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Stories from the field | Addressing resistance from locals and neighbours in Indonesia

In this video, Sam Nugraha talks about his daily reality, advocating for support with local leaders for his community-based harm reduction site
I started taking drugs when I was at university in the mid-90s. It was at a time when a whole variety of drugs were becoming available in Indonesia amphetamines, cocaine, LSD… and, heroin. I started taking heroin and got addicted. I tried to give up I went cold turkey, I went to private doctors, and I even tried taking really strong painkillers to numb the withdrawal, but it didn’t work. My family supported me and I tried abstinence at private and psychiatric hospitals many times. But ‘abstinence’ can cause more harm than intended. It tries to force you to quit.
You might be put in isolation, literally cut off from everyone, like in a prison cell to break you, to deprive you of the drugs you crave. But none of them worked. I got depressed, suicidal even, and I spent time in psychiatric hospitals. I’d experienced everything that was available, until finally, at my 6th rehabilitation course, it was a bit different. It was still abstinence-based, but it included talking sharing experiences with other drug users about the path to stopping. Relapse was accepted but complete abstinence was the goal. This time, for me, it worked. But abstinence doesn’t work for everyone.
I knew I wanted to help people who use drugs directly but my personal experience of drug treatments was all about giving up drugs. And I recognised that mandatory abstinence doesn’t work if people themselves aren’t ready to stop. I believed that in order to deliver effective harm reduction, we needed people who use drugs to become stakeholders in their rehabilitation. My idea was we would not dictate to them, and give them a one-size fits all, uniform treatment plan, but but it would be up to them to decide what is best for them. They should see themselves as their own resource for change.
My original plan was to set up a halfway house with a drop-in centre where people who use drugs could stay, or simply visit when they needed to. The facility would provide a supportive space and provide counselling and advice. We would not allow drugs to be taken on the premises, but equally, we would not condemn drug-taking either as long as it was not in the building. But then, when we invited 30 people to come to my first centre at Rumah Singgah PEKA in West Java, 100 people turned up. At that point I realised we needed to provide medical support too. So we recruited professional staff, peer workers and volunteers to meet that demand.
In particular, we set up partnerships with public clinics because we would be open 24 hours a day, where their hours were more limited. As our medical care has evolved, we now have members of staff who can accompany individuals who have a steady routine, to pick up their Methadone or Buprenorphine from the clinics to bring back to the health centre.
When we first set up, we did face some opposition. Our centre was in a narrow street, opposite an orphanage, and in close proximity to at least two schools, law firms and a busy convenience store. There were concerns from our neighbours about all these people turning up. I mean, they tend to look a bit different to the people who lived in that area. So there was anxiety and some anger.
Four official community leaders visited us and asked: “What’s going on?” We welcomed them and invited them to come and inspect us whenever they liked, day or night, to see for themselves, as long as they upheld the confidentiality of our clients. It also wasn’t long before the demand from clients led us to carefully consider how we could accommodate women alongside our male clients and at the same time be sensitive to Indonesian culture. We did find a way to give them a separate room and facilities, including a private outdoor space that didn’t impact the neighbourhood. Throughout this whole process,
We have always been very open about what we’re doing and that’s helped our relationship with the people in whose communities we work.
I’d been a community volunteer and I knew about funding to help harm reduction projects from my work with UNAIDS and UNODC in Indonesia. So I sought help from the Global Fund, UNAIDS Indonesia and National AIDS Commission to open the Rumah Singgah PEKA project. Since then I’ve had to rely on grants from the Indonesian government. But Ministry of Health grants are never big, and our salaries are generally less than the minimum wage. Sometimes, like during the Covid pandemic, we haven’t received any money because we’ve found it hard to show we are delivering harm reduction services. Thankfully many of our staff benefit from our services, so they still volunteer to help.
We have some private patients who pay, but still it’s a very small amount. Of course, to receive government money we have to report our results, and unfortunately the criteria of success is showing abstinence among our drug using patients. Because of our non-mandatory ‘stakeholder’ approach, where we don’t compel our clients to quit, this is a challenge. But we’re always full and other centres are now following our way of doing things.
I’m proud of what we’ve achieved. We’re now running 3 centres – 2 in West Java and 1 in North Sumatra, delivering harm reduction services for around 1,000 in-patients and between 3000-4,000 outpatients. Of those in-patients, less than 10% leave the programme. If they leave, after a few days, they usually return. But for the future, my vision is to help our clients really slow down and get back in touch with the environment. I’d like to open a rehabilitation centre on a 20-acre parcel of land, where patients will not only be equipped with the life skills from the drugs counselling, but they will have the opportunity to make a connection with the environment as a way to rebuild their lives.
But we have no funding for that just yet, although it’s my vision that one day it will happen.

Let’s look again at a real-world example. This time Sam Nugraha takes us through his journey of a lifetime advocating for harm reduction. We often think about advocating for harm reduction on a national or international level, but the reality is often that resistance can be found much closer to the ground.

Sam runs a local harm reduction program and he takes us through the challenges they have faced and explains how they have managed to advocate for acceptance of their centre within the local neighbourhood.

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Drug Use and Harm Reduction

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