Wednesday, August 27, 2014

Indonesia Must do more to Fight HIV/AIDS Scourge

By Andrew Manners

A recent report claims that Indonesia is losing the fight against HIV, with a dramatic rise in incidences over the past few years. While Jakarta has implemented a number of impressive programmes, a shift in attitude is sorely needed to address the growing crisis.

Experts have warned that Indonesia is losing the fight against HIV, with a significant upsurge in AIDS-related deaths recorded between 2005 and 2013. According to the 2014 UNAIDS Gap Report, released on 16 July, the country is ‘being left behind’ and faces ‘the triple threat of high HIV burden, low treatment coverage and no or little decline in new HIV infections.’ In fact, while incidences of the virus are falling around the world, the spread of HIV has risen across the archipelago. Jakarta insists it is on the right track, but a renewed focus, including a shift in attitude, is sorely needed if the crisis to be addressed successfully. 

A new report by the UNAIDS has identified Indonesia as one of six countries globally that are ‘being left behind’ in the fight against HIV. According to the Geneva-based organisation, Indonesia, along with the Central African Republic, the Democratic Republic of the Congo, Nigeria, Russia and South Sudan, must do more to improve treatment coverage and reduce a worrying increase in HIV incidences.

The embarrassing comparison to some of the poorest countries in the world was questioned by some Indonesian officials, with Indonesian Health Minister Nafisiah Mboi criticising the details of the report. Yet the overall picture is grim: between 2005 and 2013, the report says, there was almost a 50 per cent increase in new infections in Indonesia, with a 427 per cent rise in AIDS-related deaths during the same period. By contrast, neighbouring countries, including Cambodia, Thailand and Burma/Myanmar all posted steady falls. That means that Indonesia now has the third-largest number of people living with HIV in the region. Just as worrying, too, is the fact that only eight per cent of those living with HIV in Indonesia are using, or have access to, antiretroviral drugs.

Explanations for the upsurge in HIV incidences in Indonesia are not clear-cut. Local HIV/AIDS experts acknowledge the increase in new infections and deaths. But they also point out that the epidemic is a new phenomenon in Indonesia compared to other states in the region; after a rapid spike in infections, they say, numbers are likely to level off. That could prove to be the case. Countries such as Cambodia and Thailand have both managed to rein in the deadly disease after experiencing highly publicised crises in the late 2000s.

Still, that is only a part of the dilemma facing Indonesia. Jakarta has implemented some fine programmes and has important long-standing partnerships with donors, local communities and international organisations. But deep-seated cultural attitudes make it virtually impossible to combat HIV. For instance, although nine per cent of Indonesian sex workers are HIV positive, compared to just 0.3 per cent of the general population, the country has some of the most draconian laws against sex workers in the region; this is despite the fact that criminalisation of sex work is one of the most significant barriers to controlling the transmission of HIV among sex workers. Improving the conditions of sex work, rather than dismissing it as “immoral” and running it underground, is urgently needed.

As 42 per cent of Indonesians with HIV are aged between 20 and 29, making sex education a compulsory subject in Indonesian schools is also vitally important. Unfortunately, the taboo that continues to surround sex means that many young people go without sexual education. As a result, they are often are hopelessly unaware of the dangers. According to a 2011 survey by the Ministry of Health, only 20 per cent of Indonesians aged between 15 and 24 had comprehensive knowledge of HIV. That makes prevention a particularly challenging task for health workers on the front lines.
Similarly, although the HIV rate is devastatingly high among drug users in Indonesia, with more than one-third of all new cases due to intravenous use, many people are slow in seeking help. This is not surprising given the harsh laws against drug use and the discrimination and stigma that surround it. Yet, in nearby Vietnam and China, a gradual shift in attitudes has seen the rollout of a number of drug treatment programmes aimed at reducing the frequency of intravenous drug use. Indonesia would do well to follow suit.

While Jakarta has made some impressive strides to combat HIV in recent years, a shift in attitude, to one that involves helping the most vulnerable, is now needed. Ultimately, no amount of programmes will reverse the worrying increase of HIV incidences in Indonesia if those that are most in need are unable or unwilling to access them. That must change.

Andrew Manners is a Research Analyst in the Indian Ocean Research Programme. His article originally appeared in Future Directions 20 August.

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