While some Asian nations have managed to slow or even arrest the rate of new HIV infections, Indonesia is struggling to contain an epidemic. The United Nations estimates that as many as 270,000 Indonesians are living with the disease and most do not know it. Katie Hamann reports from Jakarta.
Jacky Maharja and his friends have retreated to the hills above the Jakarta for a weekend away from traffic jams, pollution and their very private battles with HIV.
|Indonesian activists hold mock hypodermic syringes and wear masks to depict HIV during a demonstration commemorating AIDS Day in Jakarta, 01 Dec 2008|
"[In] 2004 I get tested when I sick and I don't get counseling or anything," said Maharja. "They're asking me about, 'are you a drug user?' 'Yes a long time ago, yeah.' This is what happening if you're using drugs, that's all they say. Three hospitals rejected me, they don't want to treat me in the hospital because they say we don't have the place for those kind of things."
Maharja's early experiences prompted him to establish a support group called Pita. He says the group receives little government assistance but says that printing more posters does not help those already infected.
The government's response has improved since a presidential decree in 2006 established the National AIDS Commission and focused efforts on prevention. But AIDS activists say a lack of money and political will as well as the challenge of reaching communities across the archipelago hamper prevention and treatment programs.
Supplies of anti-retroviral drugs used to treat HIV patients regularly dry up because of distribution problems and limited funding.
Maharja and other Pita members have been forced to stop treatment, sometimes for months at a time. But they are still the lucky ones. It is estimated that less than 10 percent of infected Indonesians have access to any sort of treatment.
Nafsiah Mboi heads the National AIDS commission.
At a recent conference on condom use, she explained that much work is needed in building the capacity of health services.
"It's not only money," she said. "Yes, indeed, [it is] underfunded, but our whole procurement and supply management system should be improved. What we're trying to do is encourage the local health people, local government, local AIDS commissions to improve their planning and reporting system. Because if they plan say for one year and every quarter they should get so many condoms, so many needles, so many ARVs [anti-retroviral drugs], then the system can fulfill that."
Mboi says her agency has assumed control of prevention campaigns because of cultural sensitivities around issues such as condom use, intravenous drug use and homosexual activity. Those sensitivities make many political leaders reluctant to take a public role in fighting AIDS.
International health experts say condoms remain the single most effective means of preventing the spread of HIV.
However, Indonesia's religious leaders resist efforts to get people to use condoms, exacerbating an existing culture of disdain for their use.
"Condoms are associated with sex workers or migrants, if people see someone using condoms they think your sexual behavior is unacceptable," said Iskander Nugroho, an AIDS activist in the eastern province of Papua. "We actually stigmatize people who use condoms."
Todd Callahan is the country director for DKT, a nonprofit organization that works on HIV and AIDS prevention and is a major condom distributor. He says funding must be directed toward public education about condom use.
"Everybody in Indonesia, even people in very small cities and kampongs [villages] many now have televisions, so if you want to reach Indonesian society I think that's the best way," he said. "We saw this in 2006 when we had some donor money to create and air public service announcements for a year and the condom market increased by more than 30 percent."
In Papua, the HIV prevalence rate is 20 times the national average, with as many as 75,000 victims, out of a population of 2.5 million.
A thriving prostitution industry there patronized by migrant workers means the virus is being carried to their home villages, where women and babies are being infected. AIDS activists say educating those migrant workers about the disease and condom use could reduce those new infections.