HIV/AIDS: Fighting on new fronts
In a stark, cement-walled, three-room home in Sorong, West Papua, Angelina is slowly fading away. She once dreamt of being a policewoman “because I looked at them as people who could protect and help people”. But those dreams have long since disappeared. In June 2002, her once-vigorous auto-mechanic husband wasted away and died, followed six months later by her first-born infant daughter. In October, she found out why. Deathly sick with an untreatable cough and still grieving from her loss, the 21-year-old was informed she was infected with HIV: It is likely her husband contracted it from a sex worker. Angelina is one of the many innocent, ignorant victims of HIV in Indonesia, ordinary people who don't engage in high-risk behaviour but contract the virus from those who do. While much attention has, rightly, been focused on stemming the spread of HIV/AIDS among high-risk groups, UNICEF is targeting mainstream youths in a bid to stop the virus crossing over into the general community. Most young Indonesians are appallingly ignorant of HIV/AIDS and how it is spread. Few of them have access to accurate information about the disease. In one study, just over one in three Jakarta high school students could correctly identify ways of preventing the sexual transmission of the virus. This lack of knowledge creates a potentially terrifying time bomb in places like Papua, where many young people become sexually active from puberty. By training Papuan secondary schoolteachers in teaching life skills and HIV/AIDS prevention, UNICEF hopes young Papuans will understand the consequences of unprotected sex. Education is one pillar of a five-year Indonesian government HIV/AIDS strategy that remains stuck firmly in first gear: UNICEF is trying to make a difference by reaching out to high school students. “While in the schools we combine life skills education and peer education strategies for the prevention of HIV infection and drug abuse. These strategies are designed to provide young people with the kinds of inter-personal communication skills, creativity, assertiveness, self esteem and critical thinking that can help them in cases where they’re being confronted by an opportunity to try drugs, or engage in unprotected sex,” says Rachel Odede, head of UNICEF Indonesia’s HIV/AIDS unit. A major hurdle in educating Indonesians about the disease is countering the commonly held belief that it only affects "bad people" who deserve what they get - giving HIV/AIDS a stigma which has seen infected people forced out of their villages, refused treatment by doctors, threatened, shunned and ostracized. The fear and stigma surrounding HIV/AIDS is why Angelina's neighbours, and even some of her family members, don't know about her illness. “I’m an active member of my church and I don’t want people to look at me and say ‘Look, his daughter is sick’,” says her father, Yokobus, a rheumy-eyed elementary school teacher who has taken early retirement to care for his youngest daughter. Although secular Indonesia has had widespread family planning initiatives and an official “two is enough” policy towards children, public discussion about sex is abhorrent to most in this conservative, predominantly Muslim country. For now, the HIV/AIDS epidemic in Indonesia is concentrated, with still-low HIV infection rates in the general population but high rates among certain groups, such as sex workers and, increasingly, injecting drug users.
Indonesia, like Vietnam and China, is classified as having an emerging epidemic of HIV/AIDS: experts estimate that there are between 90,000 and 130,000 Indonesians living with HIV. But UNICEF believes this could escalate into a generalized epidemic unless there are changes in behaviour among high-risk and bridging populations. It's not difficult to envisage this crossover of infection in the general community when you consider that 7 to 10 million Indonesian men visit a prostitute annually and are reluctant to wear a condom, or that it's estimated that thousands of women have been infected sexually by men who inject drugs. “In the years since the 1997 monetary crisis we’ve seen more and more young people coming into the city looking for work and a rapid increase in the number of sex workers and IDUs [injecting drug users],” says Dr Barakbah, chief of the communicable diseases unit at Dr Soetomo Hospital in Surabaya. “We’re expecting the full explosion of AIDS cases in the next few years. We’re seeing exponential growth in reported cases of HIV, especially in brothels. The epidemic is entering its third stage, it is evolving into AIDS, and we’re seeing many more patients now, especially women [infected by their husbands] and children.” To understand how this scenario is unfolding, consider the story of 16-year-old sex worker Reena (not her real name), who works in Surabaya, which is Asia's biggest sex district. She's HIV positive but doesn't know it, and continues servicing at least a dozen men each week, virtually none of whom is prepared to wear a condom, and several regular “boyfriends”. Some of these men are probably among the 2,000 or so sailors who arrive every week in Surabaya, the capital of East Java and overland freight-trucking hub between Java, Sulawesi and the eastern islands of Indonesia. An ethnic hodgepodge of people from across the archipelago, Surabaya has the three “Ms” in HIV/AIDS transmission – men, money and mobility – in their rawest form. Now agencies are also becoming concerned about the rapid spread of HIV/AIDS among the growing numbers of young Indonesian injecting drug users, most of whom are in their twenties and sexually active. In some areas of Jakarta, it's estimated that 90 per cent of users are HIV positive. Over the past few years, as the price of heroin has plummeted and Indonesian chemists started manufacturing vast quantities of shabu-shabu (sufficient to become a net exporter of the drug), the junkie demographic has begun to swing. Like Thailand, which saw cheap Burmese meth stoke a grassroots inferno through the mid-1990s, drug use is taking off among Indonesia’s urban poor, a difficult group to target with a message about clean, unshared needles. To encourage these young drug users to use testing and counselling services, UNICEF has provided technical and financial support to several NGOs (non-governmental organizations) which help out-of-school youth vulnerable to drug abuse and sexual exploitation. But agencies can't fight the battle on their own. To educate the broader population they need the support and resources of national and regional governments, which are often reluctant to take a leadership role in the case of a disease which is seen as a product of 'immorality'. Some breakthroughs have been made. Governors of some of the worst affected provinces signed an agreement vowing, among other things, to pool their resources towards improving education about the disease. But there is still much work to be done. “The immediate challenge I see is translating the HIV/AIDS strategy into concrete operational plans of action,” says UNICEF’s HIV/AIDS chief Odede.
Indonesia: empowering youth to fight HIV/AIDS |
