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