Integrated effort needed to tackle HIV\/AIDS<\/p>\n
Debbie A. Lubis, Contributor, Jakarta<\/p>\n
An article of The Jakarta Post's earlier this month revealed
\nthat Minister of Health Achmad Sujudi had told the United Nations
\nsession that efforts to combat AIDS were being hampered by the
\ncontinuing gap between the availability of resources and the
\ndemand for effective and prompt implementation of related
\ncommitments.<\/p>\n
As one of the countries that signed the Declaration of
\nCommitment on HIV\/AIDS, Indonesia must file its first progress
\nreport on its efforts to combat the epidemic by the end of this
\nyear.<\/p>\n
Thus, the minister urged the international agency to enhance
\ntechnical cooperation and capacity building programs, reduction
\nof debt burdens and flexible implementation of trade-related
\naspects of intellectual property rights (TRIPs).<\/p>\n
No doubt debt relief and flexible TRIPs implementation will be
\na great help for programs on fighting the Acquired Immune
\nDeficiency Syndrome or AIDS. But there are at least three factors
\nthat can maximize the effectiveness of AIDS control programs in
\nIndonesia.<\/p>\n
First, technical and capacity building programs have already
\nbeen conducted on government as well as non-governmental bodies
\nwith the help of international funding agencies since the mid
\n1990s. Those who have been trained and assisted are our par
\nexcellence resources. It is time to transcribe their capacity and
\ncapability into real actions for those infected and affected by
\nHIV\/AIDS, or around 90,000 to 130,000 people, according to
\nofficial estimates.<\/p>\n
In so doing, the government needs to consider the second
\nfactor, which is, involving and empowering existing community
\nefforts.<\/p>\n
Obviously local level responses to the epidemic have been the
\nmost powerful tool while institutional responses are bureaucratic
\nand sometimes rhetoric. The community, front-line health workers,
\nNGO activists, along with People Living With HIV\/AIDS (PLWHA)
\nhave proven that they are able to conduct prevention as well as
\ncare and treatment programs in resource-poor settings.<\/p>\n
They carry out efforts to provide education and information
\nabout HIV\/AIDS. They also conduct programs on voluntary
\ncounseling and testing, mother to child transmission, AIDS-
\nmanagement training for health workers, PLWHA empowerment, fund
\nraising, harm reduction and advocacy.<\/p>\n
The social movement called the National Movement on Improved
\nAccess to HIV\/AIDS Therapy (GN-MATHA) has drastically increased
\naccess to generic antiretroviral (ARV) drugs from dozens to
\nalmost 1,000 within a year.<\/p>\n
The latest advance is that these community members have
\nsuccessfully invited 75 people from 13 foreign countries last
\nmonth to Yogyakarta to discuss and share efforts and strategies
\nto increase access to HIV\/AIDS treatment in resource-poor
\nsettings.<\/p>\n
Third, effective and efficient management in the use and
\nselection of programs on AIDS. The government has allocated
\nUS$5.7 million from its 2003 budget, from $3.25 million in the
\nprevious year for AIDS control programs. Meanwhile, this year,
\nforeign donors have disbursed a lavish $16.9 million, a great
\nincrease from $9.3 million last year. Unfortunately, those funds
\nare mostly exhausted in capacity building and prevention
\nprograms, which sometimes are conducted extravagantly (training
\nor seminars at luxurious hotels, etc.).<\/p>\n
Fund utilization is not about choosing prevention over
\ntreatment. Both programs are really needed to prevent the virus
\nfrom spreading. The more HIV positive people fall sick and die,
\nthe more costly the response to the epidemic will be.<\/p>\n
In this case, we need to learn from the governments of Cuba
\nand Brazil which have made ARV available and free medication to
\nall their citizens, regardless of their social or economic
\nstatus. HIV infected people, who receive access to treatment and
\ncare, are definitely able to lead productive lives. At the same
\ntime they can reduce the burden on health care services. Access
\nto ARV treatment must not be considered as a contentious,
\nirrational and unsustainable program.<\/p>\n
Perhaps, what the Jakarta administration decided last week is
\nworth taking into account. The Jakarta Health Agency agreed to
\ninclude poor HIV positive people and low income earners suffering
\nfrom diseases related to drug abuse as candidates for health
\ncards.<\/p>\n
"Initially, we did not want to include them as they need high
\ncost treatment. But the cases are increasing everyday. This is a
\nreality that we have to deal with," said Wandaningsih Parmono,
\ndeputy of Jakarta's health agency in a recent meeting.<\/p>\n
Around 93 percent of 170 intravenous drug users (IDUs) in
\nKampung Bali, Central Jakarta who took HIV tests are HIV
\npositive. Currently, there are 1,155 IDUs in that area.<\/p>\n
This year, the office disbursed a fund of Rp 75 billion for
\nhealth care insurance for the impoverished or low income earners.
\nEach recipient is entitled to a maximum of Rp 10 million to cover
\nhis or her hospital expenses. Those who hold Jakarta ID cards and
\nare recognized as poor by the head of their community unit, or
\nthose who are poor but do not have a Jakarta ID card but work in
\nthe Jakarta area and are proven to be poor, can benefit from this
\nprogram.<\/p>\n
Indeed, there are many resources that can be used. The most
\nimportant thing is to place programs on the fight against AIDS in
\na framework of social justice so that meaningful actions can
\ndirectly benefit those who in dire need. Networking among
\nofficials, regional administrators, health professionals, NGOs,
\nPLWHA and academicians is also important in tackling the
\nepidemic. Maximum efforts should be made to prevent HIV
\ninfection.<\/p>",
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"sponsor": "Okusi Associates",
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