AIDS strikes small Irian Jaya community

By Dini S. Djalal

MERAUKE, Irian Jaya (JP): As citizens of Merauke, Irian Jaya, look forward to the coming year, they may look back on this year as a year of disaster.

First, rain has been scarce for nearly a year, and crops are suffering. Fortunately the rainy season will eventually arrive. Unfortunately, the arrival of a cure for Acquired Immune Deficiency Syndrome (AIDS), the fatal disease which has struck this small community, has yet to be discovered.

In a nationwide survey conducted by the Ministry of Health, Irian Jaya rates as having the second highest number of cases of infection with the Human Immunodeficiency Virus (HIV), which is the precursor to AIDS.

In July, official data reported 58 positive test results for HIV (HIV-positive) in this immense but sparsely populated province, a statistic second only to Jakarta's list of 75 HIV and AIDS cases.

Jayapura, the provincial capital in the north of Irian Jaya, has one HIV-positive case and Merauke, a harbor side town on the south coast, has 57 cases.

Out of the 57 cases in Merauke, 50 were Thai fishermen in Merauke on monthly work visits. After agreeing to be tested by the local office of the Ministry of Health, and testing HIV- positive, the fishermen were repatriated back to Thailand by their employers. Yet the remaining seven cases of HIV among the local population remains disproportionately high, considering the remoteness and modesty of the locale and the population, which is 64,000 at present.

The newest data, as reported by Steve Osok, head of Merauke's Health Office in November, shows an increase to three cases in Jayapura, nine in Merauke, and one in Serui, a small town near Biak Island in the north. In Merauke last month two of the HIV sufferers died. They had lived quite healthily since their diagnosis two years ago.

The surprisingly high statistics have created panic in the community. A volunteer from the non-profit AIDS education center Mitra Indonesia, Agus Triwahyu said, "Even people in the interior (of Irian Jaya) are carrying newspapers. They put the papers on bus seats because they think the disease can be transmitted by any kind of contact," he explained.

Scapegoating

The panic has, in turn, resulted in a lot of finger-pointing and increasing hostilities in an otherwise stable community. Regent R. Soekardjo said, "Because you are dealing with a small town, when an illness like this arrives, it feels especially sinister."

Many accuse the Thai fishermen of introducing the virus, claiming that otherwise Merauke would be free of AIDS.

For the most part, the Thai fishing companies have opted to stay clear of the furor. Their Indonesian spokespersons participated in the first day of a workshop held by Mitra Indonesia on Nov. 29 and 30, but have since returned to their headquarters in Timika, an hour away by plane. Mitra volunteers claim that the fishermen are former criminals who provide cheap labor for the Thai fishing companies.

There are other people who blame the Ministry of Health for not handling the emergency at hand more carefully. There was no quarantine policy prior to the present panic, and many Merauke citizens feel the Thais should have never been allowed to leave their boats, at least for not longer than an afternoon.

"The immigration authorities just check their passports and let them go," local businessman Edo Maro claims. "There are four sectors involved: the Ministry of Fisheries, the Navy, Customs and Immigration, all with different agendas. The Ministry of Health is in charge of the community's well being, but what are they doing to ensure this?" Maro said.

Maro contends that the statistics would be higher if more thorough testing is carried out. "Blood tests are really expensive here because the samples have to be sent to Jakarta via Jayapura. For that reason, tests are conducted on high-risk groups only. Can you imagine the statistics if everyone here were given blood tests?" Maro said.

Osok agrees that test procedures are inconvenient, often taking up to three months to complete, but he said the Ministry of Health is doing all it can to contain the virus. "The Thai employers have tried to assure us that they will only send HIV- negative workers, but we will go on to the boats and check for ourselves," Osok said.

Sex and morality

While pragmatists may see health checks as the key issue, the community's religious leaders see AIDS as a question of morality. Representatives of the Catholic Church, for example, do not even consider the provision of contraception, and regard the only solution to be the elimination of prostitution. More specifically, they are urging prostitutes to change professions - disregarding the people who frequent prostitutes, or the economic issues which bring about prostitution.

The Islamic community also sees prostitution as the problem, although, in line with the national family planning program, they are less conservative concerning contraceptives and will allow condom dispersal for select parties, including prostitutes and married couples.

The imposition of ethnocentric norms of the normal family -- ie. monogamous marriage -- has raised protests among indigenous Irianese. Traditional local culture has less stringent rules on sexual behavior, and men with more than one wife are commonplace. Ferry Lechoi, Fak-Fak by ethnic origin, but a longtime inhabitant of Merauke, admits that "the spread of HIV is not surprising considering the sexual mores of the locals. You can prepare them with medicines and contraceptives, but you cannot prepare them mentally for the concept of safe, monogamous sex."

Lechoi's admission of free sexual behavior in this region may prove helpful, because mainstream media focus on prostitution may prove more dangerous than beneficial, as it creates the illusion of safety for the community at large. Hudoyo Hupidio, director of Mitra, said that in Indonesia, prostitutes account for only 20 per cent of HIV-positive cases. The rest are mainly heterosexuals who contracted the disease by other means.

In Irian Jaya, the dilemma of scapegoating prostitutes is exacerbated by the tendency to blame the transmigrant community for proliferating prostitution. Many locals believe that some prostitutes pose as transmigrants in order to receive residency papers for Irian Jaya, while others claim that the poverty facing newcomers forces transmigrant husbands to sell their wives as prostitutes.

Prostitution, however, is an age-old alternative for the poor. To address only prostitutes overlooks the need to address the patrons of prostitutes as being equal carriers of HIV. Yenny Sahetapi, a local social worker who has interviewed prostitutes in Merauke, said that if these patrons are not instructed in safe sex as well, then the hours spent in contraceptive instructions and dispersion to prostitutes will bear little fruition.

More importantly, the virus is not contained within the transmigrant or red-light district. The AIDS victim who died last month in Merauke was not a prostitute but a 19-year-old high school student. It was not explained how the girl obtained the disease.

The issue here is the need for public education about safe sex. HIV is indiscriminate in who it will strike. The only thing one can do, regardless of one's sexual behavior, is to use proper protection, specifically a condom. An equally important task is the improvement of the Ministry of Health's facilities regarding blood transfusions, another means of acquiring HIV.

Education

In coordination with the AIDS Awareness Festival across Indonesia, Mitra Indonesia held a two-day AIDS-education workshop and a three-day exhibition of posters and photos early this month in Merauke. The workshop targeted influential members from all sectors of the community, from youth groups to religious organizations, so that they may continue the work once Mitra leaves.

The exhibition was open to the public, and was opened on Dec. 1 by Regent Soekardjo. The Governor was scheduled to attend, but, much to the disappointment of Merauke inhabitants, declined at the last minute. A benefit concert was also held, featuring reggae bands Abrezzo and Emergency.

The volunteers at Mitra realize the enormous task at hand. One of their goals is to have an educational and counseling center established in the near future. Mitra organizer Nur Kamka explained that up until now the only AIDS-related service has been the initial blood tests. Follow-up treatments, whether medical or psychological, have not been available. For the HIV- positive patient in need of sympathetic care and attention, increasing public awareness and understanding of AIDS can only bring greater good.