A new look at HIV/AIDS, Tuberculosis and Hepatitis C
David and Joyce Djaelani Gordon, Contributors, Jakarta
The world health community looks upon three viruses -- HIV/AIDS, tuberculosis and malaria -- as being among the world's foremost health and welfare threats.
While this is without doubt accurate and accepted worldwide, it does not fully take into consideration or understand the emerging global subculture of drug users, abusers and addicts, which also includes a vast population of injecting drug users (IDUs).
Today in relation to this global drug-using subculture we must reexamine what the standard has been and immediately develop a new standard.
What clearly emerges is HIV/AIDS/Tuberculosis/Hepatitis C.
And this is not HIV/AIDS and Tuberculosis and Hepatitis C. We cannot view these illnesses separately any longer. Today we must shift our perception, to realize and entirely accept, that how we view HIV/AIDS, is exactly how we must view HIV/AIDS/Tuberculosis/Hepatitis C.
It is very common to find in areas where drugs are easily available a high population of IDUs. In such areas it is also common to find high rates of people infected with HIV/AIDS. It is now also common to find HIV-infected IDUs co-infected with Hepatitis C. Co-infection is in fact so common that the prevalence of co-infection can reach up to 60 percent in some places and in other hot spots reach 70 to 80 percent.
The hepatitis C virus is five times more contagious than HIV. Thankfully it is not easily transmitted, even through saliva. As a blood-borne disease, the virus is most effectively spread through the sharing of needles and tainted equipment.
At YAKITA -- Drug Recovery Centers in Bogor, Bali, and Makassar -- we have recorded that approximately 90 percent of IDUs are infected with Hepatitis C after sharing needles or other drug-injecting paraphernalia.
Tuberculosis has abruptly resurged around the globe and is, once again, a menacing threat to civil society. Tuberculosis has reached high levels within the drug-using and abusing community. The reason for this is explainable. IDUs who share needles have a higher likelihood of contracting HIV. And those who are infected with HIV are far more susceptible to tuberculosis. And when coupled with a decreased immune function, tuberculosis tends to become active. Tuberculosis ranks third as the major cause of death in Indonesia.
According to the Indonesian Ministry of Health in 2005, an estimated 300 people die from tuberculosis every day around the country and approximately 110,000 people die yearly. There are an estimated half a million new cases of the virus reported yearly across the nation.
Further proof regarding the resurgence of tuberculosis is that approximately 25 percent of all who die from end-stage AIDS die from tuberculosis.
Presently the World Health Organization (WHO) and many of the world's leading medical and health experts are concerned about the increasing number of drug-resistant strains or tuberculosis emerging around the world.
HIV and Hepatitis C are blood-borne viruses, transmitted and passed on primarily by blood, semen and vaginal fluids. Tuberculosis, however, is air-borne. Therefore, anyone can easily become infected with the virus in much the same way as they catch a cold or the flu.
Tuberculosis is passed on when infected people cough and sneeze, especially in small isolated spaces with poor ventilation systems such as jails, crowded entertainment centers or small living quarters. The virus can also make its way into one's mouth through the sharing of cups, utensils or food.
HIV/AIDS, Tuberculosis and Hepatitis C have spread across the entire nation many times over. Having spread back and forth from Sabang to Merauke, the diseases' victims in Indonesia have climbed into the hundreds of thousands. And while we often hear and read about the viruses, we rarely think that they are all tightly woven together.
Despite the fact a crisis already exists in relation to these viruses in Indonesia, a bigger crisis lies ahead, just a few short years away, that will dwarf the present crisis.
With AIDS, Tuberculosis and/or Hepatitis C, nothing is easily understood or lived with. All three are very medically, emotionally and physically demanding as well as being expensive to treat. Also, all are highly contagious and usually cause immense physical, mental, emotional and spiritual pain. All are known to cause long-term sickness and suffering and finally end in death.
HIV/AIDS/Tuberculosis/Hepatitis C are known medically to be systemic and opportunistic.
Systemic means each of these viruses can affect any of the body's major organs.
The viruses are considered opportunistic because a minor disease can become pathogenic or life-threatening when the host has a low level of immunity.
HIV/AIDS/Tuberculosis/Hepatitis C are all long term illnesses. All require a long-term commitment in terms of adhering to a treatment regime to prolong resistance to illnesses caused by the viruses.
This means when any combination of the viruses co-exists, which is very common among drug abusers/addicts, years of sickness, debilitation, depression, stress and dysfunction will follow.
After several years, as the diseases worsen, the patient will eventually die.
Within the global drug-abusing community, and especially within the injecting drug-using community, we must now reinterpret what we see as the global HIV/AIDS pandemic. Indeed, the pandemic these days is tri-global and involves HIV/AIDS/Tuberculosis/Hepatitis C.
Make no mistake, the driving force behind the HIV/AIDS/Tuberculosis/Hepatitis C pandemic is the drug-abusing IDU community.
Indonesia now ranks third after China and India as having reported the most cases of tuberculosis. And again, tuberculosis is the third major cause of death in Indonesia.
The HIV/AIDS/Tuberculosis/Hepatitis C combination could be one of the most destructive health and welfare threats to ever emerge in this country and across the world.