Low mark for Indonesia in fight against AIDS

Sari P. Setiogi The Jakarta Post Jakarta

Indonesia is considered to have done little to comply with its commitment made during the Special Session of the United Nations General Assembly on HIV/AIDS two years go.

A progress report on the global response to HIV/AIDS released recently by the Joint United Nations Program on HIV/AIDS (UNAIDS) said Indonesia had not met several prevention and care goals established at the 2001 special session, including support for orphans and children infected and affected by HIV/AIDS and elimination of discrimination against people living with the virus.

The report was issued in New York at the 58th United Nations (UN) General Assembly meeting last week. The year 2003 is the deadline for countries signing the Declaration of Commitment on HIV/AIDS to file their first progress reports, with the second in 2005.

"Efforts to combat the disease are being hampered by the continuing gap between the availability of resources and the demand for effective and prompt implementation of the AIDS commitments," Minister of Health Achmad Sujudi told the UN session.

He urged the enhanced facilitation through the leadership of the UN, particularly on technical cooperation and capacity- building programs, reduction of debt burdens and flexible implementation of trade-related aspects of intellectual property rights.

Flexible implementation of intellectual property rights would enable the least developed countries to provide cheap generic drugs to people living with AIDS, the minister said.

In Indonesia, drugs for AIDS, widely known as the antiretroviral (ARV) treatment, remains a big concern due to its cost.

UNAIDS country coordinator for Indonesia, Jane Wilson, told The Jakarta Post through e-mail correspondence that the generic ARV was available from the AIDS study group of Cipto Mangunkusumo Hospital Jakarta (Pokdisus), ranging from Rp 500,000 (US$58.8) to Rp 700,000.

Generic ARV has been available in the country since September 2001, imported from Thailand and India.

ARV costs on average of $1,000 per person per annum, while basic annual salaries for Indonesian workers ranged from S850 to $1,500. Not all people living with AIDS who needed the treatment could afford it, she said.

With the number of people living with AIDS across the country is estimated at 90,000 to 130,000, only 2.7 percent have access to the ARV. The percentage remains below the expectation of above 5 percent.

No country in the Asia-Pacific region -- excluding Australia and New Zealand -- home to more than seven million people with HIV/AIDS, has reported the minimum treatment coverage.

The Indonesian government said it had provided only 30 percent from the total budget spent on the anti-HIV/AIDS movement, with the rest provided by foreign donors.

Indonesia allocated $5.7 million from its 2003 fiscal budget for the fight against the virus, up from $3.25 million on the previous year. Separately, foreign donations increased to $16.9 million this year from $9.3 million last year.

Wilson said Indonesia also failed to live up to the expectation of supporting orphans and children infected with and affected by HIV/AIDS, and eliminating discrimination against people with AIDS.

It had been expected that by 2003 Indonesia would have developed national policies and strategies to build government, family and community capacities to support orphans and children infected with and affected by HIV/AIDS.

"Indonesia has not yet developed particular policy on this," Wilson said.

On eliminating discrimination, the government had also sought to develop a national legal and policy framework to protect in the workplace the rights and dignity of people with and affected by HIV/AIDS and other vulnerable groups.

"Though Indonesia has incorporated articles on the prohibition of discrimination toward people living with HIV/AIDS in its National AIDS Strategy, no laws or regulations have been enacted on this particular matter," Wilson said.

The first AIDS case in Indonesia was diagnosed in 1987, only six years after the first in the U.S. Injecting drug use and commercial sex are fueling the epidemic, with the rates reported by the UNAIDS as high as 26.4 percent among sex workers in Papua and 47 percent among drug users in Jakarta.

Other vulnerable populations include clients of sex workers and homosexuals, including transvestites.

Most HIV infected are males (77 percent), while the most affected age group are those between 20 years and 29 years old (41.7 percent).

The epidemic is spread across the archipelago, but worst affected are Papua, Jakarta, Riau and Bali.

---------------------------------------------------------- People living with AIDS in Indonesia: (90,000-130,000) ---------------------------------------------------------- 43,000 injecting drug users 10,000 gay

8,000 sex workers and 6,000 of their customers

1,500 transvestites and 6,000 of their customers 24,000 couples from the above groups ---------------------------------------------------------- Source: Ministry of Health, 2002

---------------------------------------------------------- People at high risk of HIV/AIDS infection: (estimate) ---------------------------------------------------------- 1,000,000 gay

250,000 female sex workers and 8.2 million of their customers

160,000 injecting drug users

12,000 transvestites 6,500,000 couples of the above groups ---------------------------------------------------------- Note: More than 16 million people are at high risk ----------------------------------------------------------- Source: UNAIDS