Indonesia's insulation from HIV/AIDS wears thin

Indonesia's insulation from HIV/AIDS wears thin

Peter Janssen, Deutsche Presse-Agentur, Jakarta

Cultural and religious norms may have spared Indonesia from an
HIV/AIDS epidemic for the past two decades but, experts worry,
those same factors could get in the way now that the deadly virus
is finally taking off.

Indonesia shares the same ingredients that sparked an HIV/AIDS
epidemic in neighboring Thailand -- a booming sex industry, a
serious intravenous drug abuse problem, high rates of other
sexually transmitted diseases, a large mobile labor force of
fishermen, truck drivers and mine workers and a local reluctance
to use condoms.

Despite this recipe for disaster while Thailand has some
670,000 HIV/AIDS cases, the highest estimate for infections in
Indonesia is 130,000 with only 3,614 "reported" HIV/AIDS cases as
on March 31, 2003.

Part of the huge discrepancy may be due to underreporting.

"It's a totally passive reporting system," said Stephen
Wignall, Indonesia director for Family Health International
(FHI), which has been working closely with the Indonesian
government to halt the spread of HIV/AIDS.

Health authorities have been carrying out blood tests among
high-risk groups such as sex workers and intravenous drug-users
who check into detox clinics, but has little surveillance of the
mainstream population.

Even so, the latest survey results are sobering for a country
that once prided itself on having been bypassed by the modern
plague.

According to latest statistics, some 93 percent of the drug
users attending one Jakarta voluntary counseling program tested
HIV positive, while the figures were 63 percent and 44 percent in
similar programs in Bandung and Bali, respectively.

The figures for sex workers, although less dramatic, shows an
upward trend. Last year, 23 percent of the sex workers surveyed
in Papua province were HIV positive, and 17 percent and 8.5
percent among prostitutes tested in Sorong and Riau.

Given the dramatic takeoff, especially among drug users,
health authorities estimate there will be 80,000 new HIV cases in
Indonesia this year.

"We're seeing increasing HIV rates in sex workers across the
country," said Wignall. "That means these sex workers are being
infected by men, and they in turn spread it to other people."

While an epidemic is already underway in predominantly
Christian Papua, where an estimated 500 people have already died
of full-blown AIDS, there are fears that another is fast in the
making in predominantly Muslim Java, home to almost 70 per cent
of Indonesia's vast population of about 210 million people.

The government, which last May announced a comprehensive anti-
HIV/AIDS strategy with a budget of 22 million dollars, has made
many of the right moves, including setting the goal of 100 per
cent condom use among high-risk groups, according to UNAIDS.

"The issue in the future comes back to the implementation of
the national strategy, and to what extent there are mechanisms in
the provinces and districts where they are most needed to reach
those whose behavior is risky," said Jane Wilson, UNAIDS's
Indonesia program advisor.

Getting the message across poses problems. Last September,
television stations were forced to drop a safe sex advertisement
campaign which depicted men visiting a brothel because Muslim
groups felt it was promoting adultery and promiscuity.

The incident has raised serious questions about whether Islam,
which may have helped Indonesia avoid an HIV/AIDS epidemic so
far, will prove a hindrance now that the need for a safe sex
campaign is more crucial.

Most health experts attribute Indonesia's relatively low
incidence of HIV/AIDS when compared with a country like Thailand
thus far to two main factors -- the widespread practice of
circumcision which it is believed makes men less prone to the
virus and a less entrenched practice of visiting sex workers
among Indonesian men.

Unfortunately, these same factors create a greater reluctance
to use condoms or even talk about such things.

"People are painfully shy to talk about condoms," said
Christopher Purdy, country director for DKT, a non-profit social
marketing organization that has helped double the distribution of
condoms in Indonesia over the past five years.

"Sex itself is not taboo here, but talking about it sure is."

Tarmizi Taher, a former religion minister, has launched a
personal campaign to persuade the country's two mass Moslem
organizations -- Nahdlatul Ulama and Muhammadiyah - to take a
lead in spreading the word about the need for condom and clean
needle use among sex workers and drug abusers.

He admitted, in an interview with DPA, that in promoting safe
sex in a predominantly Muslim country, "you have to use the right
sentences to persuade people."

"We call it an emergency, because under Islamic law if there
is an emergency you can change the rules," he said.

"The mosques teach every Friday don't do this and don't do
that, and secondly there is circumcision, which is why
Indonesia's HIV/AIDS problem is not as bad as Thailand's, but
maybe for open talk about condoms, Thailand is better," he said.