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.