Assessing the situation of injecting drug users anywhere
calls for special knowledge and skills. People with such attributes
are often those who have themselves tread the path of addiction,
but have survived, recovered and then committed themselves
to working in this challenging area. One group that specializes
in this field in Bali goes by the name of Yayasan Mata Hati
and is based in Batu Bulan.
Yayasan Mata Hati was established in July 2004. The founding
team had previously worked with Yayasan Hati Hati, who run
outreach programmes to drug users in the Denpasar and Kuta
areas. Yayasan Mata Hati conducted an assessment and diversified
their geographical coverage to Gianyar, Badung and Tabanan
regencies, where intravenous drug users have a different profile.
Whereas intravenous users in urban areas such as Denpasar
and Kuta tend to be concentrated in certain areas and are
easily located (for those ‘in the know’), outside
these areas users are more scattered and a door-to-door approach
is required to find and support them. For example in the Ubud
area, intravenous users often reside with their families and
tend to be hidden. Amongst wealthier groups and sometimes
higher caste groups, families can be especially difficult
to engage in frank discussion of the user’s problems
and practices, so even though they are wealthier and typically
inject in a cleaner home environment, they may not access
information about safe drug use as easily as people living
with other addicts.
In Bali there are between 2000 – 2500 known intravenous
drug users (IDU), with heroine being the main drug, and subutek
(a type of buprenorphine available on doctor’s prescription)
also commonly used. Other drugs commonly abused are shabu-shabu,
ecstasy, marijuana and prescription drugs for depression and
psychotic disorders.
Outreach programmes related to drugs generally entail key
messages: 1) Don’t use drugs; 2) If you do use drugs,
don’t inject; and 3) If you do inject, don’t share
needles. Yayasan Mata Hati’s focus is direct interventions
with intravenous users. Their operations are guided by the
three integrated concepts of supply reduction, demand reduction
and harm reduction. Combined, these ‘reductions’
amount to behaviour changes resulting in safe drug use. Herein
lies some controversy – the harm reduction approach
is inherently accepting (but not endorsing) of intravenous
drug use. It accepts that the problem exists and aims to educate
users of the main risks associated with their behaviours,
and to support and enable them to use as safely as possible.
HIV and Hepatitis are the main risks of intravenous drug use,
apart from overdose, and as these are transmitted through
body fluids, clean injecting practices are important for avoiding
transmission. More than 50% of the IDU in Bali are HIV positive.
Yayasan Mata Hati and others with networks amongst high risk
groups are ambassadors for an existing HIV/AIDS voluntary
counseling and testing programme run in Bali. Coordination
and information sharing amongst the different groups working
in the area is most important, both to avoid overlap and to
ensure efficient use of resources in the face of a serious
problem.
Yayasan Mata Hati’s central programme consists of peer
support and treatment, aftercare, media and information. They
have a team of 5 outreach staff, 2 counselors and 1 field
coordinator that conduct bi-weekly ‘meetings’
with groups of IDUs and do daily follow-up with individuals.
They also run a needle exchange programme servicing approximately
400 people. Other ‘clients’ are supported by cooperating
with the Social Department (DepSos) for employment-related
skills training. For many ex-IDUs that Yayasan Mata Hati helps,
income-generating activities that enable them to return to
their families and live productively in society are the key
to them staying clean. Recently 30 such people have been referred
to DepSos and completed training in printing, painting and
mechanics.
The team at Yayasan Mata Hati are also thinking about the
sustainability of their programme, as their current funding
expires later this year. One initiative that was undertaken
to help their clients gain skills to work in massage saw the
Yayasan working with the well-known massage parlour in Seminyak,
‘Jari Menari’. This lead to the establishment
of Massage Mata Hati (Jl. Mertanandi in Seminyak) which is
managed by Jari Menari and has a profit-sharing agreement
with Yayasan Mata Hati. The Yayasan team are also pursuing
other small fund-raising activities. The public can support
this work by going to Massage Mata Hati, by volunteering certain
time and skills to the Yayasan, or by donations or assistance
in planning and seeking further funding sources.
Apart from continuing their outreach activities, the team
at Yayasan Mata Hati would dearly love to put more energy
into education about harm reduction and reducing discrimination
towards people living with HIV/AIDS.
Contact David Mawao Adung at Yayasan Mata Hati on 299711 for
more information. Mata Hati massage tel. 7425001
By Lucy Mitchell
E-mail:writers@baliadvertiser.biz
