Institutionalizing Ngos To Response Hiv In Bandung Indonesia

Institutionalizing NGOs in the public health system to response the HIV epidemic among IDUs in Bandung City, Indonesia

Background In 2005, Ministry of Health Republic Indonesia estimated between 1,220 and 2,280 injecting drug users (IDUs) live in Bandung City, the capital of West Java Province. It is further estimated that prevalence of HIV infection among them is around 29.50%. Reported AIDS case in the city had been sharply increasing since early 2000 and dominated by injecting drug users. Bandung City AIDS Commission reported 62% of HIV/AIDS cases are from IDU among other risk factors in 2005. A project has been set up in 2002 to give information about injecting risks and behavior change by outreaching targeted 1,000 IDUs. These field based activities involving IDUs as outreach workers and one local NGO to manage the operation. Frequently they got trouble with the police, proven using illegal drugs, sometimes by urine testing. As a well known place having data of drug users, the NGO became an easy target for the police to catch the workers and asking repressively for the information. Another project distributing needle and syringe as well as condoms for IDUs started in 2004, involving three NGOs and the IDUs as outreach workers. Problems with police arrestment were still happened. Repressive act are legitimate since NGO, and its worker, is not considered as legal health institution. In the other hand, three sites of needle and syringe program (NSP) supported by at least 15 outreach workers are not enough to cover around 2,000 IDUs. The city needed law protected and more NSP site.

Initial Assessment In 2005, Indonesia HIV/AIDS Prevention and Care Project, a supported project mainly sponsored by AusAID, were involving city health department in harm reduction (HR). This early cooperation intended to disseminate information about HIV epidemic among IDUs to primary health center staffs by serial workshops. During one year cooperation, a strong commitment of city health department was arisen to build response for the epidemic faced by the city, focused on IDU. Considering potential to cover minimum target to reduce the epidemic, the city public health centers is a must be solution. It is law protected and can be found anywhere in the city.

While NGOs have low coverage but experienced in conducting HR, they must be involved to build the services in public health system. Moreover, they have been known and had a good relation with IDUs in the city. Another factor that came to consideration is community due to repressive culture to drug users. Since the first HR program in the city, there has been a plenty involvement of community. Information was still dominated by “war on drug” messages distributed by city narcotics board in the community.

Building the Response How to build HR program in public health system rather than just delivering service was a big challenge to NGOs. Personal and private approach has been applied since the first time, and it needed to be reversed to public health approach. Discussions with NGOs as well as with city health department were carried out frequently both formal and informal, analyzing the situation and possibility to build local government response, in its public health system. It also included, how to develop service system in primary health centers (PHC), how to improve skills of its staffs, how to organize drug users to access health services in PHC, to organize community to build its own system of HIV prevention and care, and the sustainability of program. Involvement of NGOs and city health department in the discussions succeed to build a plan to do gradual actions. Starting with three PHCs to provide NSP and primary health care including VCT, the city health department was preparing to scale up the service. A number of workshops were being conducted to construct a support system to the HR service involving PHCs and NGOs. A work plan was developed placing NGO as consultant for setting up service and take lead to community involvement, while PHC take lead for syringe provision as well as primary health treatment. These activities led by city health department, and involved another nine PHCs.

Community Organizing and Service Providing Community involvement to support HR services in PHC was initiated by community meetings facilitated by NGOs in PHC’s working area. Some IDUs who have already been getting sick were the main concern of the community due to high rate of mortality of youth in the neighborhood. They were also organized to do outreach as well as taking care of health of IDUs, referring to the nearest PHC and other service providers.

Referring IDUs to PHC is another big challenge. Since PHC and its staff is a government agent, same like the police, there was an anxiety among drug users to come to it. They were afraid that their identity will be detected by the police or by their neighbor. At this point, a program which is supported by community became important as well as strengthening local drug user organization to face legal issues. Service providing, especially needle and syringe, continuously trained and improved during implementation of the program in PHCs. There have been six groups of people who commit to support IDUs in accessing health care in six PHC areas so far. Bandung City Health Department fully funded HR services in nine PHCs, while the NGOs are still funded by international donors. HR program publicly recognized as a public health response run by local authorities. And, NGOs are not regarded as offender since the paraphernalia are distributed by PHCs. Needle and syringe program are easily found in the city, and health care for IDUs widely accessible within communities.

2007 | Patri Handoyo