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.