AIDS figures
I was somewhat surprised to note that your article Government AIDS figures not realistic, says official in the Aug. 19 edition quotes official figures of HIV cases. My understanding is that since May this year, doctors are no longer required to report HIV infection, only AIDS cases. This was promulgated by a decision letter from the Director General of Contagious Diseases Control and Environmental Health at the Ministry of Health, SK No.KH.00.06.4.323 dated May 5, 1998. The main reason given for this change is to avoid confidentiality problems, but it also matches normal WHO reporting practice.
The statistics released by the Ministry of Health as of July 31, 1998 show a cumulative total of 194 AIDS cases, and 101 deaths. These statistics continue to show HIV cases, though it is not clear if this will continue once the new reporting requirement is fully implemented. I am not clear if the previous system required reports when people previously identified as being infected by HIV progressed to AIDS, but I doubt this was done. So the statistics probably underreport the identified AIDS cases. Again, it is not clear if these cases will now be reported as AIDS under the new system.
It appears that HIV cases will now be "determined" from surveillance. The very limited surveillance so far carried out in Indonesia suggests a very low level of prevalence, though few would suggest that this necessarily represents the population as a whole. It is unlikely that funds will currently be available to intensify the surveillance efforts.
As noted in the article, there is considerable difference of opinion over the actual number of cases of HIV infection, with estimates varying from 2,500 to over 100,000 cases. There is no clear basis for these estimates, and the multiplier factors used to extrapolate identified cases lack any real foundation. In such a situation, it would be unsafe for anyone to use these figures as a basis for planning future treatment needs or anti-AIDS campaigns.
Other more reliable data (such as the relatively high level of sexuality transmitted diseases) suggest that even if HIV prevalence is currently low, the risk continues to exist that it could rise suddenly and dramatically. If the incidence of drug addiction estimated in The Jakarta Post article on Aug. 18 (Drop In Center offers help to narcotics 'victims') is even a fraction of the 1.3 million cases quoted this rise has certainly already started. Thus it is essential that we continue to find ways to allocate resources to AIDS prevention campaigns (which so far appear to have almost ignored drug addicts), regardless of whose estimate we accept.
CHRIS W. GREEN
Jakarta