HIV/AIDS information in W. Java patchy

Yuli Tri Suwarni, The Jakarta Post/Bandung, West Java

Siti Suhyati, a 38-year-old housewife in south Bandung, could only shudder when her daughter Della, a 12-year-old junior high school student, asked her about HIV/AIDS.

"Basically, it is an incurable disease. Just pray to God that we never contract this disease," Siti, who sells snacks to support her three children, told her daughter.

However brief and incomplete Siti's explanation to her daughter, it was probably the same basic answer most parents in West Java would give their children when asked the same question. If they answered at all, rather than just shaking their heads to show their complete ignorance about this important subject.

The people of West Java, Indonesia's most populated province, run the same risks of being infected with HIV as other Indonesians. This is why it is vital they are educated about HIV/AIDS.

Take Siti, for example. She does not think her family is at risk of infection, but her husband, eight years her junior, has two other wives whom Siti knows nothing about.

According to records from the West Java Health Office, in 2002 about 1.5 million residents of West Java were categorized as vulnerable to HIV infection.

This figured included some 23,000 injecting drug users, 18,000 commercial sex workers and about 650,000 men who frequented prostitutes.

This number did not include wives put at risk of HIV infection by husbands who were injecting drug users or who had unprotected sex outside the home.

The current state

Rumah Cemara (Casuarina House), a non-profit organization working with drug users and people living with HIV/AIDS, has seen many former drug users die without ever agreeing to get tested for HIV or tuberculosis (TB), putting their wives and children at risk.

"Many drug users stop taking drugs but refuse to get tested. Then they get married, have children and die of TB, for example. We never really know whether they died because they were HIV positive and their immune system was compromised. We also do not know what will happen to their children and wives," Ikbal Rahman, the director of Casuarina House, told The Jakarta Post.

In recent years there has been a significant rise in the number of officially reported HIV/AIDS cases in West Java, and many see this as a sign of the authorities' failure to educate residents about the virus.

In terms of rate of infection, West Java unfortunately finds itself among the top six provinces, along with Papua, Riau (Batam), Bali, East Java and Jakarta. Proper information about HIV/AIDS is needed not only to improve public awareness, but also to correct some of the misinformation out there that has led people living with HIV/AIDS to be shunned.

Since the first HIV case was officially detected in the area of Ciwidey in southern Bandung in 1989 to June 2005, the West Java Regional AIDS Management Commission (KPAD) has recorded 268 cases of AIDS and 1,042 cases of HIV. However, West Java KPAD estimates there are closer to 23,385 cases of HIV and 3,367 cases of AIDS in the province.

Tio Indra Setiadi, secretary of West Java KPAD, said the commission has collected data in all 25 municipalities and regencies in the province, except for Banjar. The areas of Bandung and Bekasi have the largest number of HIV/AIDS cases in the province, with 561 and 166, respectively.

The commission says 61 percent of HIV cases in West Java are caused by drug users sharing needles.

The second leading cause is unprotected sex. In terms of age, over 50 percent of those infected with HIV are between 20 and 29 years old.

"If the HIV/AIDS awareness campaign and the dissemination of information about HIV/AIDS continues as it is, an explosion of HIV/AIDS cases in West Java is inevitable," Ikbal said.

Currently, the dissemination of information about HIV/AIDS and the provision of medical care for people living with HIV/AIDS is centered only in major cities like Bandung.

Meanwhile, slowly but surely, the number of HIV/AIDS cases in smaller towns continues to rise. According to Ikbal, awareness campaigns and concrete action regarding HIV/AIDS have been conducted only among at-risk groups in major cities.

In addition, support for these campaigns has come only from a few people living with HIV/AIDS themselves, their families and non-governmental organizations, with very little help from the government.

Ikbal cited an experience in the towns of Cianjur and Sukabumi as a warning. It was estimated there were only 100 injecting drug users combined in the two towns, but a survey in early 2005 found this number was much larger.

"We found there were many commercial sex workers who were also injecting drug users. Even in Bandung and Cianjur, which are relatively close, the data is wrong and authorities are not serious about the handling of HIV/AIDS cases, let alone in far- off Banjar," he said.

Casuarina House has found that about 84 percent of injecting drug users who are tested are found to be HIV positive.

What to do?

Ikbal said non-governmental organizations had conducted HIV/AIDS campaigns and taken harm reduction measures only among at-risk groups because most of the funds donated from abroad required the money to be spent on these groups. And the 14 non- governmental organizations in West Java dealing with HIV/AIDS are not able to reach all of the groups at risk, he said.

KPAD, which was set up in 1995 at the instruction of the central government, has become the central body in the fight against HIV/AIDS in the province, helping to direct assistance and information where it is most needed.

Unfortunately, Tio said, KPAD is still unable to reach everyone. He said the commission was handicapped by a lack of funding as well as the stigma still attached to HIV/AIDS, which inhibits people from being open about the matter.

"The deputy governor (Nu'man Abdul Hakim) has sparked protests by his promotion of the use of condoms. Many people, for example, think the distribution of hypodermic needles to drug users, which is a harm reduction activity, encourages people to use drugs," Tio noted.

Therefore, he went on, the awareness campaigns now being developed simply approach regional administration officials, members of the regional legislative assemblies, the police and religious figures, rather than going directly to the public.

In the future, West Java KPAD plans to disseminate information on HIV/AIDS to housewives active in village family welfare programs.

As for money, the commission has seen its funding increase from Rp 600 million in the 2004 provincial budget to Rp 2.5 billion in 2005. About 40 percent of this allocation is for HIV/AIDS awareness campaigns, with the remaining 60 percent for surveys and social and coordination activities.

At the end of the day, however, whether information on HIV/AIDS reaches everyone in West Java will depend on the political will of the provincial administration.

Will the governor push through the necessary policies to battle HIV/AIDS before the province experiences an explosion in the number of cases and more people die unnecessarily?

The governor needs to show the same political will regarding HIV/AIDS as he showed when ordering all civil servants to wear batik every Friday. Everyone would agree that HIV/AIDS is a much more pressing issue than the fashion sense of West Java's civil servants.