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 Tuesday 13 May 2008
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ASIA: A Cleaner Fix

Photo: David Gough/IRIN
Timotius Hadi (right) was a heroin addict for close to 10 years. Since testing positive for HIV in 2003, he turned his life around and now supplies clean syringes to injecting drug users for Karisma.
NAIROBI, 26 March 2008 (IRIN Film & TV) - Across Indonesia there are an estimated 500,000 injecting drug users. As many as 70 percent of them are HIV positive.

Dece: “Pepin? Pepin? Cik. Where is Pepin? Is he at home?”

Woman: “I think he’s in that house by the small mosque.”

Dece: “Which small mosque?”

Woman: “It’s the white house next to Mingu’s house.”

Dece: “Oh, he’s there is he? Thanks.”

Pepin (off): “I started using heroin in 1998 because of family problems and because many of my friends were using. When I tested positive I never thought of giving up heroin. In fact, I started using even more. Now I just want to die.”

Dece: “Pepin? Hello. Pepin? Where can I find Pepin?”

Woman: “I don’t know. Try going that way.”

Dece (off): “My name is Dece and I have lived here since I was a kid. This area has a lot of dealers selling heroin, crystal meth, marijuana and alcohol. Drugs are easily available and there is a lot of peer-pressure to use.” Between 1993 and 2000 around 50 junkies from this area died of AIDS.

Pepin is 26 years old and has been a drug addict for 10. Four years ago he tested positive for HIV – he caught it sharing needles.

Today, he’s promised friends that he’ll go for a long-overdue medical test, but they’ve heard it all before and reckon he’s more likely to spend the day in search of the next fix.

Dece, meanwhile, has given up looking for Pepin and has come instead to the weekly staff meeting at the organisation where she works.

Karisma runs a needle exchange programme in the Indonesian capital Jakarta, and like Dece, Hadi is one of 12 outreach workers whose job it is to distribute clean needles to drug users. Thanks to programmes like this, injecting drug users need never share or re-use needles – making them much less likely to contract, or spread HIV.

So, every day Hadi and the others head out to distribute clean needles to the networks of users that they’ve built up over the past few years.

Like most of his co-workers at Karisma, Hadi used to be a heroin addict himself. He’s also HIV positive.

Photo: David Gough/IRIN
Although the number of people infected with HIV/AIDS is still relatively low in Indonesia, the country's large community of injecting drug users has been devastated by the disease
Hadi (off): “When I was 15 I started using heroin. At first I smoked it but after a year smoking didn’t work anymore so I started using needles. At first I always used new needles but by 1998 I was sharing needles.

“I felt bad after getting the [HIV] result but afterwards I felt grateful because if I hadn’t known my status then I’d be dead by now – I wouldn’t be a better person.”

Hadi’s first port of call this morning is a nearby health clinic.

Man: “How many are here?”

Hadi: “Ten.”

Man: “That’s not enough.”

Hadi: “Hey, don’t be scared of the camera! We’re not doing anything wrong – it’s just needles.”

The clinic also operates a methadone service – offering a free daily dose of the heroin substitute that helps wean addicts off the real thing. Dozens of users gather here every day but Hadi has a hard time trying to impress on them the importance of knowing their HIV status.

Hadi: “Have you gone for an HIV test?”

Adi: “No.”

Hadi: “Why not?”

Adi: “It’s too much for me – I don’t want to know the result. One of my friends did it but when he got the result he was very depressed. He relapsed and now he’s in an even worse condition. He had already quit heroin but when he got the result he thought there was no point in stopping.”

Hadi: “But do you know about Voluntary Counselling and Testing?”

Adi: “Yes, I know about it.”

Hadi: “And in your opinion, does VCT have more advantages or disadvantages?”

Adi: “I think there are more advantages. By taking VCT we can understand more and get treatment before it’s too late. But what I think is that if it’s already happened then it’s just too bad.”

Hadi: “Are you married?”

Adi: “Yes.”

Hadi: “Do you have kids?”

Adi: “Yes, a one-year-old.”

Hadi: “Won’t you feel guilty if you infect them just because you don’t want to take the test?”

Adi: “Of course I feel guilty but it’s better for me not to know so that I don’t have to think about it.”

Hadi is not a trained counsellor but his own experiences on the street count for a lot with the 150 or so clients that he regularly sees. He understands what they’re going through, and they trust him to provide reliable information.

For Hadi, the methadone clinic is just the start of a long day.

The Karisma meeting now over, Dece is back at home – still waiting for Pepin. Like Hadi, her own history as a drug user means that addicts trust her. That’s why she does so much of her work from home. Addicts know where she lives and that clean needles are always available here.

