22 March 2023

Harm reduction information note – Indonesia

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Harm Reduction Information Note - Indonesia

This information note has been compiled by Harm Reduction International (HRI) in collaboration with Rumah Cemara, to support Global Fund Grant Cycle 7 processes.

Epidemiological context

  • People who inject drugs size estimate: 34,517
  • National HIV prevalence estimate: 39.1%
  • New HIV infections amongst people who inject drugs (HIV incidence): 13.6%
  • HIV prevalence among prisoners: 0.7%
  • Prevalence of hepatitis C among people who inject drugs: 89.2%

HIV prevention, treatment and harm reduction for people who inject drugs

  • Existing harm reduction services are mostly government-run and heavily reliant on grants from international donors.
  • By law, civil society organisations can distribute limited needles and syringes and serve as point of referral for people who inject drugs. They are not permitted to manage opioid agonist therapy (OAT) or to distribute naloxone.
  • There are needle and syringe programmes (NSP) available in 194 facilities across 19 provinces and 72 districts/cities. Data from a 2018-2019 integrated bio-behavioural survey showed that 37.6% of people who inject drugs had paid for injecting equipment from pharmacies while 45.3% had obtained them from NSPs. In late 2018, there were 92 OAT facilities providing methadone to 1,054 clients.

Harm reduction financing

  • Harm reduction in Indonesia is primarily funded by international donors, with the largest contribution from the Global Fund.
  • Domestic public financing provides limited support. In 2021, the government funded procurement of methadone at the national level.
  • The provincial government in Kota Makassar and Bandung have provided funding for harm reduction community systems strengthening in 2022.
  • In 2022, the Global Fund supported the implementation of OAT (methadone), needle and syringe procurement and NSP implementation, alongside other prevention programming such as outreach, IEC materials, condoms and lubricants.
  • International donor funding for OAT and NSP has reduced by half from USD 500,000 (2019) to USD 200,000 (2022).
  • While social contracting is permitted within government regulations this has not been used as a mechanism to fund the HIV or harm reduction response in Indonesia.
  • The Indonesian government has not shown commitment to transitioning from international donor funded to domestically funded harm reduction programmes.

Advocacy priorities for people who use drugs in Grant Cycle 7

  • The HIV prevention package for people who inject drugs should include opioid agonist therapy (OAT), needle and syringe programme (NSP), condoms and also PrEP for people who use and inject drugs and their sexual partners.
  • Comprehensive integration service optimisation. Non-HIV services that can be an entry point for HIV services (and vice versa) i.e.: HIV- antenatal care, TB-HIV, STI-HIV, Hepatitis-HIV.
  • Community involvement in policy making and planning for OAT and overdose prevention.
  • Resilient and sustainable systems for health/pandemic preparedness.
  • Community Led Monitoring (CLM) – community capacity building in implementing CLM, and data-based advocacy.
  • Programmes to eliminate gender-based violence.
  • Reducing stigma and discrimination.
  • Advocacy to reduce legal barriers and increase funding for harm reduction.

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