Focusing Injecting Drug Users as The Main Root of HIV/AIDS Transmission.

(1)

Focusing Injecting

Drug Users as

The Main Root of

HIV/AIDS

Transmission

Shelly,dr.,Msi

(2)

Background

Indonesia faces Three HIV epidemics:



_{General population in Papua}

through sexual risk behaviour



_{Concentrated epidemic in IDU}

through shared needles



_{Concentrated epidemic in CSW}

through unprotected sex

(3)

Source : Sentinel Surveilance, Indonesia Health Department

Illustration of HIV prevalence among Injecting

Drug Users (IDUs) and Comercial Sex Workers

(4)

Source : MAP, 2005 (http://www.unaids.org/epi/2005/doc/EPIupdate2005_html_en/epi05_06_en.htm)

(5)

Estimation of IDUs population in each province in

2006

Estimation of adult person vulnerable to be infected with HIV in 2006 National report, Health Department & National AIDS commission

IDUs population

(6)

HIV Risk factors in West Java

Source UNAIDS 2006* Source chart: UNAIDS 2006 according to the risk factors form 1989-december 2004

• West Java is in the third highest (Jakarta, Papua)

• 22,000 IDU’s in Province West Java*

• 21% of IDU’s are in prison in West Java;

(7)

Characteristics of IDUs in Bandung

Compare with other countries :

 _{The age are younger (19 y.o)}

 _{Higher education background (85% senior high school or}_)

 _{Type of drug used : alcohol, marijuana, heroin, tranquilizer}

(> 75%)

 _{The most common drug used for injecting is heroin (close to}

100%)

 _{Increasing use of buprenorphine (Subutex ® = opioid agonist)}

 _{Wrong knowledge about cleaning needle (sterile water > 75%)}

(8)

 Needle sharing is 34-39% and sharing injecting equipments

 Still able to use drug in control environment (14,8% in

prison, 3,5% in rehabilitation center)

 High sexual risk behavior (no condom use 52%)

 Sexual partner : partner (88%), CSW (42%), IDUs (25%),

casual (19%), spouse (15%)

 Low number of HIV test (11%)

 Low number of Hepatitis B or C test (10%)

Characteristics of IDUs in Bandung

(9)

Clients MSM CSW

Low risk woman Low risk man

CSW : commercial sex worker; MSM : men sex with men; IDUs : injecting drug users

Transmission HIV/AIDS in Bandung

(10)

Interventions to Control HIV



Increased HIV-testing for risk groups



Harm reduction for IDUs

(11)

Target group

Harm Reduction : Methadone Program

Treatment & Care for HIV/AIDS ( including ART)

Prevention and care Treatment and care

Education

Framework for comprehensive measures to control the HIV epidemic in West Java.

Target group

Harm Reduction : Methadone Program

Treatment & Care for HIV/AIDS ( including ART)

(12)

Harm Reduction Strategies

To Control HIV Transmission

 Safe Injection (Needle & Syringe Exchange Programs)

 Heroin substitution Programs (methadone, buprenorphine)  Education and Outreach Programs

 Condoms to reduce risk of sexual transmission

 Best programs provide combination of preventive and

(13)

Heroin Substitution Program

• Methadone is a ‘synthetic opioid agonist’ 

prevents withdrawal symptoms

• Long acting (15 to 32 hours)

• Taken orally so reducing the injection of heroin

• Reduces criminality*

• Increases health status*

• Reduces depression*

• Decreases HIV transmission by reducing injecting ecreases HIV transmission by reducing injecting

risk behavior and other skin penetrating risk behavior*risk behavior and other skin penetrating risk behavior*

• Reduces the number of sexual partner*_{Reduces the number of sexual partner*}

(14)

CONCLUSION

 _{Indonesia has an explosive HIV-problem driven by IDU}

 _{Need a comprehensive approach}

 _{Sustainability of effective interventions needs}

local capacity building

(15)

(16)

(17)

Acknowledgement

Reinout van Crevel, Lucas Pinxten, Diba Basar

(IMPACT Program (Integrated Management for Prevention And Control and Treatment of HIV/AIDS Bandung, West Java,

Indonesia))

Teddy Hidayat, Bachti Alisjahbana

(Medical Faculty, Universitas Padjadjaran & Hasan Sadikin Hospital, Bandung West Java Indonesia)

Jose Boom

(Radboud University Nijmegen Department NUSI/ Internal Health)

Tamami A Zain

(Yayasan Bahtera Community HIV Prevention Program)

Octavey Kamil

(Family Health International / ASA, Jakarta)

Cor de Jong

(18)

Universitas Padjadjaran

Bandung - Indonesia Hasan Sadikin HospitalBandung - Indonesia CORDAID The HaqueThe Netherlands

Maastricht University The Netherlands Radboud University

(19)

• IEC / Health Promotion about HIV-related risk behavior in adolescents

• Scaling-up HIV-testing & VCT

• Harm reduction (including methadone), for IDU’s

in community, prison & hospital

• Scaling-up treatment & care for HIV/AIDS, incl.

antiretroviral treatment

• Building Capacity, transfer of knowledge to local

professionals to conduct and up-scale the above activities

(20)

 Harm Reduction focuses on reducing the harms related to

drug use rather than eliminating drug use itself. Harm Reduction aims to: prevent the spread of infections including HIV/AIDS, Hepatitis and other blood-borne infections; reduce the risk of overdose and other

(21)

Proportion of HIV new infection among subpopulation in Indonesia in 2020

(22)

(23)

CONCLUSION

Indonesia faces an explosive HIV-problem which is mostly driven by Intravenous Drug Use.

The nature of the epidemic requires a comprehensive approach: integrating prevention, harm reduction, addiction medicine and HIV/AIDS treatment and care and building on both behavioural and medical sciences

Use of local capacity and technical expertise will enable the establishment of effective and sustainable interventions in HIV/AIDS.

(24)

(25)

(26)