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.