by Rudhy Sinyo

Recently, Indonesia’s health services have begun to scale
up the implementation of harm reduction in Surabaya. From a positive
standpoint, government support for this program is improving,
though there are down sides as well.

Broadly speaking, public health services are
improving health care provision for injecting drug users. Both service
providers and program implementers are increasingly integrating their  efforts in HIV prevention programs. At the same time,
implementation has not yet included integrating law enforcement agencies and
the general community, let alone improving drug policy. As a result, we can
expect to see problems emerging in the future that will affect the overall
implementation of harm reduction programs. In addition, the lack of active
involvement by civil society through the coordination of the National AIDS
Commission, and the lack of advocacy clout at relevant agencies, will make it
difficult to improve relevant policies.

Other policies will create obstacles for full
implementation of the harm reduction program. For one, beneficiaries must pay a
fee every time they access these services, including syringe services. Although
the nominal cost is pretty small (Rp 2,500, or US25 cents) this still has a big
effect, considering that the drug user community has received free harm
reduction services from civil society for so long. These fees are also not
comparable with HIV programs, which are free of
charge.

Meanwhile, there are some logistical problems
relating to syringe distribution. The needles being distributed need to be
assessed by the government in order to make sure that they
actually meet the community’s needs. Also, the provincial and city health
department has not set a limit or quota for services in each unit that provides
Methadone Maintenance Therapy. In order to encourage patients to use public
health services, hospitals have continued to accept patients without providing
recommendations for referral services to satellite agencies. Some agencies are
therefore overrun with patients who could be accessing services in other parts
of town, and this will affect the quality of service patients can receive.

MMT services are also not yet complete. For
example, during the intake process, until recently health services have not
provided urine tests. Urine tests are standard in the provision of MMT, as a
way to identify whether or not patients are  still injecting drugs. In addition,
clinics that offer MMT are not yet providing psychological counseling or
consultation rooms. This shortcoming combines with the infrastructure of MMT
clinics to make these spaces unfriendly to patients. Some service rooms seem like
prisons, heightening the feeling IDU patients have that they are receiving
a lower standard of care than are other patients.

In sum, it is essential that the evaluation of
health care for injection drug users in this government program be conducted
with full involvement by the beneficiaries, who can help to provide a balanced
view. These views should be solicited and collected not only through research,
surveys and other metrics that evaluate aid projects, but should involve the stakeholders
directly expressing their views at all levels of the program.

The perspectives
of program beneficiaries (in this case, injecting drug users) is important to
the sustainability of HIV prevention, and important in helping to target those
programs effectively. Bringing in the perspectives of program beneficiaries
helps to create a fair process – rather than positioning program beneficiaries
as commodities or objects of assistance by a government program.

Rudhy Sinyo is General Coordinator of East Java Action, www.eastjavaaction.org.