HIV/AIDS Prevention

Major Achievements on HIV/AIDS Activities in Indonesia

Introduction

The first case of AIDS was reported in 1987 in Indonesia. By December 2004 there were 3368 HIV and 2682 AIDS reported cases. Around 40% of the cases are coming from the youth age group (10-24 years). The actual number of HIV/AIDS cases is estimated between 90,000 – 130,000 people. Infection rates are growing fast, partly due to better statistics and voluntary counseling and testing (VCT) services that are starting to become available in many places and partly because infection is spreading rapidly into segments of the population especially among injecting drug users (IDUs), female and male sex workers, their clients and transvestites.

The report from Ministry of Health (MOH) in 2002 stated that Indonesia has moved from a low prevalence to a concentrated area country. This means that there are areas in Indonesia where number of HIV/AIDS cases has exciding 5% in high-risk behavior groups. Until the beginning of 2004 there were 6 provinces concerned by the high number of HIV/AIDS cases and have become “priority provinces” (Jakarta, Papua, Bali, East Java, West Java and Riau). At the end of 2004 Indonesia has 12 priority provinces adding West Kalimantan, North Sumatra, North Sulawesi, Central Java, Jogjakarta and Banten.

Major mode of transmission is still through sexual activities due to the very low use of condom in every risky sexual activity, which is less then 10%. However number of transmission due to sharing needles among IDUs is rapidly accelerating. For example the HIV/AIDS prevalence of IDUs in Jakarta is more than 50%, the same with Surabaya (the capital city of East Java), while in Pontianak (the capital city of West Kalimantan) the prevalence has increased to around 15-25%. The latest joint report by UNAIDS/WHO in 2003 gives an indication that Indonesia now has one of the fastest growing HIV/AIDS epidemics in the world

General Achievements

Indonesia has established a National AIDS Commission (NAC) based on Presidential decree no. 36 / 1994 and at the time being is implementing its HIV/AIDS National Strategy 2003 – 2007. All provinces and districts have been instructed to have their own Provincial/District AIDS Commission (PAC/DAC) and also HIV/AIDS Provincial/District Strategy. However in reality many of the PAC and DAC are not well functioned.

On December 2003 the National Narcotics Board and the NAC have signed a Memorandum of Understanding (MOU). Although the controversy is still high, some progress due to this MOU has started shown results in several pilot districts with harm reduction programs for IDUs. On April 2004 Ministry of Manpower also has declared a commitment to fight HIV/AIDS and urge companies to integrate HIV/AIDS programs as a way to protect its employees from the transmission. With around 150,000 – 250,000 female sex workers, it is assumed that HIV/AIDS program in the workplace is a strategic way to provide potential clients of sex workers with information and related services they needed.

In January 2004 the NAC had meeting with 6 governors from 6 priority provinces and came out with “Sentani Commitment”. It stated that HIV/AIDS is a major threat to their provinces development programs and a serious action should be taken immediately including self-funding, acknowledge sex industry to make 100% Condom Use Program (CUP) success and the need of harm reduction programs for IDUs. After a year of the “Sentani Commitment” on 14 February 2005, the NAC met and urged all related ministries, provinces and other stakeholders to strengthen the commitment and take more serious responses. Some outcomes are to strengthen social marketing of the dual protection of condom from BKKBN; statement from the ministry of religion that condom need to be use if a person consciously aware that out of marriage sex is a sin but still want to do so; MOH committed to 100% support the purchase of anti retroviral (ARV) drugs for People Living With AIDS (PLWA) who cannot afford it; MOH will increase the number of hospitals with complete services for PLWA from 25 hospitals in 2004 to 50 hospitals throughout Indonesia in 2005; and the NAC will have a sub commission on women, children and young people.

UNFPA Indonesia Major Achievements

In the 6th Country Programmes, UNFPA implement and integrate HIV/AIDS program in its 4 supporting provinces of South Sumatra, West Java, West Kalimantan and NTT. The continuous program since 2001 is to educate and assist female sex workers in the capital cities of the 4 provinces on STI/HIV/AIDS through partnering with BKKBN and an NGO called Perkumpulan Keluarga Berencana Indonesia (PKBI). Early 2004 as a respond to the mid term project evaluation and the accelerating new HIV/AIDS cases, UNFPA has enhanced some of its strategies. Not only provide comprehensive information and condoms to around 1600 female sex workers, but the project also has motivate them to do regular STIs’ check up whether they have symptoms or not. The project also started to reach potential clients of sex workers through PKBI’s outreach staff. Advocacy and close communication between PKBI with stakeholders at provincial and districts level has been strengthened to get better support.

