HIV/AIDS in Indonesia

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia’s fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated.

History

Indonesia’s first case of HIV was reported in 1987 and between then and 2009, 3,492 people died from the disease. Of the 11,856 cases reported in 2008, 6,962 of them were people under 30 years of age, including 55 infants under 1 year old. There are a high number of concentrated cases among Indonesia’s most at risk including injection drug users (IDUs), sex workers their partners and clients, homosexual men and infants who contract the disease through the womb or from being breast fed.

In the last 15 years, HIV/AIDS has become an epidemic in Indonesia. The highest concentration areas are Papua, Jakarta, East Java, West Java, Bali and Riau and all are considered to be zones that need immediate attention.

Due to the increasing number of IDUs, the number of new infections has grown rapidly since 1999. Moreover, a generalised epidemic is already under way in the provinces of Papua and West Papua, where a population-based survey found an adult-prevalence rate of 2.4% in 2006. A whopping 48% of Papuans are unaware of HIV/AIDS, and the number of AIDS cases per 100,000 people in the two provinces is almost 20 times the national average. The percentage of people who reported being unaware of HIV/AIDS increases to 74% among uneducated populations in the region.

The epidemic in Indonesia is one of the fastest growing among HIV/AIDS in Asia. The epidemic of injecting drug use continues to be the primary mode of transmission, accounting for 59% of HIV infections, and heterosexual transmission accounted for 41% in 2006. According to the Indonesian Ministry of Health, recent surveys report that more than 40% of IDUs in Jakarta have tested positive for HIV, and about 13% tested positive in West Java. Many IDUs sell sex to finance their drug habits. Yet in 2005, 25% of IDUs in Bandung, Jakarta, and Medan said they had unprotected paid sex in the last 12 months.

The Indonesian archipelago stretches more than 3,000 miles along the Equator. Cultural practices and levels of urbanization affect the HIV/AIDS epidemic. For instance, a culture of paid and “transactional” sex among young men and women aged 15 to 24 has been a driving factor in Papua. Among 15- to 24-year-olds, HIV-prevalence rates were 3% in 2006, according to the Ministry of Health. Prevalence rates among sex workers in Papua’s major urban areas ranged from 9% in Timika to 16% in Sorong in 2004.

Numerous factors put Indonesia in danger of a broader epidemic. Risky sexual behaviors are common. Only 54.7% of sex workers and 56.5% of men who have sex with men (MSM) use condoms consistently, and just 18.5 percent of IDUs consistently use both sterile needles and condoms, according to Indonesia’s 2006 report to the United Nations General Assembly Special Session on HIV/AIDS (UNGASS). Many IDUs are also sex workers or clients of sex workers, increasing the likelihood of HIV/AIDS spreading to the general population. Awareness of HIV status among at-risk populations is low. According to a 2004–2005 study cited in the UNGASS report, 18.1% of IDUs, 15.4% of MSM, 14.8% of sex workers, and 3.3% of clients of sex workers had received HIV testing in the previous 12 months and knew their test results. Stigma and discrimination persist and many people living with HIV hide their status for fear of losing their jobs, social status, and the support of their families and communities, thus decreasing the likelihood that they will receive proper treatment and increasing the chances of HIV spreading undetected.

National response

Indonesia established a National AIDS Commission in 1994 to focus on preventing the spread of HIV, addressing the needs of people living with HIV/AIDS, and coordinating government, nongovernmental organizations (NGOs), private sector, and community activities. The Government of Indonesia signified its continued commitment to fighting HIV/AIDS in 2005 when it budgeted $13 million to HIV/AIDS programs, an increase of 40 percent over the amount disbursed in 2004. However, the national budget for HIV/AIDS has since been stagnant. A 2006 Presidential Regulation reinforced the Commission’s position as the National AIDS Strategy for 2003–2007 stressed the role of prevention as the core of Indonesia’s HIV/AIDS program, while recognizing the urgent need to scale up treatment, care, and support services. The strategy emphasized the importance of conducting proper HIV/AIDS and sexually transmitted infection (STI) surveillance; carrying out operational research; creating an enabling environment through legislation, advocacy, capacity building, and antidiscrimination efforts; and promoting sustainability. Building upon this framework, the National AIDS Strategy for 2007–2010 added the priority targets of reaching 80 percent of people most-at-risk with comprehensive prevention programs; influencing 60 percent of the most-at-risk population to change their behaviors; and providing antiretroviral therapy (ART) to 80 percent of those in need.

The Government of Indonesia initiated a program to subsidise the cost of ART in 2004. By 2005, the program provided low-cost ART at 50 hospitals. However, only 20 percent of HIV-infected people received ART in 2006, according to UNAIDS, and for every one person who starts ART another six get infected. Treatment adherence continues to be a challenge in Indonesia as more often than not, people living with HIV drop out of antiretroviral therapy due to many complex factors. Other competing demands on the government such as dealing with natural disasters and other health emergencies such as avian influenza also pose challenges to sustaining the momentum of the AIDS response.

Indonesia's local governments have investigated innovative techniques to slow down the spread of the disease, including using microchip tagging technology to keep track of the infected individuals known to be sexually active.

International Help

Indonesia receives assistance from several international donor organizations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund approved a fourth-round grant in 2005 for Indonesia to provide comprehensive care for HIV/AIDS-infected and -affected individuals.

In 2007 Australia donated A$100 million to help contain the epidemic in Indonesia. The aim of the program is to limit the number of people who contract the disease though education of at risk groups, improve the quality of life for suffers, and reduce the socioeconomic effects on Indonesia. Australia has been assisting Indonesia to tackle HIV/AIDS for over 15 years and introduced the first methadone program to a prison in Asia, the program is now in 95 prisons across Indonesia.

America also supports Indonesia’s National Aids Program, donating US$8 million annually . The program aims to increase awareness of the risks and prevention methods and will work closely with NGO’s and provincial governments to develop services in areas where the spread is now considered to be an epidemic.