Spread of AIDS in Papua at alarming level

Spread of AIDS in Papua at alarming level

Chris W. Green, AIDS Activist, Jakarta, chrisg@rad.net.id

An African-style AIDS epidemic in Papua is not outside the
bounds of probability. And yes, I am talking about the Indonesian
half of the island, previously called Irian Jaya.

I recently visited four towns in the province, Jayapura (the
capital), Merauke, Sorong, and Timika. I was a member of a team
of four from the Spiritia Foundation, a team that included two
people with HIV/AIDS (PLHAs).

We had been asked by the Aksi Stop AIDS (Stop AIDS Action,
ASA) project (a USAID-funded program) to meet with PLHAs in the
province, with a view to empowering them to play an active role
in the response to AIDS there. We also met with groups supporting
PLHAs, including non-government organizations (NGOs), doctors
and hospitals, and those in government responsible to respond to
the epidemic.

Papua is a huge province with a very small population -- a
little over two million, of whom half are migrants from other
parts of Indonesia. The indigenous people are members of a large
number of tribes, most with their own language and customs.
Literacy is low, as is ability to communicate in Bahasa
Indonesia.

We had been aware that the epidemic in Papua is more developed
than in other parts of Indonesia. There have been more than 1000
cases of HIV infection reported in the province, and the reported
prevalence of AIDS is almost 30 times the national average. And
we had heard that surveys among sex workers in Merauke, thought
to be the worst affected place, had shown that one in four are
infected with HIV.

However, we were not prepared for the scale of the problems
surrounding the epidemic in Papua. Clearly poverty
contributes -- even though Papua is by no means the poorest
province in Indonesia. Attitudes towards sex among the indigenous
population also impact -- as in Africa, most HIV infections in
Papua are sexually transmitted. Alcohol use also must bear some
of the responsibility.

But if these factors tend to drive the epidemic, it must be
said that efforts to stem its spread are sporadic at best. As is
so often the case, political factors intervene. There is a common
belief among local leaders that AIDS was introduced to the
province in a deliberate effort to decimate the indigenous
population. This hinders any reasonable discussion about ways of
addressing the spread of infection. Meetings become dominated by
calls for quarantining PLHAs, even though this has been proved
counter-productive, and clearly violates human rights. Others
call for closing the provincial borders to visitors who cannot
prove that they are not HIV-infected -- again, a useless
response.

Many of those who are responsible to coordinate the response
-- officials who are ex-officio members of AIDS Control
Commissions at province and district levels -- openly admitted to
knowing little about AIDS. Much of what they do know is
incorrect. Yet there has yet to be a determined effort to educate
decision and policy makers, or community and religious leaders.

One immediate effect of all this is that stigma and
discrimination by the community -- and families -- is a daily
experience for many PLHAs in the province. Following an AIDS
diagnosis, families often quickly remove patients from hospital.
We heard of cases of patients being abandoned to die.

As a result of these and other factors, many believe that an
AIDS epidemic is exploding in Papua. Dr. Gunawan, an expert with
many years experience in the health ministry in Papua and now
responsible for the Stop AIDS Action program there, fears that as
many as 5 percent of the total population may already be
infected. This matches the level found in many countries in sub-
Saharan Africa.

What should be done? Clearly there must be much greater
efforts to raise the level of concern among local leaders.
Indeed, there are hopeful signs here -- the province's Deputy
Governor Constant Karma led a party of Papuan officials on a
fact-finding visit to Uganda to see the situation there at first
hand. He is now a dedicated campaigner for effective and
practical responses.

There are some similar activists at district levels, but they
are too thinly spread -- and overloaded with a multitude of other
problems, requiring equally urgent solutions. We must find ways
to involve more community leaders -- particularly religious
leaders -- and provide them with a balanced education on how the
challenge of AIDS may be addressed.

One approach that has demonstrated success around the world is
the involvement of PLHAs. Indeed, this has already been shown to
be extremely effective in Papua. One PLHA, affectionately known
as Mama Dora, was active in openly addressing public meetings in
the latter part of last year. Sadly she succumbed to AIDS early
this year, and she died in January.

Despite her example, we were frequently told that it would be
unlikely that we could identify candidates for such involvement
in Papua. Everyone said that PLHAs there would not be willing to
reveal their status in public; they don't have sufficient
education; they're all too sick.

However, we proved this incorrect. In each location we met at
least one PLHA who was willing and able -- with guidance -- to
play such a role. Doubtless they will require development of
their skills, and education on HIV and AIDS, as part of an
empowerment process that must also be directed to increasing
their self-confidence. Spiritia will provide all of this as part
of our ongoing program, financed by the Ford Foundation.

In a meeting with the Deputy Governor we challenged him to
include a PLHA in all of his frequent public appearances to talk
about AIDS in the province. He whole-heartedly accepted our
challenge, but challenged us to identify and train suitable
candidates. This is a task we have already started to address.

It is already be too late to prevent a major AIDS epidemic in
Papua. But we must find ways to mitigate its impact, and to
introduce programs that will reduce the spread of infection. This
will require leadership by officials, politicians, and community,
especially religious, leaders. It will require them to open their
minds and their hearts to the realities of the disease and the
way it is spread. They must be prepared to do their homework, to
learn the truth about AIDS, and ignore the myths and stigma that
surround the disease.

Several African countries have demonstrated that such an
approach can be effective in combating the AIDS epidemic. We must
be willing to learn from them.