[Nasional-e] Spread of AIDS in Papua at alarming level

[Holy Uncle]

http://www.thejakartapost.com/detaileditorial.asp?fileid=20021003.F03&irec=2

Spread of AIDS in Papua at alarming level
Chris W. Green, AIDS Activist, Jakarta, chrisg@rad.net.id

An African-style AIDS epidemic in Papua is not outside the bounds of 
probability. And yes, I am talking about the Indonesian half of the island, 
previously called Irian Jaya.

I recently visited four towns in the province, Jayapura (the capital), 
Merauke, Sorong, and Timika. I was a member of a team of four from the 
Spiritia Foundation, a team that included two people with HIV/AIDS (PLHAs).

We had been asked by the Aksi Stop AIDS (Stop AIDS Action, ASA) project (a 
USAID-funded program) to meet with PLHAs in the province, with a view to 
empowering them to play an active role in the response to AIDS there. We 
also met with groups supporting PLHAs, including non-government 
organizations (NGOs), doctors and hospitals, and those in government 
responsible to respond to the epidemic.

Papua is a huge province with a very small population -- a little over two 
million, of whom half are migrants from other parts of Indonesia. The 
indigenous people are members of a large number of tribes, most with their 
own language and customs. Literacy is low, as is ability to communicate in 
Bahasa Indonesia.

We had been aware that the epidemic in Papua is more developed than in other 
parts of Indonesia. There have been more than 1000 cases of HIV infection 
reported in the province, and the reported prevalence of AIDS is almost 30 
times the national average. And we had heard that surveys among sex workers 
in Merauke, thought to be the worst affected place, had shown that one in 
four are infected with HIV.

However, we were not prepared for the scale of the problems surrounding the 
epidemic in Papua. Clearly poverty contributes -- even though Papua is by no 
means the poorest province in Indonesia. Attitudes towards sex among the 
indigenous population also impact -- as in Africa, most HIV infections in 
Papua are sexually transmitted. Alcohol use also must bear some of the 
responsibility.

But if these factors tend to drive the epidemic, it must be said that 
efforts to stem its spread are sporadic at best. As is so often the case, 
political factors intervene. There is a common belief among local leaders 
that AIDS was introduced to the province in a deliberate effort to decimate 
the indigenous population. This hinders any reasonable discussion about ways 
of addressing the spread of infection. Meetings become dominated by calls 
for quarantining PLHAs, even though this has been proved counter-productive, 
and clearly violates human rights. Others call for closing the provincial 
borders to visitors who cannot prove that they are not HIV-infected -- 
again, a useless response.

Many of those who are responsible to coordinate the response -- officials 
who are ex-officio members of AIDS Control Commissions at province and 
district levels -- openly admitted to knowing little about AIDS. Much of 
what they do know is incorrect. Yet there has yet to be a determined effort 
to educate decision and policy makers, or community and religious leaders.

One immediate effect of all this is that stigma and discrimination by the 
community -- and families -- is a daily experience for many PLHAs in the 
province. Following an AIDS diagnosis, families often quickly remove 
patients from hospital. We heard of cases of patients being abandoned to 
die.

As a result of these and other factors, many believe that an AIDS epidemic 
is exploding in Papua. Dr. Gunawan, an expert with many years experience in 
the health ministry in Papua and now responsible for the Stop AIDS Action 
program there, fears that as many as 5 percent of the total population may 
already be infected. This matches the level found in many countries in 
sub-Saharan Africa.

What should be done? Clearly there must be much greater efforts to raise the 
level of concern among local leaders. Indeed, there are hopeful signs here 
-- the province's Deputy Governor Constant Karma led a party of Papuan 
officials on a fact-finding visit to Uganda to see the situation there at 
first hand. He is now a dedicated campaigner for effective and practical 
responses.

There are some similar activists at district levels, but they are too thinly 
spread -- and overloaded with a multitude of other problems, requiring 
equally urgent solutions. We must find ways to involve more community 
leaders -- particularly religious leaders -- and provide them with a 
balanced education on how the challenge of AIDS may be addressed.

One approach that has demonstrated success around the world is the 
involvement of PLHAs. Indeed, this has already been shown to be extremely 
effective in Papua. One PLHA, affectionately known as Mama Dora, was active 
in openly addressing public meetings in the latter part of last year. Sadly 
she succumbed to AIDS early this year, and she died in January.

Despite her example, we were frequently told that it would be unlikely that 
we could identify candidates for such involvement in Papua. Everyone said 
that PLHAs there would not be willing to reveal their status in public; they 
don't have sufficient education; they're all too sick.

However, we proved this incorrect. In each location we met at least one PLHA 
who was willing and able -- with guidance -- to play such a role. Doubtless 
they will require development of their skills, and education on HIV and 
AIDS, as part of an empowerment process that must also be directed to 
increasing their self-confidence. Spiritia will provide all of this as part 
of our ongoing program, financed by the Ford Foundation.

In a meeting with the Deputy Governor we challenged him to include a PLHA in 
all of his frequent public appearances to talk about AIDS in the province. 
He whole-heartedly accepted our challenge, but challenged us to identify and 
train suitable candidates. This is a task we have already started to 
address.

It is already be too late to prevent a major AIDS epidemic in Papua. But we 
must find ways to mitigate its impact, and to introduce programs that will 
reduce the spread of infection. This will require leadership by officials, 
politicians, and community, especially religious, leaders. It will require 
them to open their minds and their hearts to the realities of the disease 
and the way it is spread. They must be prepared to do their homework, to 
learn the truth about AIDS, and ignore the myths and stigma that surround 
the disease.

Several African countries have demonstrated that such an approach can be 
effective in combating the AIDS epidemic. We must be willing to learn from 
them.



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