HIV/AIDS: A developing crisis in Indonesia

HIV/AIDS: A developing crisis in Indonesia

Meiwita Budiharsana, Ford Foundation
David & Joyce Djaelani Gordon, YaKita

HIV/AIDS is growing at an alarming rate in Indonesia. One of
the main ways in which it is spread is through the sharing of
infected syringes by injecting drug users (IDUs).

In these three related articles the spread of HIV/AIDS is
examined, as well as the role of the police and of corrupt
officials in the distribution and circulation of illegal drugs in
the country.

HIV/AIDS now infects one new person every 15 minutes, of every
day, somewhere in Indonesia.

This means there are some 96 new cases per day, 672 per week,
34,944 per year. These figures are growing daily.

New infections are documented daily in Jabotabek, Bandung,
Yogyakarta, Surabaya, Bali, Makassar, Medan, Bantam, Papua, from
Sabang to Merauke.

HIV/AIDS has crashed through the entire governmental
protective structure, the defense line of health, welfare,
medical institutions and organizations has breached the security
of both the police and military, and casts aside beliefs and
values of the religious community.

It now threatens the social system from palace to kampung, a
foreseeable portion of economic development and stability is in
jeopardy, has given rise to another meaning for malu -- a
destructive attitude of guilt and shame within the Indonesian
culture, and has witnessed "damage" to the heart of many
families.

The main "target" of HIV/AIDS is young males and females, sex
workers and those having random and unprotected sex, drug abusers
and addicts, those in jail and large quantities of those employed
in large-scale industrialized businesses and migrants/transients.

That means millions are in jeopardy, as they are open and
vulnerable targets to HIV/AIDS. And from those who are highly at
risk, and become infected, they are the ones that most often pass
the virus to the unsuspecting multitudes of others.

These include wives and lovers, boyfriends and girlfriends,
and those in casual and sexual relationships..

If the government is unprepared to produce a workable defense
against HIV/AIDS, it means the entire medical community is
unprepared to meet the needs and treatment of those stricken with
HIV and AIDS, and related illnesses and problems.

In turn, that means the entire "school system" is without
proper or adequate educational instruction, data, materials and
instruction.

Taking all this into account, it means "much" of the entire
Indonesian population is wide open, nearly defenseless, against
the spreading HIV/AIDS pandemic.

In the mid-1990s only a few thousand were recorded as infected
with the virus; by 2000 it was tens of thousands; today, hundreds
of thousands.

"Education" must be targeted at the general population,
families, the most reasonable and responsible lines of defense.

Fathers and mothers must lay aside their embarrassment and
fear of the unknown, stop stigmatizing and discriminating, learn
the truth between fact and fiction, and realize that HIV/AIDS
must be declared a family and community issue.

Putaw (low-grade heroin) and shabu-shabu (methamphetamine) are
presently the two main choices for drug abusers and addicts,
throughout most populated areas, across the nation.

Both are injectable. Injecting is the most efficient way to
transfer the virus. Unprotected sexual intercourse is the second-
most effective way to transmit the virus. Young people are
attracted to drugs and drug culture because of fun and the
thrills.

Sex is part of the fun, excitement and thrill, and is in large
part why the young are attracted to drugs.

Only a few short years ago, we, as a nation, ignored the
possibility of HIV/AIDS being harmful to our population. Then, as
we began counting the infected, we thought it would only infect
and affect "gays, the unclean and outsiders".

Then, as it spiraled rapidly upward, we thought it would
mostly infect drug addicts, prostitutes and those at the bottom
of the economic ladder.

Today, as a horrible homage to the reality we are praying that
we lose only one generation of young people, not two (or more).

The discovery of students, young women and men in the
universities infected with HIV/AIDS has been shocking and has
brought rapid attention to parents and the parental community --
parents who only a few years ago did not even know what HIV/AIDS
was.

Parents, multitudes of parents, from Sabang to Merauke, are
now seeking help and advice on HIV/AIDS. Yet reliable and
definitive advice remains elusive for most of the nation;
doctors, hospitals, specialists, experts and medication are all
still haphazardly scarce.

