Document supports fight against HIV/AIDS

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.