Evidence-informed response to illicit drugs in Indonesia

Irwanto, Irwanto; Wirawan, Dewa Nyoman; Praptoraharjo, Ignatius; Irianto, Sulistyowati; Mulia, Siti Musdah

doi:10.1016/s0140-6736(15)61058-3

Cited by 8 publications

(7 citation statements)

References 2 publications

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“…Advocates for rights of PWID around the globe, including many in the research and public health communities as well as diverse and numerous NGOs 6061 have been consistently calling for improved access to harm reduction interventions such as SEP and OST. 4 These interventions are proven effective and cost-effective in reducing the risk of acquiring HIV and viral hepatitis and can help engage PWID in clinical care.…”

Section: Standards Of Care and Prevention: What Standard Of Care And mentioning

confidence: 99%

Addressing ethical challenges in HIV prevention research with people who inject drugs

et al. 2016

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Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.

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Section: Standards Of Care and Prevention: What Standard Of Care And mentioning

confidence: 99%

Addressing ethical challenges in HIV prevention research with people who inject drugs

et al. 2016

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“…Despite reductions in HIV incidence, morbidity and mortality (Joint United Nations Programme on HIV/AIDS (UNAIDS) 2014), such advances have not occurred similarly in PWID despite numerous evidence-based HIV prevention recommendations (Dutta et al 2012; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2014). It is increasingly recognized that law enforcement strategies have failed to curb drug use (Irwanto et al 2015) and contribute greatly to the risk of injection-related HIV infection (Booth et al 2013; Ti et al 2014). Punitive drug policies including compulsory drug detention for PWID and the death penalty for drug trafficking, continue to be a direct barrier to evidence-based HIV prevention services for PWIDs in Southeast Asia, including access to needle and syringe programs (NSPs) and opioid agonist therapies (OAT) like methadone or buprenorphine (Irwanto et al 2015; United Nations Office on Drugs and Crime 2014).…”

Section: Introductionmentioning

confidence: 99%

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

Culbert

Pillai

Bick

et al. 2016

J Neuroimmune Pharmacol

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Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a‘perfect storm’of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent. Although promoted by official policy, evidence-based drug treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80% of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, enlarging the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0% and 75.7% respectively. We discuss the further deployment of these interventions in Malaysian prisons.

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“…According to UNODC estimates, methamphetamine is also the most widely used illicit drug in the country after cannabis, followed by heroin and MDMA [10]. Although its validity has been strongly criticized, the only national survey on drug use presents similar results to UNODC estimates, with methamphetamine, locally called shabu , as the second most popular drug in the country [11, 12]. Jakarta, Denpasar, Batam, Medan, and Makassar are the cities with the highest prevalence of methamphetamine use in Indonesia [9].…”

Section: Introductionmentioning

confidence: 99%

From opiates to methamphetamine: building new harm reduction responses in Jakarta, Indonesia

2019

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BackgroundDespite the rise of stimulant use, most harm reduction programs still focus on people who inject opioids, leaving many people who use methamphetamine (PWUM) underserviced. In Asia, especially, where methamphetamine prevalence has overtaken opioids prevalence, harm reduction programs assisting PWUM are rare. The few existing innovative practices focusing on methamphetamine use lie underreported. Understanding how these programs moved their focus from opiates to methamphetamine could help inspire new harm reduction responses. Hence, this paper analyzes a newly implemented outreach program assisting methamphetamine users in Jakarta, Indonesia. It addresses the program’s critical learning points when making the transition to respond to stimulant use.MethodsThis case study is part of a more extensive research on good practices of harm reduction for stimulant use. For this case study, data was collected through Indonesian contextual documents and documents from the program, structured questionnaire, in-depth interviews with service staff and service users, a focus group discussion with service users, and in-loco observations of activities. For this paper, data was reinterpreted to focus on the key topics that needed to be addressed when the program transitioned from working with people who use opioids to PWUM.ResultsFour key topics were found: (1) getting in touch with different types of PWUM and building trust relationships; (2) adapting safer smoking kits to local circumstances; (3) reframing partnerships while finding ways to address mental health issues; and (4) responding to local law enforcement practices.ConclusionsThe meaningful involvement of PWUM was essential in the development and evaluation of outreach work, the planning, and the adaptation of safer smoking kits to local circumstances. Also, it helped to gain understanding of the broader needs of PWUM, including mental health care and their difficulties related to law enforcement activities. Operating under a broad harm reduction definition and addressing a broad spectrum of individual and social needs are preferable to focusing solely on specific interventions and supplies for safer drug use. Since many PWUM smoke rather than inject, securing funding for harm reduction focused on people who do not inject drugs and/or who do not use opioids is fundamental in keeping programs sustainable.

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Evidence-informed response to illicit drugs in Indonesia

Cited by 8 publications

References 2 publications

Addressing ethical challenges in HIV prevention research with people who inject drugs

Addressing ethical challenges in HIV prevention research with people who inject drugs

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

From opiates to methamphetamine: building new harm reduction responses in Jakarta, Indonesia

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