Parents and those in authority, religions, educators and the
War on Drugs all say "Don't use drugs!" yet multitudes of people
around the world still use drugs, while the War on Drugs lost
position and respect a decade ago.

The supply reduction approach says "stop trafficking, dealers
and production, destroy crops and laboratories that produce the
drugs, and put the dealers in prison or execute them, enact more
reliable legislation".

Demand reduction says "produce more information, education,
communication, hotlines, peer programs, counseling, outreach,
treatment, 12-step programs, advocacy".

Harm reduction says, "teach people about the effects of drug
abuse and people will be more sensible about how they use them,
what they use, and with whom they use them.

"They will adopt a common sense attitude ... Establish more
risk reduction programs, testing & counseling, treatment &
clinics, hospitalization, therapeutic communities, HIV/AIDS
education, hospices, family aftercare".

All the reduction programs are sensible, well-structured,
wizened by time and experience, and well-known worldwide, yet ...
while each "reduction" approach has achieved some success, in
reality the success is found to be minimal.

Afghanistan and Myanmar (and Colombia and Mexico) are growing
more heroin-producing poppies than ever before. Putaw is easily
located and purchased (because of well-developed trafficking
routes and systems) in most densely populated areas of Indonesia.

Use of ecstasy and shabu-shabu is rapidly increasing with
young people. (Both ecstasy and shabu-shabu are now being
produced, in large quantities in Indonesia.)

More and more (mostly young) people are becoming drug users,
as growing numbers of young people, from junior high school age,
are turning to drugs for fun and excitement.

More marijuana and alcohol is being used than ever before
across the nation.

More outreach, recovery, treatment and aftercare programs are
available than ever before, yet residencies are declining in many
treatment centers and facilities due to high costs, relapse and
lack of aftercare plans & programs.

More individuals are being convicted of crimes, directly
related to drugs and being sentenced to prison than ever before.

Low awareness among medical professionals is obviously shown
by their limited knowledge of the meaning of terms like "user",
"abuser", "junkie", "IDU", "CD 4 count", "antiretrovirals",
"detoxification", etc.

All these are "words" that need definition, education and
training to realize and understand when confronting HIV/AIDS and
issues related to the virus.

Many opportunities are missed when some clients and/or IDUs
who are HIV-positive, are not informed of their status and are
sent home without any counseling or adequate information
regarding testing and treatment alternatives.

A few weeks ago a 28-year-old man died of cancer, caused by
AIDS-related complications.

A few weeks ago a 24-year-old woman, who was six months
pregnant, died of AIDS, so did the unborn child.

A couple days ago a young man of 21 years died of AIDS.

A month ago, a couple, both with HIV, and both taking
antiretrovirals, gave birth to a child. Now is the waiting time
to see if the baby will be infected with the virus.

Young people with HIV and AIDS are getting married ... Some of
the partners know their partner is infected with HIV, and marry
for love and wanting to be with the partner under any and all
circumstances.

Others marry, yet do not know their partner is infected with
the virus (often the parent knows, but ... does not say anything
to the partner or the partner's parents).

At present there is no hospital in Indonesia directly devoted
to work with those infected with HIV/AIDS (or Hepatitis).

Testing sites for HIV/AIDS remain limited across the nation.

Confidentially remains an issue of anxiety and significance.

The spread of tuberculosis (TB), as a result of AIDS is
increasing rapidly. TB is airborne, which means anyone can become
infected. TB is transmitted like a cold or flu.

Each of us must do our part, learn about HIV/AIDS, confront
the issue and related issues at home, and in our own communities.

Yayasan Harapan Permata Hati (Yakita) is a non-governmental
organization involved in drug prevention and the rehabilitation
of drug addicts.

It can be contacted at:

Villa Pandawa YAKITA,
Jl. Ciasin No. 21, Desa Bendungan,
Ciawi, Bogor, Jawa Barat,
(PO Box 126, Bogor)
tel. (+62-251) 243069/243077
wisma_srikandi@hotmail.com
http://www.yakita.or.id