HIV/AIDS threat gets more worrying with every passing day

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

HIV/AIDS is spreading across Indonesia faster than we can identify and verify, and many who were considered at low risk just a few years ago are now thought to be vulnerable or exposed to higher risks.

Often, conversations with lay people, unfortunately, confirm that they believe Indonesia is still viewed as low-risk for HIV transmission.

This unjustly conceals the reality that tens of thousands are already infected -- and many millions more individuals are now vulnerable and now at high risk as the HIV/AIDS virus flash- spreads across Indonesia, from Aceh to Papua, in uncontrolled fashion.

Indonesia is still in the First Phase of escalation with the HIV/AIDS pandemic, not the newly-quoted Second Wave which is at present aggressively striking many parts of the world.

The Second Wave -- in places, nations and areas where new infection rates had leveled off and stayed fairly constant for a period of time -- are currently experiencing a rise in rates of new infections. This is now being called, and justifiably so, the Second Wave.

Indonesia, just a few years ago, was looked upon as a "low- prevalence" nation, with concentrated pockets of high infection rates among some focused high-risk-groups.

High-risk groups

Much has changed; at present, high-risk groups include sex workers (both male and female) drug abusers and addicts, especially injecting drug users (IDUs), and now common drug users, individuals that are not injecting users but are sexually active yet without practicing safe sex.

Also included are men who have sex with men, because of unsafe sex practices; males and females in prisons, because of the (extremely) high rate of unsafe drug use, especially needle- sharing when inmates manage (often) to get drugs into prisons, unsafe sexual practices and prison tattooing.

Migrant workers are also perceived to be at high risk, because their work takes them away from their home areas, and some often seek out the services of sex workers, indulging in unsafe sex because of very rare condom usage; many are also known to drink (which if done to excess can result in loss of self-control) and use drugs.

Truck, becak and taxi drivers are at risk due to unsafe sex, while the risk of greatest concern today is young people. Why young people? Simply because young people, with their curiosity, search for fun and excitement, naivete and desire to conform with their peers, are open to all the above risks.

It is no wonder that young people, in the 15 to 30 age group represent the largest percentage on the HIV infection charts across the nation.

Within these groups of young people, in general, women are especially at risk. Even if they are not involved in drug use or abuse themselves, they are often involved with men who use drugs and/or inject drugs, or have habits/patterns of other high-risk behavior.

Since women are physically more vulnerable to sexual infections compared to men, more are becoming infected with HIV/AIDS in ever-increasing quantities. Also, as with women, we are beginning to see an increase in newborn babies with HIV, babies that have to begin antiretroviral therapies shortly after they are born.

Now, a factual and alarming realization: Since 2002, Indonesia has been using estimates that there could be some 90,000 to 130,000 infected with HIV/AIDS. These numbers are now over three years old, and thus obsolete by most mathematical standards.

Specialists estimate that the rate of new infections during the years 2002, 2003, 2004 and half way through this year is about 30,000 to 40,000 new infections per year.

Projecting these approximations to the present, halfway through 2005, on the low side about 180,000 would be infected with HIV/AIDS, and on the high side over 250,000 are infected. Those figures would seem to be much more realistic.

By 2010, approximately 16 percent to 20 percent of the nation's population, of approximately 230 million people could or will be "at possible risk" of infection from HIV/AIDS.

That means approximately 38.8 million on the low side and 46 million on the high side, "could" be vulnerable or at risk of contracting the virus. This does not necessarily mean they will be infected by the virus.

Young especially at risk

It does mean, though, that they could be vulnerable or at risk, of becoming infected a more aggressive campaign and large- scale intervention is done to prevent HIV from spreading. However, if there are only limited amounts of services, programs, and funds available, then as a nation we must put more effort into common sense approaches and increase work in two areas of prevention; curbing unsafe sex and curbing needle-sharing.

Yet, curbing unsafe sex could be problematic, if findings from a study done by UNICEF about young people are an indicator of what we can expect. In the study done by UNICEF with 1,034 respondents aged 14 to 17, 84 percent responded that they did not know much about HIV/AIDS, and a whopping 73 percent could not even explain what a condom is.

In 2003, the Indonesian Ministry of Health estimated that there were some 124,000 to 196,000 IDUs throughout the nation, although some experts said, "the actual numbers could be as high as a million IDUs".

Most of the drug users/abusers are young people, and hence it is not alarming to find that the majority of new cases of HIV/AIDS infection in Indonesia are people in their twenties, and two-thirds of them are sexually active. Another study done in Jakarta and Bali by Yayasan Harapan Permata Hati Kita (YAKITA) and the Ford Foundation (2003) found that 27 percent of HIV- positive addicts in recovery at YAKITA were aged 16 to 20, 47 percent 21 to 25, and 22 percent 26 to 30, compared with 2 percent for those aged 31 and above. The same study also found that most young addicts had lost their virginity by the time they were 16 years old, while 83 percent reported that they rarely or never used condoms.

So young males and females between the ages of 16 and 28 are the ones who are and will be infected most. The youth are the most sexually active and the ones that use and abuse drugs the most.

Fast track

Indonesia has decided to fast-track its approach to a number of problems: from politics to the economy, from health and welfare to natural resources, from corruption to poverty, from education to employment, and from transportation to pollution.

Although we do not need additional problems, we have to face the fact that we are plagued by a virus so complex, so elusive, so debilitating and deadly, which has already taken the lives of thousands, and which is at present infecting and devastating the lives of several hundred thousand-plus individuals, and which will, without doubt, infect a million more individuals in the coming decade.

We are confronted and humbled by the reality, the truth that the world quest for a vaccine still remains elusive, and as a nation we remain virtually unprepared to meet the challenges necessary to prevent escalation of the HIV and AIDS crisis.

Each day, the numbers of those who become infected with HIV increases, not diminishes. Let us update the figures, now, to be more accurate about the rising numbers of people who are infected, and what increase we can expect to see each and every day.

If we accept the low estimates, there were 90,000 to 130,000 people infected with HIV or AIDS in 2002. With a spread rate of approximately one person becoming infected with HIV every 15 minutes from 2003 to 2005 we must add, at least, 105,000 people to those figures.

So, using the low estimate of 90,000 plus 105,000, that would put the low figure of those infected with HIV/AIDS at 195,000. This would be the lowest possible number of people infected at present.

Indonesia is still in the First Phase of the HIV/AIDS pandemic. Today, just this one day, approximately 96 people across the nation will become infected with the HIV virus. Tomorrow is another day. If it had been a bombing or a series of bombings, then these 96 people, or more, would be seen as victims -- with updates on the front page of all newspapers and on television around the clock.

The media would pick up on the injustice of it all. With HIV/AIDS it has almost been always viewed as a silent disaster, and this should not be so. The virus still kills daily, and does so silently.

This is the reality, no less! Unless we see these figures as reality, and put forth the effort needed to defend ourselves and our families, as well as the nation against HIV and AIDS, these numbers cannot lessen but only increase.

One of these numbers may mean YOU or your loved ones. Your children may end up being one of the fatalities. The future begins now, and changes in our response, also, must begin now.

in box:

The authors can be contacted at Jl. Ashari Jaya II/40, RT 04/RW 04 Sindangsari, Tajur, Bogor, West Java tel. (0251) 244375 http://www.angelfire.com/hi/joydave

Yayasan Harapan Permata Hati Kita Villa Pandawa YAKITA Jl. Ciasin No. 21, Desa Bendungan Ciawi, Bogor, West Java (PO Box 126, Bogor ) tel. (0251) 243069/243077 wisma_srikandi@hotmail.com http://www.yakita.or.id