HIV/AIDS the `reality', `the spread', `tomorrow'

HIV/AIDS the `reality', `the spread', `tomorrow'

David and Joyce Jaelani Gordon, Contributors, Bogor, West Java

Greater Jakarta, Bali, Maluku, Bandung, Yogyakarta, Surabaya, Malang, Manado, Makassar, Papua, Medan -- all are areas where new cases of HIV and AIDS are increasing.

Many of us who are closely involved with the pandemic expect an increase of approximately 35,000 new cases of HIV in 2006 in Indonesia.

That translates to one newly HIV infected person every 15 minutes of every day for the entire year across the nation. Estimates of those living with HIV/AIDS in Indonesia are between 180,000 and 250,000.

The reality is HIV/AIDS may now be found across the nation, from Sabang in Banda Aceh to Merauke in Papua. The virus is fueled, driven, in increasing acceleration, primarily by sexual activity and drug use, abuse or addiction.

Injecting drug use and unprotected sex while under the influence of drugs and alcohol have been primary causes of the past years' increase of HIV cases. It is important to note that transmission of HIV among injecting drug users in Indonesia has increased eight-fold since 1998, and most of these injecting drug users are young people.

"All the elements are here for the rapid spread of HIV, so it's (up to us) to express concern and to highlight the opportunities that are there. The opportunities are enormous to really stop the epidemic, to nip it in the bud," said Peter Piot from UNAIDS, during his four-day visit to Indonesia to commemorate World AIDS Day, which fell on Dec. 1.

According to the Ministry of Health, as of July 2005, the majority of people who are HIV positive in Indonesia are those aged between 20 and 29. This age group comprises 54.7 percent of the total number of people living with HIV.

Individuals between the ages of 15 and 19 represent 6.4 percent of the total HIV cases.

So, the majority of those infected by HIV are young people, most of whom were born into a world where HIV/AIDS was already a fact of life. While the epidemic is fueled by drug use and sex, reality exclaims "there is no way to stop people from having sex, or to stop people from using drugs and alcohol".

The "wars on unsafe sex and drugs" have only shown a modicum of success, and in many areas across the world both are seen as having failed.

Regarding the issue of sex, in our close contact with young people we at YAKITA find that "the beginnings of sexual experimentation and experience start for many between the ages of 14 and 20 years.

While the subject of sex and sexuality is generally not found to be openly spoken about at home with parents and family members, or approached educationally within high schools and universities, sex is definitely a prime subject often spoken about between youth, both males and females.

Sex is also exploited by every form of media, from TV to magazines, from leaflets to billboards, from shoes to headdresses, from nail polish to hair gel, every single day.

We are bombarded with advertisements with sexual overtones. Pornographic VCDs are easily found for Rp 10,000 in many areas across the nation. And the reality is that sex is used to entice people because sex looks good, sounds good and feels good.

People seek, long for and lust for relationship(s), and sex is often a large part of what defines relationship. But for some individuals, the end result of a sexual relationship is a sexually transmitted disease or HIV/AIDS.

Drug abuse

With drug use, abuse and addiction, the reality shows that there are more and more people, especially young adults, using and abusing drugs.

More people are using alcohol and smoking marijuana these days. More individuals are trying ecstasy.

It is easy to find ecstasy across the nation today in most any nightspot, mall or place of entertainment, or on or close to school campuses. More, many more, individuals are abusing and addicted to shabu-shabu (crystal methamphetamine) and putaw (low- grade heroin).

Part of the reality of using drugs is that "drugs are fun, drugs are exciting, the come-on with drugs makes finding and having sex much easier".

Today, often, using drugs is seen and considered as a ritual and rite of passage by youth. Some studies have shown that there are a higher percentage of young people experimenting with drugs than with sex.

In the mid 1970s, there were hundreds of morphine addicts in the country. In the late 1980s, there were thousands of drug abusers/addicts across the nation. Today, there are a few million drug abusers/addicts.

Another current reality is that within Indonesian culture there exists a subculture, a youth-movement, which plays to the proverbial lifestyle of "sex, drugs and rock 'n' roll".

They are video-game-ed, internet-ed, MTV-ed, sinetron-ed, shopping mall-ed, hip-hugger-ed and cap-ed, fear-factor-ed, fast food-ed young people looking for, and wanting to be part, of the next "craze, rave and crave". The reality is that many of these youth are exposed to the most high-risk populations of people susceptible to becoming infected with HIV or already infected with HIV.

Education top strategy

The reality is that there will be more new HIV infections tomorrow. The spread-rate increases daily. The number one defense against HIV/AIDS still remains education.

If, and on a national level, there is not a radical shift concerning the importance of education, and these subjects are not (respectfully) and directly spoken about and taught, in the language of facts and reality, beginning at the junior high school level through the universities, there will be many more HIV/AIDS cases throughout Indonesia.

Education also must cover the reality of drug use, abuse, addiction, reproductive health, sex and sexuality.

Today we are at a place and time when we must speak of both prevention and intervention when discussing HIV and AIDS.

We, as a family-oriented nation, are ill-fated if we wait upon the resources of government, officials, schools, religion, the medical profession and medicine, business and organizations to help with prevention/intervention and assistance with HIV and AIDS. We all need to put an honest effort into changing the course of the epidemic.

As in the World AIDS Day theme this year, "Stop AIDS: Keep the Promise", it is no longer time to just make promises.

Indonesia needs strong leadership, committed and responsible action, medical agencies and services, and programs that are specifically designed to aid in the fight against HIV/AIDS.

As Piot explained, while President Susilo Bambang Yudhoyono has expressed a clear commitment to fighting AIDS, the same level of commitment is needed from all levels of society

Both prevention and intervention are absolutely necessary to understand and are related to each other. Both are equally important. And in the home, even before schools begin educating students about HIV/AIDS, moms and dads must be the main teachers in educating their children about HIV/AIDS and protecting them from the virus.

Meaning that mom and dad must themselves learn about HIV/AIDS and related issues surrounding the virus. Parents must also be role models at home.

We, as a nation, are still years away from containment and then a reduction of HIV/AIDS. Indonesia is no longer considered in the low-stages of the pandemic; we have now entered the high- risk category. There is much we can do, and much we must do.

The key to minimizing, containment and reduction of HIV/AIDS is the word "we". If we work together, as a family, in the Indonesian sense of gotong royong (mutual work), beginning with education in the home, then within schools, there is much we can do, but if not we will surely suffer far greater consequences than what we are already suffering.

The authors, David Gordon and Joyce Jaelani Gordon, are directors of the Bogor-based Permata Hati Kita Foundation (YAKITA), a drug rehabilitation and addiction recovery center.