Dece was an addict herself for six years but kicked heroin in order to nurse her first husband when he fell sick with a drug-related illness.

For her, the work is personal.

Photo: David Gough/IRIN
Thanks to organisations like Karisma, injecting drug users need never share or re-use needles
Dece: “My first husband died of drugs. My second husband is still alive, but he’s in prison for drugs. When he went to prison he was using heroin for at least eight months. I kept telling him: ‘In prison you share needles. Be careful or you’ll catch HIV.’”

There’s not much Dece can do for her husband when he’s locked up behind prison bars but she’s always on hand to help out her neighbours and friends.

Man: “I’m on methadone now.”

Dece: “Hey, did you hear that? He’s taking methadone now.”

Man: “I haven’t taken any drugs since I left prison.”

It’s late in the evening and Hadi is still working. He’s trying to make contact with drug users who are also sex workers.

Tonight he’s looking for Yolanda.

Yolanda: “I started using because of an ex-boyfriend who also happened to be a drug dealer. I broke up with him but by then I was already addicted. Then, since he was no longer around, I had to sell my body.

“I rarely share needles – we usually buy them - but sometimes we are forced to share. If that happens then I only share with friends, but even then we don’t know who’s infected and who isn’t.”

A regular supply of clean needles from Hadi, however, will make Yolanda considerably safer.

Hadi: “I can give you 10 packs of three a week. Will that be enough?”

Yolanda: “I normally buy a box of 12 twice a week.”

Hadi: “So if I give you 30 that would be enough?”

Hadi has also been trying to persuade Yolanda to go for an HIV test but so far without success.

Yolanda: “Of course I’m not brave enough to go for the test. What’s the point? It will just make me more stressed and depressed.”

Unlike Yolanda, Hadi has been brave enough to be tested, but he’s still scared to hope for a normal life.

Hadi: “I’m not brave enough to reach for my dreams anymore. There are a few girls who like me but they’re not HIV positive. They can stay as good friends, but if they ask for more I get paranoid. I keep thinking, why should I ruin someone else’s life?”

Early the next morning, Dece and a colleague have come to visit a friend in hospital.

Octa: “How are you doing brother?”

Reynold: “I’m OK.”

Reynold has been admitted to hospital with HIV-related complications. Like many users he learnt about HIV and how to prevent it too late.

Reynold: “Now most of my friends understand that if you share needles you will get infected by HIV. But a lot of people don’t care and they carry on sharing needles. They need their fix fast otherwise they will feel pain. Even though they know they can get clean needles they still share because they need their fix.

“I want to be well and I want to change – to be a better person. I want to get married.”

Back in east Jakarta, Hadi is still on the road making house calls.

He’s come to visit a family that’s been devastated by heroin.

Drugs have already claimed the life of their eldest son and they’ve also lost a profitable small business trying to meet the medical bills of their surviving son, Andri, who’s living with HIV.

Mother: “All our possessions are gone, nothing is left.”

Father: “How can you protect your belongings when you have an addict in the house? But I’d rather he stole from us than someone else.

“I don’t have a regular job – only casual work. I’m like a chicken scratching around in the dirt. If I get $5 then I buy food and if I get $10 then I buy medicine for Andri as well.”

Hadi has recently persuaded Andri to stop using heroin and to switch to methadone, which he sips throughout the day.

Andri: “I heard about HIV by word of mouth, but it was only talk – we kept on using. I only really understood the risk of HIV when I met Hadi.”

Hadi: “I’ve known him for a year.”

Andri: “He was the one who told us to go onto methadone.”

Hadi: “His Dad said to me: ‘Take him and look after him. I’m sick of looking after him.’”

At long last Dece has found out where Pepin is and she’s heading off to meet him.

She wants to check up on a promise he made her a couple of days ago that he would finally go for a CD4 test – a procedure that measures how well the immune system is working.

Unless he takes the test, he won’t be eligible for life-prolonging medication. And without the medication he’ll die.

Dece: “Have you been for your CD4 test?”

Pepin: “Not yet. I went yesterday but they told me it wasn’t free.”

Dece: “But there are some free ones.”

Pepin: “Yes, but I had to get the paper saying that I was eligible for free treatment. I haven’t done it yet because it’s difficult to meet the chief. I really want to sort this out but it’s hard to meet him.”

Dece: “It’s all talk with you, you never go for the CD4. I even sent Jessica over here to remind you. You junkies are so difficult to deal with. It’s only when you start dying that you come running for help.”


Theme(s): (IRIN) Health & Nutrition, (IRIN) HIV/AIDS (PlusNews), (IRIN) Urban Risk


[This report does not necessarily reflect the views of the United Nations]
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