AIDS behind bars

The Kerobokan area in Denpasar, Bali, used to be a sleepy little hamlet with rows upon rows of rice paddies turning golden during harvest time, but in 1983, following new city planning, the government constructed a prison to replace the old Dutch-built penitentiary in Pekambingan.

Following the imprisonment of Schapelle Corby and the Bali Nine for drug trafficking in 2004 and 2005, the Kerobokan State Penitentiary gained a notorious reputation exacerbated by hundreds of websites detailing life behind bars.

“A nightmare destination not featured in any travel brochure,” Queensland-based newspaper The Courier Mail was quoted as saying in one website.

Faced with overcrowding, the prison became a breeding place for infectious diseases, including HIV. In 2000, a sero-survey of Kerobokan prison’s inmates found 35 people tested positive for HIV. It does not help that about 60 percent of the prison’s inmates were convicted for drug-related cases – the sharing of contaminated needles and syringes is identified as one of the main modes of HIV transmission.

Happily, conditions have improved since then, and a report in March 2009 said that based on sero-surveys conducted in the last three years, the number of inmates testing positive each year has steadied to between 12 and 14 people.

Attributed to the success of this is the establishment of an HIV and AIDS mitigation task force in 2004, and the implementation of harm reduction programs in Kerobokan.

Focusing on reducing the harm caused by needle and syringe sharing between people who use drugs, the inmates were taught that this behavior increases the probability of someone being infected with HIV.

“The program being implemented here has made them aware that needle and syringe sharing is a very risky practice because it makes them vulnerable to HIV infection,” task force head Anak Agung Gde Hartawan said in an earlier report.

A breakthrough in HIV mitigation efforts is the establishment of a methadone maintenance therapy (MMT) clinic in the prison. MMT is considered the most effective intervention available for the treatment of opiate dependence, and has been shown to be effective in improving the physical and social wellbeing of the patient. It has been associated with reductions in risk behavior, illegal drug use, criminal behavior, participation in sex work, unemployment, mortality and HIV transmission.

In Indonesia, MMT is available in only four prisons, namely Kerobokan, Cipinang and Pondok Bambu in Jakarta, and Banceuy in Bandung. Providing inmates with a regular supply of orally taken methadone, the program aims at weaning inmates off the habit of injecting drugs.

[This article was published in the 9th ICAAP congress newspaper, The 9th ICAAP Post]