Expanding Harm Reduction: Indonesian Model

1. The Indonesian Experience: Government and civil society partnership model for expanding coverage of harm reduction Dr. Nafsiah Mboi, SpA, MPH Secretary to the National AIDS Commission Presented at UN RTF ICAAP SYMPOSIA

2. Issues: Twin epidemic of drugs and AIDS: • IDU driven, almost all provinces are reporting a growing drug user community

3. Issues: Criminalization of drug users • Prohibitive drug laws 5 and 22/1997 • Drug users are a covert & underground community, unprotected by the public system, isolated from society • Prisons are filled with young drug users, increasing vulnerability to HIV, Hep C, sexual abuse, etc • No access to health care  fear of arrest + stigma & discrimination from health providers

4. The journey towards partnership • [1999- 2006] drug users as a community not recognized by government; programs very little consultation; drug users mere projects’ targets not involved in any form of planning; • Presidential Regulation75 /2006 about Nat. AIDS Comm • Civil society rep. : equal members of the Commission • Drug users, PLHIV, sex workers, academics, etc. all active & participating members in policy making meetings

5. The journey towards partnership • Coord Min for People’s Welfare/ Chair NAC: reg 2/2007: “harm reduction” = public policy for HIV prev and care for people who inject drugs IDUs NOT criminals , they have Human Rights Then there was the drug users movement: - local communities organized themselves - a national network was established (2007) - consistently providing inputs to ensure the public health system accommodates drug users needs

6. It took the realization from both parties, government and civil society: The government… • drug users = citizens, protected from human rights violation, violence, abuse and any form of discrimination • drug users (in and out of prisons) are not denied their human rights, including the right to life, education, health care etc

7. It took the realization from both parties, government and civil society: Civil society… • educated itself concerning civic rights and obligations • became contributing members of society, monitors the running of the public ‘engine’: social, economic, legal, health, etc • Learned to become an agent of change when system doesn’t accommodate their needs

8. Indonesian drug users communities actively involved in policy making processes from national to the local levels • Org & financial support to the National Drug Users Network, incl Drug Users Congress 2007 & 2009 • NAC established: (WG) gender & human rights all elements of civil society: legal aid, human rights group, women’s movement groups, etc. • HR WG all levels: Aids Comm, Health, Police, Narc Board, CSO, Org Drug victims, prison officials, etc  for planning, coordination, M&E • Together: Govt, CSO, drug users, PLHIV networks, support efforts for drug law reform

9. Combining forces to scale up…. • The government’s commitment and support to universal access for prevention and care: •  domestic resources : e.g. Jakarta supports all public health centres for NSP and some including MMT, Pontianak, Mataram, etc • Increasing coverage, particularly among drug users (+ IPF, GFATM, AUSAID)

10. NSP until Dec 2008 Source: NAC

11. MMT – Dec 2008 Source: NAC

12. The trust of the people in the leaders reflects the confidence of the leaders in the people. Paulo Freire Terima kasih Thank you