'We have put harm reduction for meth users on the map'

Mainline has worked in Indonesia for more than 10 years. Since 2016, this work has fallen under the Bridging the Gaps II programme. This programme will end in 2020. Nick Veldwijk, regional manager for Mainlines work in Asia, reflects on the work that has been done with Mainline’s partners in Indonesia.

Mainline currently works together with two local organisations: Karisma in Jakarta and PKNM in Makassar. Mainline supports their partners to provide harm reduction services to people who use methamphetamine (meth).

A knowledge gap on meth
In 2016, Mainline’s partners noticed the rise of meth use in Indonesia. While lots of expertise on heroin and harm reduction programming was available, knowledge about meth and its effects was lacking. People who use meth express different needs and require specific services. Nick explains: “Meth and heroine are two different kinds of drugs. Meth is an intense stimulant drug. It gives you lots of energy and hides your fatigue. You can use it to stay awake, to party for multiple days or in a sexual setting. However, when you use it very often and in high doses it can cause (mental) health issues.

Since 2016, 21 outreach workers, four managers and three coordinators have been trained by Mainline. The training topics consisted of mapping hot spots and finding clients, building communication skills, providing harm reduction services around safe drug use and linking clients to (mental) health service providers.

Training health workers on meth and mental health
In February, Nick travelled to Indonesia to discuss and observe the progress of the programme. An exit strategy was one of the topics Nick discussed with the partners. Nick: “An exit strategy is and should be discussed throughout the whole project period. But now we must make concrete plans. Some of the topics which we discuss are: How and when do you share the closing of the project with your staff? What additional support do partners need? And, very importantly, how do you make sure your clients will continue receiving essential services when the project ends?”

Nick explains that Mainline achieved some excellent results. “In 2019, Karisma and PKNM reached more than 1,100 clients with their services. In addition, our partners collaborated with several community health centres in Jakarta and Makassar. These are first-line health care clinics where clients can utilise several (mental) health services.” 

Mental health
Mental health issues among people who frequently use meth are common. But there are rather few mental health professionals in the country, and mental health problems are still taboo. “Just like in a lot of Asian countries, people do not talk about mental health issues. Only “orang gila” (crazy people) will go to a clinic.” explains Nick.

In collaboration with Atma Jaya University, Karisma, PKNM and the Ministry of Health, Mainline trained health workers from 12 community health centres. These health workers are now better equipped to provide (mental) health support to people who use meth. Mainline’s next step is to develop a training module for the Ministry of Health so that they can support community health centres to implement this training on a larger scale. Nick: “Now that there are services in place for people who use meth, I hope this next step is going to succeed. It would sustain the hard work that our partners have done in recent years.”

Mainline and Atma Jaya University have established a strong collaboration over time. One of the studies they have worked on together was to identify health behaviour, HIV, Hepatitis C and STD prevalence among 1,500 people who use meth. The results of this 2016 study informed new harm reduction interventions. Karisma and PKNM have piloted and implemented these interventions ever since. Nick: “This year, Atma Jaya will evaluate the effectiveness of these interventions. With this, we are gaining valuable evidence on what works and what doesn’t.”

Planning is difficult
At times, it is difficult to coordinate with Indonesian government institutes, such as the Ministry of Health and the police. Indonesia has harsh law enforcement measures in place towards drug users. Policies and national guidelines to support people who use meth are not in place. As a result, people who use drugs are often criminalised and incarcerated. And to change policies in Indonesia? This takes time.

In the meantime, this restricts Mainline and its partners in their work. The continuity of the services after 2020 is, therefore, unsure. “I expect that organisations like PKNM and Karisma will continue to exist. But it is difficult to predict if all their services will continue or not. If I ask how they will continue with their services in 2021, there are no concrete solutions ready at hand.” Nick explains. To support its partners, Mainline developed the sustainability tool. Partners can apply this tool to their organisation to identify issues but also opportunities in sustaining services after 2020.

Sustaining results
During his trip to Indonesia, Nick visited many organisations to ensure that Mainline’s work is aligned with other programmes. Local harm reduction and HIV-related organisation, but also UNAIDS, the Global Fund and the Dutch Embassy. Nick: “We are not working in isolation and we strive to complement other initiatives in our field. And when the programme ends, we need to ensure that our partners’ work can continue.”

Over the years, Mainline has created a body of evidence around their harm reduction programmes for people who use stimulant drugs such as meth. Nick: “With this evidence, we advocate for the integration of these interventions in HIV and harm reduction programmes of major donors, such as the Global Fund.” It seems to work. Indonesia’s civil society is planning to integrate this into their new grant proposal to Indonesia’s 2021-2023 Global Fund programme.

Nick: “Our goal after five years of Bridging the Gaps 2 is to leave something behind. We have achieved a lot of great things. Thanks to our work in Indonesia, we have put harm reduction for meth users on the map. We can be proud of that.”

Read more on our work in Indonesia on our project page.

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