers little or no incentive for an addict to stop taking drugs.
