Unfinished Independence: Combating HIV in Papua
Every August, the Indonesian nation celebrates its independence with pride. The Red and White flag flies in various corners of the country as a symbol of freedom and unity. However, behind the splendour of the celebrations, there is still an unfinished struggle. In West Papua, independence has not been fully realised when some communities still face the threat of HIV, limited access to health services, and stigma that hinders their right to a healthy life. HIV is no longer just a medical issue, but a matter of social justice. As long as there are people who are diagnosed late, struggle to access treatment, or are shunned because of their health status, independence in the health sector has not truly been achieved.
More than four decades after it was first recognised, HIV remains a global health challenge. The World Health Organisation (WHO) reported that by the end of 2024, there were approximately 40.8 million people living with HIV, with 1.3 million new infections and around 630,000 AIDS-related deaths worldwide (WHO, 2025). Indonesia is still facing the same problem. As of March 2025, an estimated 564,000 people were living with HIV, yet many are still unaware of their infection status or have not received antiretroviral (ARV) therapy. This indicates that the global 95-95-95 targets set by UNAIDS remain a major challenge for Indonesia (Ministry of Health of the Republic of Indonesia; WHO, 2025). Among all regions in Indonesia, Papua and West Papua have distinct characteristics. The HIV epidemic in Tanah Papua has evolved into a generalised epidemic, where transmission is no longer confined to high-risk groups but has spread to the general population through heterosexual transmission. This condition makes Papua one of the regions with the highest HIV burden in Indonesia and requires a more comprehensive approach to control. The consequences are not only an increase in morbidity and mortality. Many patients arrive at health facilities in an advanced stage of the disease and suffer from opportunistic infections, one of which is oral candidiasis. This fungal infection often signals a weakened immune system and significantly reduces the patient’s quality of life (Meylani et al., 2021; Merati et al., 2025).
The key question is no longer why HIV still exists, but why the epidemic persists despite the availability of medication. The answer lies not only in the virus itself but in various social determinants that remain major obstacles. Stigma causes many people to fear taking an HIV test or seeking treatment due to concerns about being ostracised by family and the community. Consequently, diagnosis is often delayed, reducing the chances of successful therapy. UNAIDS emphasises that stigma remains one of the biggest barriers to HIV control in many countries, including Indonesia (UNAIDS, 2025). Beyond stigma, the geographical challenges of West Papua cannot be ignored. The vast territory, difficult natural terrain, and uneven distribution of health facilities mean that some people must travel long distances just to get an HIV test or collect ARV medication. This inequality leads to late diagnosis, poor treatment adherence, and high rates of loss to follow-up. The problem is compounded by low health literacy. Myths about HIV still circulate in communities, ranging from misconceptions about transmission to the belief that HIV is a ‘punishment’ for certain behaviours. In fact, proper knowledge has been proven to reduce stigma and increase people’s willingness to undergo early testing and adhere to therapy. Therefore, controlling HIV cannot rely solely on hospitals and medication. A broader approach is needed, one that eliminates stigma, expands access to health services, and improves public literacy.
This is where science plays a crucial role. Health independence means not only being able to treat diseases but also being able to produce solutions that suit the nation’s own needs. A country that is self-reliant in the health sector is one that can develop innovations based on local potential to address public health challenges. Papua possesses one of the world’s greatest biodiversity riches. Its tropical rainforests, coastal areas, and marine ecosystems such as Raja Ampat and Cenderawasih Bay harbour thousands of species of plants, animals, microorganisms, and marine life that have the potential to be sources of bioactive compounds for new drug development. Various studies have shown that Indonesian natural materials have promising antimicrobial, antibiofilm, and anti-inflammatory activities, making them potential candidates for developing therapies for infectious diseases, including opportunistic infections in people with HIV/AIDS (Ajetunmobi et al., 2023; Fróis-Martins et al., 2024; Kumar & Kumar, 2024; Meylani et al., 2026). This potential needs to be combined with advances in biotechnology. One example is the development of cinnamaldehyde–chitosan nanoencapsulation, which utilises bioactive compounds from cinnamon with nanoparticle technology to enhance stability, bioavailability, and effectiveness. Our research shows that this formulation not only inhibits the growth of Candida albicans but also damages biofilms and suppresses the expression of virulence genes involved in adhesion, hypha formation, and tissue invasion. This approach demonstrates that innovations based on Indonesia’s biodiversity can evolve from mere natural materials into more effective modern therapeutic candidates through the application of science.