Estimating the number of drug injectors in Indonesia

BackgroundDrug injection, little known in Indonesia just a decade ago, is apparently a growing practice, especially among young men. In some cities, HIV prevalence has been recorded at close to 50% among injectors. Yet authorities in the world's fourth most populous nation had no information on the magnitude of the problem.ObjectivesTo estimate the number and distribution of drug injectors in Indonesia, and to use the estimates to draw the attention of policy makers to the need for services for this population.MethodsThe Ministry of Health asked a wide variety of partners to collect all data relevant to drug injection in the country. Data were made available by treatment centres, health authorities, social welfare workers, law enforcement authorities and non-government groups providing services for drug users. Data sources were compared and it was decided that data would support estimates at the provincial level using multiplier methods. Three estimates were made based on different data sources.ResultsThe results of the three methods were in a very close range, between 145,000 and 170,000. Methods and data sources were published in detail, and weaknesses clearly acknowledged. The estimates were accepted by all groups, and formed the basis for subsequent modelling and advocacy work which greatly increased attention to the need to provide services to drug injectors in the country, and contributed to the adoption of harm reduction approaches in the national HIV strategy.ConclusionAn inclusive and transparent estimation process based on existing data sources can provide an important starting point for advocacy and rational planning of drug-related services. It has proven feasible, affordable and useful in the context of a large and diverse developing country with an IDU-driven epidemic of HIV.