As part of the adolescent reproductive health (ARH) program, UNFPA integrate STI/HIV/AIDS information and ensure access to services for young people (10 – 24 years) through out of school programs. One component of the Essential Reproductive Health program has been to support government clinics in the 4 provinces to provide youth friendly RH services. Currently around 50 government clinics claimed providing youth friendly RH services. On all HIV/AIDS programs, UNFPA gives serious attention to its correlation with other aspects including culture, social, economic and gender issues.

In March 2004 West Kalimantan has become one of the priority provinces for HIV/AIDS. With no other funding agencies in that province, UNFPA Indonesia has provided immediate support to the province especially in relation to the “Three Ones” (one coordinating framework, one coordinating authority and one monitoring and evaluation framework). Due to UNFPA support, currently West Kalimantan and its capital city Pontianak have their own HIV/AIDS Provincial / City Strategic Planning 2004 – 2009; established and run secretariat PAC and DAC office to motivate, coordinate and facilitate appropriate HIV/AIDS programmes and policies; provide access to other funding agencies; make local government committed to start allocate local funding for HIV/AIDS programmes. In the 3 other provinces although there has been support from other funding agencies to the PAC and DAC, still UNFPA provide some support especially in assist the PAC and DAC to have a better HIV/AIDS strategy and programs for young people and other vulnerable groups.

At national level, since the HIV/AIDS National Strategic Planning does not have special focus on strategy for young people and the concerning new HIV/AIDS cases among the young people age group, UNFPA has approach the NAC and at the moment in the process to support NAC in developing HIV/AIDS strategy for young people. Since the current HIV/AIDS National Strategic Planning cannot be changed, the strategy for young people will be integrated through NAC annual work plan and later on will be integrated into the next cycle of HIV/AIDS National Strategic Planning (year 2008-2012). UNFPA is also supporting the NAC in having a sub commission on women, children and young people. In relation to the commemoration of the World AIDS Day 2004, UNFPA has supported the National World AIDS Day 2004 where at this event the president has stressed the important to have special HIV/AIDS programs for women and young people especially girls. At part of his commitment to respond to the HIV/AIDS problems in Indonesia, the president has asked the

Minister of Health to directly meet and provide him with update report for every 3 months. This UNFPA effort is part of the UNFPA mandate in the UN Joint Action Programme for HIV/AIDS.

Currently the UN is implementing UN Joint Action Programme for HIV/AIDS 2003 – 2007. To provide a good quality HIV/AIDS program and management based on its mandate, at the beginning of 2004, UNFPA Indonesia hired a national program officer (NPO) on HIV/AIDS who is also in charge for ARH program. This NPO is part of the UN Focal Points on HIV/AIDS coordinated and facilitated by UNAIDS. Major UNFPA achievements through the UN HIV/AIDS Joint Action Programme (UN JAP) not only shown on the support to the NAC to have a HIV/AIDS national strategy for young people and the availability of special HIV/AIDS focal point but also on the efforts to do joint activities with other UN agencies for example joint activities with UNESCO, and UNICEF on the national commemoration of the Youth International Day 2004 focusing on young people to speak up on their situation and needs in relation to HIV/AIDS. At the moment UNFPA is in the process to prepare a joint activity with UNESCO and UNICEF to do need assessment on how to do joint action programme for young people. It is hoping that in the near future the three agencies can collaborate their programs in the same working area where UNFPA with out of school program, UNESCO with in school program and UNICEF with life skills education program. Until now no other UN Agencies have conducted joint activity nor joint action programme.

In the UNFPA office, every staff has been provided with basic information of STI/HIV/AIDS including its relation to social, economic and human rights aspects. Informal education sessions on STI/HIV/AIDS are also conducted regularly. Every staff and guests who come to the UNFPA office have free access to condoms. (indonesia.unfpa.org)