The following is an excerpt from ANCD report:
Indonesia comprises more than 17 000 islands and has a population in the vicinity of 240 million people. It is a republic with an elected legislature and president. Indonesia is a signatory to the IDADIN.
Amphetamine-type stimulant use
In Indonesia cannabis has been the drug of most concern since 2004. Crystal methamphetamine was ranked fourth overall in 2004 and 2006, and fifth in 2005. However, in 2008 and 2009 crystal methamphetamine was ranked second. The trend in usage figures echo these, with ATS use reported to have increased in both 2008 and 2009 (only). While smoking is the predominant mode of administration for crystal meth/amphetamine, injecting is reported as the second most common method (United Nations Office on Drugs and Crime, 2010b). A national survey of drug use in Indonesia indicated that 2 per cent of the population aged 10–59 years had used an illicit drug in the previous year, and 6.8 per cent of those aged 11–19 years reported lifetime drug use, with 4.4 per cent reporting drug use in the last year. This suggests that drug use among young people is increasing (United Nations Office on Drugs and Crime, 2010b). The most commonly used drugs in this study group of students were cannabis, ecstasy and ATS (United Nations Office on Drugs and Crime, 2010b).
Injecting drug use
There were an estimated 126 429 people who inject drugs in Indonesia in 2008, a number considerably lower than previous estimates (Indonesian National AIDS Commission, 2010). The proportion of PWID who inject crystal methamphetamine as opposed to heroin is unknown. However, the HIV epidemic in Indonesia is considered to be driven by unsafe injecting practices.
Manufacture and trafficking
More than 35 manufacturing laboratories were dismantled in Indonesia during 2009. These included 25 large-scale operations and 12 smaller laboratories (United Nations Office on Drugs and Crime, 2010b). The National Narcotics Board suggests that ATS producers may be moving towards smaller operations which are harder to detect (Indonesian National Narcotics Board, 2010) A large proportion of crystal methamphetamine seized in Indonesia in 2009 was apparently trafficked into the country from Iran and from China (United Nations Office on Drugs and Crime, 2010b). There are concerns however that a suspected increase in domestic production of crystal methamphetamine is changing this pattern. Indonesia faces special problems in terms of opportunities for the trafficking of ATS in and out of the country due to the geographic characteristics of the country (United Nations Office on Drugs and Crime, 2010b). Indonesia consists of more than 17 000 islands, of which one-third have permanent residents. This equates to almost 150 recognised entry points including international airports (22) and 150 seaports. Most reportedly lack adequate security resources and are thus vulnerable to trafficking. Criminal groups, often from West Africa, are thought to be involved in the trafficking and sale of ATS, especially in Jakarta (United Nations Office on Drugs and Crime, 2010b).
Drug seizures
Seizures of crystal methamphetamine decreased markedly between 2006 (1241kg) and 2009 (237.8kg) (United Nations Office on Drugs and Crime, 2010b). However, this decrease may be the result of the recorded increase in domestic production with a concomitant decrease in trafficking from other countries.
Drug treatment
Of the 14 852 individuals admitted to treatment in Indonesia in 2009, the vast majority were opiate users (United Nations Office on Drugs and Crime, 2010b). Twelve per cent of treatment admissions were for ATS: 984 for methamphetamine and 332 for amphetamine. While OST is available for opiate users, no details of the treatment given to ATS users were available.
Drug-related arrests
Of the 38 173 drug-related arrests, just under one-third were for crystal methamphetamine (United Nations Office on Drugs and Crime, 2010b). This represents a 29 per cent increase from 2008 figures. The vast majority of those arrested were male and Indonesian nationals.
HIV in the community and among high-risk groups
While the country prevalence of HIV is 0.2 per cent, it is higher among high-risk groups: 20.3 per cent among male sex workers; 7.1 per cent of female sex workers; 5.2 per cent among MSM; 52.2 per cent among male PWID; and 56.1 per cent among female PWID (UNAIDS, 2010a). These prevalence figures confirm that the major risk factors for HIV transmission are injecting drugs, unprotected paid sex and unprotected sex among MSM. Cross-over risks between PWID and sex workers are acknowledged but, beyond the fact that 25 per cent of paid sex is unprotected, no specific data are available. No cross-over data examining ATS use among these high-use groups were available.
HIV testing
Data on HIV testing in the general community were not available. However, during 2005, 50 per cent of male sex workers and 25 per cent of female sex workers reported having been tested for HIV and reportedly knew their results (UNAIDS, 2010a). More than one-third (35.7%) of male PWID and 41.5 per cent of female PWID had also been tested and knew their results.
HIV anti-retroviral treatment
Almost a quarter (22.2%) of men with HIV were receiving ART. This figure was higher for females, at 43.8 per cent (UNAIDS, 2010a). No breakdown of those on ART by high-risk group was available. Six per cent of PWID living with HIV are reportedly receiving ART.
Prevention education
Coverage of high-risk groups in terms of prevention programs during 2006 was between 39.6 per cent for sex workers (59.9% for male sex workers, and 34.3% for female sex workers), 40.1 per cent for MSM and 44.7 per cent for PWID (UNAIDS, 2010a). Condom use among male and female sex workers was greater than two-thirds while, among men practising anal sex, it was lower at 39.3 per cent (UNAIDS, 2010a). Condom use in the last sexual encounter among PWID was also low at 33.9 per cent.
Harm reduction
An estimated 23 per cent of PWID are accessing NSP services and the total number of needle and syringe units distributed in 2007 was 1.17–1.52 million (Hagarty, 2010). However, this represents only three needle and syringe units per PWID per year.
Concerns
Decentralisation of health services, which occurred in Indonesia in 2001, has reduced the government’s ability to influence decisions about health priorities. This has resulted in challenges, one being that disease surveillance has become more difficult (Indonesian National AIDS Commission, 2007).