Document supports fight against HIV/AIDS

I Wayan Juniartha, Denpasar

The battle against the HIV/AIDS epidemic in Bali reached a turning point after the Bali governor and scores of high-ranking officials from the island's nine regencies recently agreed to endorse the Sanur Commitment, a written document that will provide stronger political, legal and administrative support.

According to Prof. DN Wirawan and other HIV/AIDS activists in Bali, after weeks of intensive lobbying, the document was presented and endorsed last Friday in Sanur during a special meeting organized by the Ministry of Health, the Bali Commission for HIV/AIDS Eradication (KPAD) and the AusAID-Indonesia HIV/AIDS Prevention and Care Project (IHPCP).

"This (the commitment) will provide solid ground and a moral and political boost for government agencies, non-governmental organizations (NGOs) and the general public, which, for years, have tried relentlessly to scale up various efforts to fight this dangerous epidemic," Wirawan said.

Among the signatories of the document were Bali Governor Dewa Made Beratha, Bali Legislative Council chairman IB Putu Wesnawa, Bali Police deputy chief Brig. Gen. Teguh S, Gianyar Regent AA Bharata, Jembrana Regent Winasa and Tabanan Regent Adi Wiryatama.

The event was also attended by Minister of Social Affairs Bachtiar Chamsyah and Minister of Home Affairs Hari Sabarno, who hailed the document as a much-needed regional initiative to curb the spread of the epidemic.

"The Sanur Commitment is, in a way, an amplification of the national-level Sentani Commitment last January. It was endorsed by the governors of six provinces that have suffered the most from the HIV/AIDS epidemic, namely Papua, Bali, East Java, West Java, Jakarta and Riau," asserted Surya Dogi Anaya of Bali's IHPCP.

The first point of the eight-point commitment outlined critical targets the signatories agreed to achieve in reducing the spread of sexually transmitted HIV/AIDS, particularly among commercial sex workers. It advocates the routine use of condoms, and aims to cover 60 percent of all HIV/AIDS-risky sexual encounters by the end of 2005 and 80 percent by the end of 2007.

"It is a very important point for us because it signifies the government's willingness to get involved in an issue that previously had been considered as morally unacceptable and politically incorrect," Wirawan said.

As chairman of Yayasan Kerthi Praja (YKP), a local NGO that worked primarily with sex workers, he knew too well how difficult it was to popularize condom use among their clients.

"We have been working on that for 10 years. At that time, the percentage of condom use was 7 percent; nowadays it is still only 30 percent. It shows that one-to-one intervention by NGOs has failed to achieve optimal results," he claimed.

He admitted that the unpopular move was due to ignorance by sex workers and their clients of safe sex, not to a lack of knowledge or awareness of the deadly viral infection.

"We now need a structural intervention that has the power to introduce condom use as obligatory for the clients of sex workers," he said.

"One interesting example is the Thai government's success in introducing and implementing a specific regulation that dictates 100 percent condom use in all brothels," he added.

In the past, the Bali administration refused to draft a regulation to cover sex workers through fear that by doing so the government would effectively acknowledge prostitution as a legal business enterprise.

"It's about time that fear of the epidemic's spread outweighs fear of that legalistic mumbo jumbo. Legal or not, there is a huge population of sex workers on the island right now and most of them are involved in high-risk sexual behavior," he said.

Wirawan estimated that by 2004 the incidence of HIV/AIDS among sex workers had reached 10 percent, a slight, but alarming increase from the 7 percent in 2001.

"The truly frightening thing is that some sex workers, who have been tested positive for HIV/AIDS, continue to do business without using condoms," he said.

Recent research conducted by YKP shows that, currently, there are around 3,000 commercial sex workers on the island. They have a total of 90,000 different clients and generate around 300,000 sexual transactions per year.

"We will soon approach the regency administrations to convince them to use the commitment as a foundation to draft and introduce their own local regulations on condom use and sex workers," Wirawan stated.

The second point of the document outlines the aim of widening the impact of the island's ongoing harm reduction program, so as to cover 75 percent of injecting drug users (IDUs), including those serving terms in prison, by the end of 2005. The number of IDUs on the island is estimated at 2,500 people.

Currently, the island is running two harm reduction-based pilot projects, namely a community-based needle exchange program and hospital-based methadone maintenance therapy. Both were too limited in terms of size or coverage to have a significant impact in curbing the epidemic.

The third point in the document is a declaration regarding future initiatives to increase medical services and support for people living with HIV/AIDS. It is expected that antiretroviral (ARV) drugs will be provided to at least 200 people by the end of 2005 and to 500 by the end of 2007.

"The document also speaks about fighting and decreasing stigma and discrimination, which have hampered our work," Wirawan added.

The rest of the document outlines a variety of educational and advocacy efforts aimed at increasing the general public's awareness of HIV/AIDS issues and creating a more conducive atmosphere for the eradication of the disease, including amending laws and regulations that have hitherto restricted the access of IDUs to sterile injecting paraphernalia.

Separately, Bali KPAD chairman Kesuma Kelakan disclosed that the cumulative total of reported HIV/AIDS cases on the island had reached 452.

"However, that is just the tip of the iceberg. Current estimates places the number of HIV-infected people on the island at around 3,000 people. Unless effective measures are taken we will soon face a situation in which the island's health is jeopardized and financial resources stretched to their limit by the epidemic," he said.

The Sanur Commitment, he said, was expected to give birth to plenty of regency-level initiatives and legislation, which would eventually strengthen the island's response to the epidemic.