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.