Major challenges lie ahead at the end of HIV/STD project

By I Wayan Juniartha

DENPASAR, Bali (JP): With more than four million condoms distributed and at least 30,000 people educated in the basic knowledge of sexually transmitted diseases (STDs) and HIV/AIDS in Bali alone, the five-year Indonesia HIV/AIDS and STD Prevention and Care Project Phase One officially ended in June.

"I am quite pleased with the result of the project. I believe that it has succeeded in delivering what it promised in the first place. The project also managed to reach a wider population in the past few years," Australian team leader Tim Mackay said on the sidelines of a seminar held to mark the end of the program.

Started in the middle of 1996, the project was a collaboration between the Australian government, through its aid agency AusAID, and the Indonesian government. AusAID allocated A$26 million to finance various programs of the project in the provinces of Bali, East Nusa Tenggara and South Sulawesi.

Through the project, AusAID provided financial assistance to 21 organizations in Bali, 17 organizations in East Nusa Tenggara and 27 organizations in South Sulawesi, mostly NGOs engaged in health education. Over the course of the project, AusAID financed 140 different programs in the three provinces and funded the publication of 54 media, such as books, brochures, magazines, research reports, cassettes and videocassettes.

The project also made it possible for scholars and scientists in those provinces to conduct at least 15 research projects, dealing mostly with the behavior of commercial sex workers, the commercial sex industry and the general public's perception of STDs and HIV/AIDS.

Skill-building and human resources development was also a major focus of the project. In the last five years, funds were made available to finance at least 112 training programs, involving AusAID's partner institutions, government officials and the general public.

"The project has succeed in becoming an important resource in developing comprehensive and effective responses to the problems of STDs and HIV/AID," the project coordinator of HIV/AIDS Bali, Made Suprapta, said.

The vice governor of Bali, IGB Alit Putra, expressed his deep appreciation, saying the project provided great help to underfunded government-run health programs.

"The project has also made it possible for NGOs to become more involved and make greater contributions to our efforts to cope with the HIV/AIDS epidemic," he said.

The importance of the project can be seen in the work accomplished by three of Bali's major NGOs -- Yayasan Kerti Praja, Yayasan Hatihati and Yayasan Citra Usadha -- and the Indonesian Planned Parenthood Association (PKBI), which received financial assistance from AusAID.

Yayasan Citra Usadha, which focuses on helping gay, male sex workers and the transvestite community at its six drop-in centers, conducted outreach programs for 10,000 people and provided counseling to more than 7,000 people.

Meanwhile, Yayasan Kerti Praja, which targets female sex workers and their clients, succeeded in providing basic STD and HIV/AIDS information to at least 12,000 people, and in providing STD treatment and medication for 30,000 people. Moreover, at the end of June, it will begin a new outreach program, this time for some 6,000 sailors at Bali's main harbor of Benoa.

Programs

The project also made it possible for Yayasan Hatihati to sustain its "harm reduction programs", which specifically target IV drug users. The dangerous behavior of sharing needles has been fertile ground for the explosion in HIV/AIDS infections.

In the past two years, Yayasan Hatihati succeeded in providing basic health information on that risky behavior to at least 2,500 people, most of them IV drug users.

PKBI, which focuses its efforts on youths and housewives, was able to increase its ability to deal with various reproductive health issues. PKBI provided more than 10,000 youths basic information about STDs and HIV/AIDS, and its medical clinic provided treatment and medication for an average of 20,000 patients per year.

The four organizations also distributed more than four million free condoms and at least 100,000 educational handouts, such as posters, brochures, stickers and flipcharts.

"The project and these NGOs have made information on STDs and HIV/AIDS widely available to the general public, a critical thing in our battle against these diseases, if I may say so. It also provided the public with the tool, in this case the free condoms, to prevent the spread of those diseases," Alit Putra said.

Yet, it does not mean that the project and the NGOs were able to achieve all their goals in only five years. The level of people's awareness of STDs and HIV/AIDS prevention and care is one of a few still unfulfilled goals.

"The level of people's awareness, especially on safe sex issues, is progressing at such a disturbingly slow pace that it might be better if we call it creeping instead of progressing. Knowing what safe sex is all about and implementing it turned out to be two different matters," Prof. Wirawan of Yayasan Kerthi Praja said.

In 1992, he noted, the percentage of sex workers' clients in Bali who consistently wore condoms was only 7 percent. Nine years and four million free condoms later, the percentage was still low, 20 percent. Moreover, the prevalence of STDs, such as gonorrhea, was still high among sex workers, ranging from 60 percent to 70 percent in 2001, indicating that many people still did not implement the principles of safe sex.

Ignorance about safe sex, according to Mangku Karmaya of PKBI, also causes 3,000 unwanted pregnancies among young women per year.

"We must find a new method to make the use of condoms more popular. Moreover, the government should learn from Thailand, where a 100 percent condom regulation has been implemented for years. There, if a sex worker fails to abide by that regulation, the government will immediately close down her brothel," he said.

Another critical and still unfulfilled goal concerns the NGOs' ability to financially sustain programs and their organizations. Almost all NGOs in Bali are heavily dependent on funding agencies such as AusAID.

Even though there is a high probability that Bali will be selected as a target area for phase two of the project, many believe it is time Bali's NGOs accelerate their efforts to reach financial self-sustainability.