Chika Yamada is an assistant professor at the Center for Southeast Asian Studies, Kyoto University, who specialises in Southeast Asian area studies and public health, focusing on the modern history of Indonesian drug user activism. Her interdisciplinary work explores the intersection of health and society, blending qualitative and quantitative approaches.

The dominant presentation of harm reduction (HR) in ongoing Indonesian drug policy reform rests on the premise that HR is monolithic, value-neutral, pragmatic, and counterbalances supply and demand reduction. Instead, we argue that HR is an evolving and socially constituted entity with varied—sometimes conflicting—ideologies. Through a post-structuralist lens, we narrate the genealogy of three intertwined HR practices: public health, legal, and liberatory, in the Indonesian context.

HR was pioneered by civil society in response to the AIDS crisis in late-1990s Indonesia. Facilitated by foreign donors, HR was presented as a fixed, amoral set of evidence-based methods benefitting public and global health, which successfully led to state-sanctioned programs in the mid-2000s. However, this technocratic approach has fostered an epistemic hegemony, which, in Foucauldian terms, undermines the 'subjugated knowledge' of people who use drugs, eventually reducing them to commodities and grassroots actors to implementing tools. Their collectivisation, however, galvanised scrutiny of the rights infringement of ‘criminals,’ prompting legal aid and advocacy to quell violence and exploitation during legal processes. Legal-focused harm reduction led to restorative justice initiatives, but drug use remains criminalised, and abstinence remains the goal through mandatory rehabilitation. Critical to the above contingencies, liberatory HR rejects value-neutrality and calls for radical structural changes, e.g., dismantling the justice system, reclaiming health agendas co-opted by donors and authorities, addressing intersectional injustices, and overturning neo-colonial knowledge generation. Importantly, they validate the pleasure and benefits of drugs based on bodily subjectivity and Indonesian cultural and historical perspectives.

We conclude that HR, in any form, has been fostered by a collective space for critical thinking—often nurtured by countercultures—that challenges the legitimacy of hegemonic knowledge. This ‘scientific citizenship’ is threatened by the status quo of bureaucratised HR practices. Incorporating HR into drug policy without understanding its diversified ideologies and their material-discursive effects could, paradoxically, create harm.