Community Action on Harm Reduction endline evaluation report - Indonesia

The HIV epidemic in Indonesia has been driven by injecting drug use, with prevalence in people who inject drugs (PWID) reaching 48% nationally or 60% in the West Java province. Basic harm reduction services have been widespread and available in public health facilities in priority provinces and municipalities with a significant estimate of PWID size following the rapid scale-up in the 2005—2010 period

This report was commissioned by Rumah Cemara under support of the International HIV/AIDS Alliance to document the endline evaluation results of CAHR implementation in 3 cities of West Java, Indonesia and provide directives to resolve gaps in outcomes and programmatic responses.

The present report is the first of the two in series with a substantial focus on the descriptive results in comparison to the 2011 baseline situation. We surveyed 216 randomly selected clients (18 female) in Bandung, Bogor, and Sukabumi based on the pre-determined sampling strategies.

Baseline data were extracted from a published report and reconstructed to fit the statistical properties necessary for our comparative analyses.

Our recommendations centred around developing a robust capacity for timely provision of harm reduction services utilizing the standard, proven methods including relentless education campaign, intensive outreach, and integrated referrals. It is also important that Rumah Cemara ensures a systematized monitoring system, funding security, and integrates harm reduction into mainstream services that are now priority areas in HIV.

This report also underlined the importance of a gendered approach to safer sex with stable partners. We recommend steps to improvements in the T(rain staff and clients), I(ntensify harm reduction work using proven methods), M(onitor systematically the risk patterns for informed decision), E(xpand care more widely to those in need) with L(ow-cost, non-inferior, integrated services), and comply (with the standard conduct of care that we know works), or TIMELy, manner.

In conclusion, a timely approach to care provision is needed to minimize missed opportunities in prevention. A shrinking yet higher-risk cohort captured in our survey challenges the general wisdom of displacing priorities disproportionately outside harm reduction following the national shift in health burden to sexually acquired infections.

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