About real figures of AIDS

About real figures of AIDS

It may seem ungrateful to criticize your supportive editorial
(AIDS: Where do we stand?, The Jakarta Post, July 8). But
we do need to have a clearer understanding of the figures related
to AIDS in this country, and unfortunately the editorial tends
more to cloud the issue.

First, we must always very clearly differentiate between three
sets of figures: Reported cases, estimated cases and reality.
Thus to state that "the number of people living with HIV/AIDS in
Indonesia grew by 3,924 from 1987 to 2003, of which 2,685 were
HIV-positive and 1,239 had developed AIDS" confuses statistics
with reality.

In fact, these are the figures reported to the Ministry of
Health by the provincial health services as at Sept. 30, 2003,
and certainly do not represent the total number of cases, or even
all the cases identified at that time, since there is usually a
discrepancy between provincial figures and those reported by the
center.

You are correct in reporting that the best estimates put the
total number of cases of HIV-infection in the region of 100,000.
However, to state that 2,746 of these are HIV-positive and 1,413
have developed AIDS appears to leave a huge gap. In fact these
latter figures represent the cases reported by the ministry up to
March 31, 2004.

Given that we have details of less than 5 percent of the
estimated number of cases, it is inappropriate to extrapolate
this data to the wider population of those thought to be
infected. Therefore, while it may be reasonable to assume that
unsafe sex is driving the epidemic in Papua and Riau (read the
Riau archipelago, not Pekanbaru as incorrectly stated in a report
a couple of weeks ago), I doubt the same is true of the real
epidemic in Bali.

Having just paid a return visit to the Kerobakan prison
in Bali, it is clear that injecting drug use is now almost
certainly the main mode of HIV transmission on that "isle of
paradise".

Regarding the government plans for treatment, it is the intent
of the Ministry of Health to provide drugs at a subsidized price
to as many as 4,000 people with AIDS this year. However, since a
cost of Rp 200,000 per month is well beyond the means of most
people with AIDS in Indonesia, the activist community is strongly
urging the minister to reconsider this approach. To achieve the
ministry's target of treating 10,000 people by 2005, it will be
essential to make the drugs available free-of-charge,
just as they are for tuberculosis.

Finally, sadly it is not true to say that domestic production
of the drugs alleviates the cost. In fact, locally produced
antiretroviral drugs still cost well over twice the price of
similar drugs on the international market. The Clinton Foundation
has negotiated an annual price of US$140 for this treatment. At
current exchange rates, the Indonesian product costs over $500
per year; even the subsidized price is more than $250 per year.

CHRIS W. GREEN, Jakarta