Irianese women targeted in HIV/AIDS campaign

By Simon Sinaga

TIMIKA, Irian Jaya (JP): In 1985, a missionary's prediction about the spread of HIV/AIDS, then an alien disease in Indonesia's far-flung province, caused people in Irian Jaya to shrink in fear.

The missionary said that in the Baliem Valley at the highlands of Wamena, there would be many deaths and orphaned children once the deadly HIV virus infected people in that area.

Now, more than one-and-a-half decades later, the missionary's concern has proven not that far-fetched. Irian Jaya has the highest rate of HIV/AIDS in the country.

In fact, "the curve of HIV spread here follows that of Papua New Guinea or the African curve; it has reached an alarming level," said Dr. Paul Crouch-Chivers of AEA, who is working for mining company PT Freeport Indonesia (PTFI).

Those who have contracted HIV are mostly men in their productive years from 20 to 39 years of age and sex workers. But military personnel, government employees and a Catholic priest have also been infected by the unbeatable virus.

As of June this year, official figures showed 599 people had contracted the HIV virus, 224 of whom had developed full-blown AIDS. More than half of them have died.

The number of people infected with HIV/AIDS in Indonesia has reached 1,956 overall, meaning Irian Jaya's figures make up almost 30 percent of the figure.

There has been no documentation about the origin of HIV virus infection in the easternmost island of Indonesia. Local communities used to believe, and some people still do, that it was introduced by outsiders.

Doctors believe that the disease was first contracted in Irian Jaya through Thai fishermen docking in Merauke, the country's and province's southernmost port.

The first case of HIV infection was officially reported in Merauke in 1992. Two years later the first AIDS patient was also identified in Merauke. Last year, one case of HIV infection was found almost every day, with Merauke now making up more than half of the HIV/AIDS cases in Irian Jaya.

Heterosexual intercourse has been the main means of the spread of HIV.

"In Merauke, HIV cases are mostly detected among people who keep on changing sex partners," said Fransisca Nuhunayan, a campaigner for Santo Antonius Foundation (YASANTO) that provides counseling and support to HIV/AIDS patients.

HIV transmission in Irian Jaya, however, is part of a web of complexities.

In mining communities in Timika, the presence of many lonely and unattached miners has helped sustain the availability of commercial sex workers. These miners mostly come down to Timika over the weekend for various purposes including seeking prostitutes.

Crouch-Chivers said while the HIV epidemic in Timika was in the early stages "the annual incidence rate would continue to increase unless there were significant changes in sexual behavior by using condoms or limiting the number of partners."

Part of the speed of transmission can be attributed to the Irianese way of life. Doctors, health officials and NGO workers say the male members of a number of local communities still practice free sexual relations such as exchanging wives, passing on widows to younger brothers and acquiring new partners.

They say the potential for transmission during tattooing, practiced by many locals, cannot be underestimated. There is also the habit of having sex without foreplay that can easily injure genitals.

In Timika, for example, more than two thirds of the 111 HIV cases are found among the Irianese. By the end of this year, the number is likely to be confirmed at 200, said health officials.

Women

Officials, doctors and activists said special attention needed to be directed at mothers. Dr. Crouch-Chivers said that in Timika, for example, there was the potential for infection during pregnancy and blood transfusion. "I am sure we will start to see infected new-born babies in the future."

Indeed, surveys by Irian Jaya health agency show that sexual harassment and ill treatment of wives are still rampant among the local population in Irian Jaya villages and towns. They come in the form of verbal attacks, forced sexual activity and having sex with other women with the wives' knowledge.

"Some of the women still have sexual intercourse with their husbands although they know that their husbands are infected," said Dr. Gunawan Ingkokusumo, a senior member of staff of a health agency in Jayapura.

Much can be learned in the efforts to curb HIV spread in Irian Jaya by studying similar challenges in other countries.

More people, including the private sector, the government and NGO activists are now involved in programs and campaigns to raise awareness and prevent the wider spread of HIV. The media have also tried to attract the attention of the local population and migrant workers by reporting on HIV/AIDS issues in the news and by organizing seminars.

In Merauke, YASANTO has played a leading role in awakening the awareness of the community to the danger of HIV/AIDS.

But Fransisca said it takes more than just knowledge to halt the spread. The foundation has helped develop small businesses in Merauke communities to improve the people's wellbeing, thereby increasing awareness of health issues.

The small business program of YASANTO has given special attention to mothers and women in their productive age. "By improving the welfare of women, we improve the welfare of their families," said Fransisca.

Crouch-Chivers said his company's had incorporated the sexually transmitted diseases (STD) program from 1995. "The virus is transmitted easily when a person has unprotected intercourse, especially when there is also coexisting STD such as syphilis or gonorrhea."

Since the ready availability of sex workers has become a major attraction of Timika, PTFI's program has reached out to commercial sex workers, bars and discos.

This approach has enabled widespread dissemination of information and condoms. The doctor cautioned, however, that while awareness and knowledge of prevention and the use of condoms has increased, the situation has yet to improve.

He said more people knew they had to use condoms for safe sex with sex workers but they tended to forget during sex. Providing HIV/AIDS drugs for infected people is not feasible in the near future due to the steep costs.

Officials and doctors said sex education about the dangers of HIV/AIDS would take place effectively among families and school- aged children.

Health official Ingkokusumo has also called on the tribal foundations and local government to help with the campaign.

Ingkokusumo said the government and local foundations needed to act promptly to curb the fast-growing sex commerce in parts of Irian Jaya, through the use of condoms in red-light districts.

The doctor, who completed his masters degree in medical anthropology with a research on the sexual behavior of Dani men in Wamena, said that the authorities could, for example, ban the sexual activity that took place in the Honai shelter house in Wamena.

He said the HIV/AIDS problem in Irian Jaya was similar to a fire that ignited in a dry forest.

"If we are not alert to the fire, it will spread and scorch a big part of the human resources needed to build this province. The concern (of the missionary) that villages will be ravaged due to HIV/AIDS may actually come true."