Sat, 13 Aug 1994

Indonesia has AIDS challenges ahead

The 10th International Conference on AIDS, the first in Asia where the disease is spreading fastest, was closed Thursday leaving behind some unanswered questions.

By Tony Kahane

YOKOHAMA (JP): As the 11,000 delegates prepare to go home, the questions raised by Dr. Michael Merson remain: What should be the priorities of the global response to AIDS? Is enough being done now? And is enough being done in Indonesia to prevent the spread of HIV?

As Dr. Merson, the executive director of the World Health Organization's Global Program on AIDS, said we must deal with the three forces in society that are driving the spread of HIV and blocking effective prevention and care -- denial, discrimination and disempowerment.

"Denial," said Dr. Merson, "is what keeps society's leaders from taking the pandemic of AIDS seriously and investing the resources needed."

So is there denial in Indonesia? According to Dr. Tuti Parwati, a leading social researcher on AIDS at Udayana University in Bali, there is. "Denial is still an obstacle to be overcome in Indonesia," she says.

Dr. Dede Oetomo, lecturer at Surabaya's Airlangga University and coordinator of a leading national gay organization, agrees. Oetomo says, "too many of the authorities try to deny the fact that many adolescents have sexual experiences. These young people therefore do not get the proper sexual education and information which might protect them from HIV, and they are at unnecessary risk. There is similar denial in ignoring the fact that many married men also have sex with prostitutes or with wari, and that many have sex with other men."

Denial apart, Dr. Oetomo is also critical of other aspects of the national AIDS effort. "Still not enough is being done," he says. "The National AIDS Committee is out of touch with reality. And it does not have a clear policy on HIV testing. Testing for surveillance, for the purpose of building an effective public health policy, must be systematic and it must be confidential and unlinked."

Discrimination and disempowerment, Dr. Merson's two other great enemies in combating the spread of the pandemic, also have yet to be faced squarely in Indonesia. In a book published this year, Dr. Rosalia Sciortino revealed the results of her survey on the AIDS coverage in the Indonesian-language press over the past four years. Like in many other countries, the first group, according to Dr. Sciortino, that was blamed for the disease was white foreigners (bule). Then it was gay men. Now it is female sex workers.

Not only are these people blamed, but the testing policy is still used more as a form of moral judgment than as a tool for public health policy. "The men who frequent prostitutes are never tested," argues Dr. Oetomo. "They only go after the sex workers with their HIV tests, as if they were trying to catch criminals."

There are, all the same, some positive aspects within the national AIDS effort. One place where there seems to be good cooperation between health ministry personnel, AIDS researchers and non-governmental organizations is Bali. Dr. Tuti, who is also chair of the Citra Usadha AIDS Foundation in Bali, stresses that information to different target groups -- people who might be at extra risk because of their behavior -- must be more forthcoming, appropriate, and handled delicately and thoughtfully.

Most Indonesian researchers in Yokohama agree that Indonesia must now seize the moment and improve its national AIDS effort. Indonesia, says Dr. Tuti, can learn from other countries who have progressed further down the road of the epidemic, including Thailand and the U.S. "AIDS," says Dr. Tuti, "is not just a health issue. It has myriad social implications which must be addressed."

Indonesia sent 30 AIDS experts this year, from national and provincial government and non-government organizations alike, to the world's most important AIDS gathering. As these people fly home they will want this meeting to provide "a landmark which divides the past from the future," quoting Dr. Merson who borrowed Nehru's words.