Men vital in fight against AIDS

By Wita Krisanti

JAKARTA (JP): Indonesia were struck in 1987 when the country's first AIDS case was uncovered in Bali, when a tourist died due to an "unknown" illness. It was only a few years later that HIV/AIDS campaigns began in Indonesia.

Cultural values, lack of information and a lack of proper surveillance systems have led to the belief that HIV/AIDS figures here are just the tip of the iceberg.

The Indonesian government is still reluctant to take concrete steps to prevent the transmission of HIV/AIDS.

When several NGOs proposed stocking condoms in hotel and motel rooms as well as providing condom vending machines, many people resisted the idea, saying it would encourage promiscuity. The initiative was banned.

Awareness of the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome among Indonesians is better now, particularly in urban areas, yet many prevention programs continue to target mainly women.

Information about sexually transmitted diseases and reproductive health, as well as health services, is often given to sex workers, while the clients -- men -- are often overlooked.

But many sex workers have found it difficult to make clients use condoms, even if not wearing one means putting their lives at risk.

While more men now are known be living with HIV/AIDS, women are actually at a greater risk of contacting HIV/AIDS.

This is because first, women have less control over when, where and whether sex will take place. Second, women contracting HIV easier than men.

In sub-Saharan Africa, HIV-positive women account for 55 percent of the 22 million adult population in the region, according to the United Nations.

By actively involving men in preventing HIV/AIDS, the risk of transmission could be significantly reduced. Hence the theme of the campaign launched on Dec. 1 by the World Health Organization and UNAIDS: Men can make a difference.

First, men's reproductive health is important, but often receives insufficient attention. Young men are more at risk than older ones, because they are more likely to be sexually active and using drugs than older men. Moreover, about one in four people with HIV is a male under the age of 25.

Second, the behavior of many men puts them at risk of HIV. In certain circumstances, men are less likely to pay attention to their sexual health and safety than are women.

Men are more likely than women to use alcohol and other substances that lead to unsafe sex, which increases the risk of HIV transmission.

Men are also more likely to inject drugs, risking infection from needles and syringes contaminated with HIV.

Men having to migrate and live away from their families, and men in all-male environments and institutions such as the military and prisons also face exposure to HIV.

Third, due to the vulnerability of women in determining where and when sex takes place, targeting men for HIV prevention and the promotion of responsible and safer sexual practices, therefore, would be more efficient in reducing HIV infection.

Fourth, unprotected sex between men endangers both men and women, because many men having sex with men also have sex with women -- their wives or regular or occasional girlfriends. Fifth, most sex between men is hidden.

Surveys in several countries show that up to a sixth of all men report having had sex with another man. Hostility and misconceptions about sex between men have resulted in inadequate HIV prevalence measures in many countries. Engaging men as partners in fighting AIDS is then the surest way to change the course of the epidemic.

Over 80 percent of HIV transmissions worldwide occur through sexual intercourse. Another 5 percent or so takes place among injecting drug users, four-fifths of whom are male. At the end of 1999, 34.3 million people were living with HIV or AIDS, of which 17.3 million were men and 15.7 million were women.

Meanwhile, 18.8 million have died from complications related to HIV/AIDS; 7.3 million of these people were men and 7.7 million were women.

According to a WHO report this year there have been 5.4 million people newly infected with HIV, 2.4 million of them men and 2.3 million women,

In Indonesia, from April 1987 to Oct. 31, 2000, a total of 1,083 HIV and 438 AIDS cases were reported. Of these, 968 (63.64 percent) involved males.

Most of these cases of HIV/AIDS (60.15 percent) were the result of heterosexual sexual contact. Most, or 61.28 percent, of those infected were between 20 and 39 years of age.

In October 2000, 27 AIDS and 46 HIV cases were reported; 26 AIDS and 46 HIV cases were found in Jakarta, and there was one AIDS case in Bali.

Of these numbers, 25 AIDS and 40 HIV cases involved men. By age group, 96.28 percent of the AIDS cases involved those between the ages of 15 and 49, and the 20 to 29 age group had the highest number of AIDS cases.

From January to the end of October 2000, there were 314 HIV and 164 AIDS cases. In Jakarta alone, cumulative HIV/AIDS cases for 2000 are 356 HIV and 182 AIDS, while 78 people have died from complications from HIV/AIDS.

With the increasing number of drug users in Indonesia, the risk of HIV infection is also rising. Recent reports show HIV infections among drug users accounted for 90 percent of all HIV cases in Jakarta this year, up from 54 percent in 1999.

In its November report, the World Bank stated that intravenous drug use was increasing in the region due to cheap heroin supplies, deepening poverty and social desperation following the 1997 economic crisis, and a lack of effective law enforcement.

UNAIDS has confirmed that HIV/AIDS is now the number one cause of death in many parts of the world. However, many governments have underestimated just how widespread the HIV/AIDS epidemic is. New cases of HIV/AIDS are now far exceeding predictions from a decade ago.

The issue has gone far beyond health. Economic growth could be slowed given the prevalence of HIV/AIDS in productive age groups.

The funds needed for HIV/AIDS research are also needed for research for incurable diseases, or even for other activities, such as fighting the trafficking of women and children.

Political will alone is not enough to prevent HIV/AIDS transmission if not articulated into real action. What is needed now, particularly in Indonesia, is to start cutting the bureaucracy and create a better, more effective and less bureaucratic system.

One step toward this would be to create an integrated surveillance system among the Ministry of Health and Social Welfare, all health institutions -- from community health centers to hospitals -- as well as non-governmental and community-based organizations.

The public should also have access to low-cost HIV tests and free consultations. Prevention programs should not only focus on women, but also men.

Providing more information about men's sexual health, special health clinics or special sections in hospitals that specialize in men's reproductive health, as well as reproductive health education for students, are among the steps that might effectively protect men and women from the transmission of STDs and HIV.

However, the most important step in preventing HIV/AIDS is to actively involve people in providing nondiscriminatory services and information. This means that everyone should open their minds to any method that might be effective in preventing the transmission of HIV/AIDS.

Wita Krisanti, MA earned a Master of Social Anthropology from Monash University and currently works for Church World Services Indonesia.