A question of political will

A question of political will

Much hope has been raised by the new plan which the World
Health Organization announced on Worlds AIDS Day on Monday, to
provide treatment for some 3 million people living across the
world with HIV/AIDS, by 2005.

Among the few hundred thousand sufferers targeted in Southeast
Asia, thousands of people in Indonesia will also be able to get
treatment with anti retrovirals, which is the essential
combination of drugs that have been infamously difficult to
access for millions of people in need.

The news follows a flicker of progress that appeared in
August, when the World Trade Organization reached an agreement to
overcome the barrier it had imposed by limiting the export of
generic drugs to treat HIV/AIDS. Without this agreement, any
effort to stimulate India's manufacturing and export of generic
drugs to countries in Africa -- which would free HIV sufferers of
their dependence on the much more costly products of the big drug
companies of the industrialized countries -- would be illegal
under international rules on patenting.

All around us, fortunately, we see increasing sources of
inspiration. This shows how government attitudes toward the
HIV/AIDS epidemic is changing, which implies a willingness to
confront the issue and no longer dismiss it as one that can be
left to activists while appearing to listen more to the moral
sensitivities of groups with political clout.

Similarly China, which not unlike us in Indonesia, has been
known to cover up delicate issues, has now backed a campaign for
the use of condoms. South African President Thabo Mbeki seems to
have admitted his previous lack of knowledge on AIDS. He has now
promised to provide his citizens in need free treatment over the
next five years, following successful negotiations for cheaper
drug prices.

Thailand is another oft cited example where much less
discrimination and higher visibility of government action has at
least made it possible for wide-ranging efforts to be made to
treat people living with HIV/AIDS (PLWHA).

Lessons abound of the cost of complacency: One sees it in the
eyes of Africa's 14 million orphans, many of whom are also
infected with the Human Immunodeficiency Virus. Sick parents
cannot fend for their children, or even feed themselves. The
average Indonesian family, especially among the poor, which there
are more of now than in the early days of the economic crisis,
cannot take care of others infected with HIV, who over time are
likely to develop further complications such as tuberculosis.

It is this complacency of letting people fend for themselves,
or with the help of a few NGOs, that is most frightening, even
though Indonesia has done much to its credit compared to the
situation that existed a decade ago. According to the United
Nations AIDS body, UNAIDS, Indonesia has about 130,000 PWLHAs
whose condition will worsen if unchecked, and it is estimated
that millions more are infected though they do not even know it.

One in two injecting drug users are estimated to have been
infected, while spouses, especially women, do not dare ask their
partners or husbands to use condoms for fear of the consequence
of appearing to question their fidelity.

Among the government's crucial measures have been the 1994
National Strategy to Overcome AIDS, which managed to accommodate
both moral sensitivities and urgent, practical messages --
including loyalty to one partner and safe sex. Another has been
the inclusion of the anti-retroviral drugs in the list of
national essential drugs, which is progress, compared to other
neighboring countries, as activist and physician Samsuridjal
Djauzi noted.

But these steps and a number of others taken nearly 10 years
ago have proven far from enough. Even basic information, such as
on how the virus spreads, is unfamiliar to some in the nursing
profession if we go by stories of how patients have been treated.

Many schools, including those set up by religious foundations,
remain without sex education, which likely contributes to the
perception of AIDS as a issue that is confined to drug users,
gays and prostitutes. Some teachers have even said that it is
parents who discourage sex education, fearing that youthful
curiosity and hormones would do more harm than good while the
elders themselves do not feel the need, or have the ability, to
even address sexual issues.

NGOs have stressed time and again that it is only government
resources that can sustain and multiply efforts across this large
archipelago.

In the words of Zubairi Djurban, chairman of the Indonesian
AIDS Society, the government is good at preparing data, documents
and plans to fight the spread of the virus. "But we need true
leadership at the level of implementation" to prevent further
overlapping of programs and to upgrade others, he said.

Such teamwork is needed, activists like Zubairi note, if the
country is to remain true to its commitment to the UN Millennium
Development Goal, including the halting of the epidemic by 2015.

For Indonesia, at least, it should mean that no child should
become an orphan only because his infected parent could not
afford treatment, or because his parents did not even seek to
test themselves, dreading life-long discrimination. That indeed,
would be immoral.