Business as usual won't stop AIDS
Warief Djajanto Basorie, Jakarta
Indonesia estimates it has between 90,000 and 130,000 people living with HIV-AIDS. The alarming matter is that as much as 85 percent of them are in their productive years, aged from 15 to 45. The implication is if the numbers are left to grow, the loss of a future working generation could hurt the nation.
Indonesia has modestly aimed for 5,000 people with access to antiretroviral treatment by 2004 and 10,000 by 2005. ARV treatment is a combination of at least three drugs that slows HIV progression and helps to prolong life.
The total number of patients receiving ARV by the end of 2004, however, was 1,553, according to one government count. This figure is based on data compiled from 25 hospitals nationwide the health ministry assigned since July 2004 to accept and treat for free low-income people with HIV.
The actual reach is in fact higher as services outside the 25 hospitals also provide therapy. These service providers include outreach NGOs like the Jakarta-based Yayasan Pelita Ilmu that works in voluntary counseling and testing as well as in care and treatment.
Indonesia's country report of January 2005 on its follow up to a 2001 UN General Assembly Special Session on HIV/AIDS (UNGASS) estimated the total number of people who had received treatment at the end of 2004 was 3,000, still well short of the 5,000 target.
Not all of the designated hospitals have adequate medical, nursing and counseling capacity. The voluntary counseling and testing clinics in the hospitals often do not yet properly function.
Detection of cases is also another problem. HIV-positive people may not be aware they are infected. Those that are aware may be reluctant to be tested and treated for fear of discrimination.
Health authorities will have to scale up the means of the 25 hospitals and put in place a case detection mechanism with NGO outreach help that protects HIV positive people from discrimination.
Indonesia is just one country in Asia and the Pacific with much work to do on AIDS. The current overall picture of the epidemic in the region that houses half of humanity is daunting if not grim.
Some highly-populated countries like China, India, and Indonesia have not reached a generalized epidemic where 1 percent or more of its people are already HIV infected. However these countries do have at-risk groups that can infect the public at large.
The prospect of stopping the spread of HIV infection becomes dim when nations take a business-as-usual approach.
"If it's business is usual, we'll miss the sixth goal of the MDGs (Millennium Development Goals) ," UNAIDS Asia-Pacific director Prasada Rao says. The sixth goal of the eight UN- initiated goals is to halt and begin to reverse the spread of HIV/AIDS by 2015.
The call then is to scale up the response to AIDS so that the sixth goal can be reached. Increasing the response according to a fixed ratio includes more effort in prevention, care and treatment.
Prevention focuses on promoting behavioral changes, education for individuals in vulnerable groups on safer sex and use of sterile needles. Initiatives to that end include a 100 percent condom use program in brothels and a needle and syringe exchange for injecting drug users.
The WHO and UNAIDS launched care and treatment programs for three million people already infected with HIV in December 2003 in the region.
What about vaccines? After 20 years of research none are viable yet. We all need to work harder to fight this disease.
The writer managed a 12-month workshop on AIDS for journalists in 2004 at the Jakarta-based Dr. Soetomo Press Institute, LPDS. He can be reached at wariefdj@yahoo.com.