Irianese women targeted in HIV/AIDS campaign

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."