Integrated effort needed to tackle HIV/AIDS

Integrated effort needed to tackle HIV/AIDS

Debbie A. Lubis, Contributor, Jakarta

An article of The Jakarta Post's earlier this month revealed
that Minister of Health Achmad Sujudi had told the United Nations
session that efforts to combat AIDS were being hampered by the
continuing gap between the availability of resources and the
demand for effective and prompt implementation of related
commitments.

As one of the countries that signed the Declaration of
Commitment on HIV/AIDS, Indonesia must file its first progress
report on its efforts to combat the epidemic by the end of this
year.

Thus, the minister urged the international agency to enhance
technical cooperation and capacity building programs, reduction
of debt burdens and flexible implementation of trade-related
aspects of intellectual property rights (TRIPs).

No doubt debt relief and flexible TRIPs implementation will be
a great help for programs on fighting the Acquired Immune
Deficiency Syndrome or AIDS. But there are at least three factors
that can maximize the effectiveness of AIDS control programs in
Indonesia.

First, technical and capacity building programs have already
been conducted on government as well as non-governmental bodies
with the help of international funding agencies since the mid
1990s. Those who have been trained and assisted are our par
excellence resources. It is time to transcribe their capacity and
capability into real actions for those infected and affected by
HIV/AIDS, or around 90,000 to 130,000 people, according to
official estimates.

In so doing, the government needs to consider the second
factor, which is, involving and empowering existing community
efforts.

Obviously local level responses to the epidemic have been the
most powerful tool while institutional responses are bureaucratic
and sometimes rhetoric. The community, front-line health workers,
NGO activists, along with People Living With HIV/AIDS (PLWHA)
have proven that they are able to conduct prevention as well as
care and treatment programs in resource-poor settings.

They carry out efforts to provide education and information
about HIV/AIDS. They also conduct programs on voluntary
counseling and testing, mother to child transmission, AIDS-
management training for health workers, PLWHA empowerment, fund
raising, harm reduction and advocacy.

The social movement called the National Movement on Improved
Access to HIV/AIDS Therapy (GN-MATHA) has drastically increased
access to generic antiretroviral (ARV) drugs from dozens to
almost 1,000 within a year.

The latest advance is that these community members have
successfully invited 75 people from 13 foreign countries last
month to Yogyakarta to discuss and share efforts and strategies
to increase access to HIV/AIDS treatment in resource-poor
settings.

Third, effective and efficient management in the use and
selection of programs on AIDS. The government has allocated
US$5.7 million from its 2003 budget, from $3.25 million in the
previous year for AIDS control programs. Meanwhile, this year,
foreign donors have disbursed a lavish $16.9 million, a great
increase from $9.3 million last year. Unfortunately, those funds
are mostly exhausted in capacity building and prevention
programs, which sometimes are conducted extravagantly (training
or seminars at luxurious hotels, etc.).

Fund utilization is not about choosing prevention over
treatment. Both programs are really needed to prevent the virus
from spreading. The more HIV positive people fall sick and die,
the more costly the response to the epidemic will be.

In this case, we need to learn from the governments of Cuba
and Brazil which have made ARV available and free medication to
all their citizens, regardless of their social or economic
status. HIV infected people, who receive access to treatment and
care, are definitely able to lead productive lives. At the same
time they can reduce the burden on health care services. Access
to ARV treatment must not be considered as a contentious,
irrational and unsustainable program.

Perhaps, what the Jakarta administration decided last week is
worth taking into account. The Jakarta Health Agency agreed to
include poor HIV positive people and low income earners suffering
from diseases related to drug abuse as candidates for health
cards.

"Initially, we did not want to include them as they need high
cost treatment. But the cases are increasing everyday. This is a
reality that we have to deal with," said Wandaningsih Parmono,
deputy of Jakarta's health agency in a recent meeting.

Around 93 percent of 170 intravenous drug users (IDUs) in
Kampung Bali, Central Jakarta who took HIV tests are HIV
positive. Currently, there are 1,155 IDUs in that area.

This year, the office disbursed a fund of Rp 75 billion for
health care insurance for the impoverished or low income earners.
Each recipient is entitled to a maximum of Rp 10 million to cover
his or her hospital expenses. Those who hold Jakarta ID cards and
are recognized as poor by the head of their community unit, or
those who are poor but do not have a Jakarta ID card but work in
the Jakarta area and are proven to be poor, can benefit from this
program.

Indeed, there are many resources that can be used. The most
important thing is to place programs on the fight against AIDS in
a framework of social justice so that meaningful actions can
directly benefit those who in dire need. Networking among
officials, regional administrators, health professionals, NGOs,
PLWHA and academicians is also important in tackling the
epidemic. Maximum efforts should be made to prevent HIV
infection.