HIV/AIDS NGOs switch strategy, embrace local communities
Anton Muhajir , Contributor, Denpasar | Thu, 09/11/2008 11:04 AM | Surfing Bali
In response to a recent government regulation that designated state health workers as the only people officially allowed to distribute syringes and needles to IDUs (Injecting Drugs Users), Bali’s HIV/AIDS non-governmental organizations have developed a new strategy.
Prior to the issuance of the regulation, NGO outreach workers were responsible for distributing needles directly to local IDU communities that participated in government-condoned NEP (Needle Exchange Program) pilot projects.
The NEP has played a crucial role in reducing the deadly habit of needle sharing among IDUs. This habit has been blamed as the single biggest cause of transmission of HIV/AIDS among IDUs. The NEP is a part of a comprehensive harm-reduction strategy implemented in Indonesia with assistance from various international donors.
Wahyunda, an activist from the Bali Health Foundation (Yakeba) said new strategies were needed, because the government’s regulation clearly stated that only registered medical personnel were allowed to dispense needles and syringes.
Consequently, IDUs now need to make regular visits to their nearest community health center (Puskesmas) to receive free needles and syringes. Previously, IDUs waited in their homes for NGO outreach workers who supplied them directly.
In mid-June, executives from the island’s HIV/AIDS NGOs gathered to discuss the new strategy. The gathering was attended by Yakeba, Yayasan Matahati and Yayasan Hatihati.
“We have agreed to develop a closer and more active relationship with community health centers across the island,” Wahyunda said.
This strategy would enable the NGOs to play an important role in the implementation of the new government regulation on the distribution of needles and syringes.
The close relationship with community health centers would provide NGOs with more opportunities to assist medical personnel in various intricate aspects of dealing with IDUs. Moreover, it would also place the NGOs in a position to help bewildered IDUs navigate through the new procedure.
Besides establishing a constructive relationship with community health centers, the NGOs also agreed to build a partnership with the island’s many banjar (traditional neighborhood organizations).
Each village in Bali comprises between three and six banjar, which wield a powerful influence among the Balinese due to the important roles they play in every socio-religious aspect of Balinese life.
Through the new partnership, the NGOs would train and assign a member of each banjar as a key local figure. This figure would act as a liaison between NGO outreach workers and IDUs who live in their banjar.
“With this new scheme, NGO outreach workers will give supplies of new needles and syringes to local community health centers as well as to key persons. The latter two will be responsible for dispensing the supplies directly to IDUs,” another Yakeba activist, Kadek Adi Mantara, said.
Wahyunda said the new government regulation was not the only factor which had influenced the development of these new strategies (implemented by the NGOs on Aug 1.).
The Australian government’s aid organization AusAid, the primary donor for the island’s HIV/AIDS NGOs, had also asked NGOs to devise new strategies to expand the NEP’s coverage.
“The donor said our programs were not progressing as fast as had been expected, so they asked us to devise new strategies,” Wahyunda said.
Thus, the active partnership between community health centers and banjars was introduced, aiming to speed up the progress of the harm-reduction program.
So far, four community health centers and three hospitals have been appointed as implementers of the NEP.
The community health centers are Puskesmas Kuta, Puskesmas Abiansemal, Puskesmas Sanur and Puskesmas Singaraja and the hospitals are Wongaya General Hospital, Dharma Usadha General Hospital and Sanglah Central Hospital.
The main obstacle in the new distribution scheme has been psychological in nature. The IDUs, who for a long time were targeted and criminalized by the state’s legal apparatus, have found it very difficult to deal with a formal, state-run institution, such as the community health centers.
“A large number of IDUs still have this issue. They feel uncomfortable if they have to deal with government officials or institutions. There is still a certain lack of trust among the IDUs toward the new scheme,” former IDU turned harm-reduction activist Yusuf Rey Noldy said.
Noldy currently works as a harm-reduction officer at Kuta community health center.
“In Kuta, the IDUs prefer to take their new needles and syringes from harm-reduction officers, rather than community health center officials. This has a lot to do with the very nature of the IDU community as a closed, underground community,” he added.
Another obstacle is the community health centers’ office hours.
“Community health centers are not open 24 hours a day. However, the IDUs’ may need new needles or syringes at any time of day or night,” he said.
To deal with these obstacles, the NGOs agreed to conduct a six-month campaign aimed at introducing the new needle and syringe distribution scheme with the island’s IDU communities.
“Hopefully, the new distribution scheme will motivate IDUs to become more self-reliant and more disciplined,” Wahyunda said.