Indonesia and HIV - Where Are We Now?

As we all know, the recent global economic crisis has had deep impact in every part of the world. As a result, institutions working in all manner of social issues have been dealing with a decrease in funding levels and in other cases, funding has been cut off altogether. Non-governmental organisations (NGOs) and community based organisations (CBOs) have been devastated because many of their programs have had to be terminated.

This state of affairs is especially applicable in developing countries where many governments have been unable to provide the financial support needed to tackle issues such as HIV and as a result rely predominatly on foreign donor organisation and/or international institutions to provide the majority of investment needed.

Since 2009, the Indonesian government has spent Rp. 180 billion [approximately USD1,700,000] on HIV prevention which is a tiny sum in relation to the financial package to establish adequate prevention, treatment, care and support programs within the country.

Despite this and the fact that HIV infection rates continue to rise within the country, the Minister of Communication and Information has recently issued statement stating that the amount should be reduced so the money can be utilised in other areas that is more ‘beneficial’ to the country. Neither the National AIDS Commission of Indonesia nor the Ministry of Health has commented on this statement which flies directly in the face of existing pledges to Universal Access or the wider Millennium Development Goals (MDGs). That is why Indonesia is relying a lot on international and foreign funding aides and why the financial crisis has been so detrimental to tackling this issue.

A further arising issue within the country is the need to increase the self-empowerment of PLHIV communities which remains dreadfully low. While there have been a few organisations who have sought to tackle this issue through vocational and income generating programs, such programs remain unsustainable because of no significant support from the government to sustain these programs on any considerable timeframe.

Economic empowerment is also essential for the PLHIV communities, who have often failed to secure decent livelihoods because after the empowerment programs, no capital was given to start the business or for those who have the capital, no buyers to come and place orders. Such a severe problem also directly increases the poverty levels of PLHIV in Indonesia. Many of who live below the poverty line and struggle to feed themselves and the family on a daily basis.

This issue must be seen as directly related to the issue of access to treatment and medication because even though ARV is provided for free, the travel expenses for people to go to and from the hospitals is sometimes considerably huge in relation to their overall income. As a result of this situation, many PLHIV are forced to choose between feeding their families and travelling to the hospital to get ARV, they obviously chose to feed the family.

To make matters worse, Indonesia has been continuously struck by natural disasters such as earth quakes and typhoons which further complicates efforts to tackle HIV. Not only does this often render the health care services inaccessible, it also affects the livelihood of PLHIV in the locality affected. On September 30^th 2009, West Sumatra was struck by an earthquake and many of the health care facilities have not been repaired since. In one of the villages affected, over 30 PLHIV families are living below the poverty line. Many suffer from malnutrition as a direct result of damage to their livelihoods which impacts on the levels of food security and renders the family unable to afford trips to hospital further afield.

Talking about human rights protection in Indonesia long endless story, especially for women and girls living with HIV. Mandatory HIV testing and sterilisation sadly remains a frequent practise where many HIV-positive women are forced to be sterilised to prevent further pregnancies. The pressure arising from stigmatisation towards HIV-positive women now means that many are forced to feel guilty for their desire to have children. Yet all women bare the right to become a mother but the information on sexual and reproductive health for HIV-positive women and girls remains limited. Being sexually active and HIV-positive at the same time is very difficult. Women and girls living with HIV are often severely restricted in their options for sexuality.

The need to recognise the importance of Sexual and Reproductive Health Rights for women and girls remains crucial in Indonesia. The responsibility of preventing HIV transmission is not solely the women’s’ responsibility and men need to actively engaged in this process and to provide support for women by treating them as equal partners. People need to understand and realise that men and women need to support one another at all levels both in Indonesia and worldwide.

PLHIV need integrated, comprehensive and friendly health services that enables them to encompass the rights of sexual enjoyments without being discriminated and stigmatised as the response to their strategic gender needs. It is essential to always link HIV with sexual and reproductive health issues. It is also essential to address the issues related to growing up and being sexually active for girls and boys; and ageing with HIV for adult women and men as well as to link HIV complications regarding treatment with other female and male specific illnesses such as cervical cancer and prostate cancer.