'Prevention is key' to fight against AIDS

By Wirasti Wiryono

YOGYAKARTA (JP): Doctors must continue enforcing the proper diagnosis of sexually transmitted diseases and maintain patients' confidentiality, including those infected with HIV/AIDS, a medical expert said recently.

Director of the AIDS counseling and testing center Pelita Ilmu Foundation, Dr. Samsuridjal Djauzi, told 20 print journalists at a recent workshop on media training about AIDS here that a person can carry the syndrome for five to seven years before showing any sign of it, a prevalent situation among HIV/AIDS carriers.

Samsuridjal called for an increased awareness of HIV, the virus that causes AIDS, and said health care professionals should practice universal precautions, diagnosing and treating sexually transmitted diseases frequently found in Indonesia. He said the lack of HIV counselors meant doctors had to understand the basics of AIDS counseling to be able to help their patients.

He said that anonymous HIV testing and proper monitoring need to be increased nationwide.

Ninety percent of HIV/AIDS cases in Indonesia is from sexual intercourse and prevention is the key to promoting public awareness about the syndrome because treatment for AIDS is costly, he said.

The costs of treating an HIV/AIDS carrier are staggering, with basic treatment reaching as much as Rp 144 million (US$58,872) over three years for medication and one year of blood tests worth Rp 9.6 million, he said.

The medications available on the market include AZT, DDI, DDC and Zidovudine.

In a book titled Sebelas Langkah Memahami AIDS (Eleven ways to understand AIDS) published by the Yogyakarta Institute of Education, Research and Publishing (LP3Y), the use of water- based, not oil-based lubricants with condoms is promoted in the prevention of HIV/AIDS. This is to avoid tears in the latex condoms. Female condoms can also be used if a person develops allergies to latex condoms.

Differing views

Samsuridjal expressed his concern about the differing figures on HIV/AIDS cases in Indonesia. Neighboring Malaysia reported 20,000 HIV cases as of December 1996 while Thailand reported 800,000.

According to official figures released by the Ministry of Health, there are currently 545 HIV/AIDS carriers in 21 provinces.

"HIV/AIDS carriers need tremendous public acceptance and support, not 'quarantine'," he said. "The best treatment that the public can afford currently to fight AIDS includes a healthy diet, use of medications available at public health centers and for the more affluent, a combination -- known as cocktail -- of AIDS medications."

HIV enters the human body through unprotected sexual contact, blood transfusions and can also be transmitted from a HIV positive pregnant woman to her baby. The virus attacks white blood cells known as CD-4, which helps to maintain the body's immunity levels.

The US-based Center for Disease Control and Prevention (CDC) defines a person infected with AIDS as having CD-4 count of 200/mm3 (per cubic millimeter). A healthy person maintains a CD- 4 count of 1,200 per cubic millimeter. The low CD-4 count makes the AIDS carrier vulnerable to other diseases including hepatitis, tuberculosis, pneumonia and even a cold.

A member of the LP3Y, Rondang Pasaribu, said that HIV thrives inside the human body, blood, sperm and vaginal fluids but cannot survive in the open air, perspiration, tears, saliva and urine, despite the public's continued perceptions of infection ranging from shaking hands, hugging, kissing and swimming in pools.

Rondang said there is a "window period" of three to six months, in which HIV infects someone but the test results could be negative, a "false negative".

In Indonesia, HIV testing is done through the popular Elisa and Western blot methods. Elisa tests for HIV antibodies while Western blot confirms the positive detections, Samsuridjal said. Testing for HIV antigens is used for cases where tests for antibodies are difficult to detect, he said.

Samsuridjal said that testing must be voluntary, maintain confidentiality, and include informed consent and counseling. He acknowledged that violations of these procedures persist, causing a person with HIV undue anxiety, seclusion or worse, feelings of suicide.

Pretest and posttest counseling help a person who could test positive or negative for HIV accept the situation and prepare ways to cope with the carrier's problems more constructively, he said.

Minister of Health Sujudi warned on June 15 that the spread of AIDS would affect one to 2.5 million Indonesians by the year 2000, Antara reported. The figures were estimated from the ministry and epidemiologists.

During his three-day official visit to West Sumatra, Sujudi said that by 2000, there would be 30 to 40 million people infected with HIV/AIDS worldwide, with 80 percent of them in Asia.