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

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.