Indonesia has AIDS challenges ahead

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.