HIV/AIDS PREVENTION STRATEGIES AND COMMUNITY EMPOWERMENT YTB AND PPSW PROGRAM

By : M. Suhud and Sanusi

BACKGROUND In 1987, the first case of HIV was found in Indonesia: a Dutch man died in Bali of AIDS. The following year, the first Indonesian victim, a man aged 35 years, also died of AIDS at a hospital in Denpasar, Bali. Until December 2003, HIV/AIDS case in Indonesia; 4091 cases; 2720 HIV+, 1371 AIDS and 479 death The fact shows that Indonesian men had been infected with HIV between 5 and 10 years earlier and that the HIV epidemic had hit Indonesia between 1978 and 1983 when the first case was discovered in the United States. Year HIV+ 1987 4 1988 5 1989 4 1990 4 1991 6 1992 18 1993 96 1994 71 1995 68 1996 105 1997 83 1998 126 1999 178 2000 403 2001 732 2002 648 2003 169 Total 2720

AIDS Total 2 6 2 7 3 7 5 9 12 18 10 28 17 113 18 89 20 88 32 137 34 117 74 200 47 225 178 581 219 951 345 993 353 522 1371 4091

% 0.15 0.17 0.17 0.22 0.44 0.68 2.76 2.18 2.15 3.35 2.86 4.89 5.50 14.20 23.25 24.27 12.76

800 HIV+ 700

AIDS

600 500 400 300 200 100 0 1987

1989

1991

1993

1995

1997

1999

2001

2003

Table and Chart 1: HIV/AIDS cases by year.

New cases had continued to emerge since then, mainly among sex workers, following surveillance tests or HIV tests conducted under the guise of STDs (sexually transmitted diseases) examinations. The increase of cases is illustrated in Table and Chart 1. Between 2000 and 2002 the number of cumulative HIV/AIDS cases rose sharply, probably because many people living with HIV/AIDS were discovered through surveillance tests.

1

Recently it became clear that that the spread of HIV/AIDS in Indonesia is not even geographically, just like in the rest of the world. Jakarta has the most cases of HIV/AIDS: 1,208 of 4,091 (29.53 percent). This finding did not come as a surprise. It is possible that people from other regions feel more secure to undergo HIV tests and seek medical treatment in Jakarta because of the availability of facilities and assured secrecy. On the other hand, the high number of cases in Papua – 1,020 or 24.93% of the total raises a question. The reason is local people have been infected with HIV through foreigners, especially Thai fishermen. The transmission was uncontrollable and now Papua has the bulk of the HIV/AIDS cases in Indonesia.

No

Province

HIV+

AIDS

Total

%

1

DKI Jakarta

861

347

1208

29.53

2

Papua

632

388

1020

24.93

3

East Java

282

213

495

12.10

4

Bali

206

76

282

6.89

5

Riau

202

73

275

6.72

6

West Java

66

67

133

3.25

7

West Kalimantan

75

43

118

2.88

8

Central Java

76

22

98

2.40

9

South Sumatera

72

8

80

1.96

10 Sumatera Utara

30

46

76

1.86

11 Yogyakarta

30

18

48

1.17

12 East Kalimantan

34

4

38

0.93

13 South Sulawesi

32

2

34

0.83

14 Central Kalimantan

27

0

27

0.66

15 Maluku

16

8

24

0.59

16 Jambi

17

5

22

0.54

17 South East Timor

8

14

22

0.54

18 Norh Sulawesi

1

21

22

0.54

19 Lampung

19

1

20

0.49

20 West Sumatera

9

2

11

0.27

21 South Kalimantan

5

3

8

0.20

22 South West Timor

5

3

8

0.20

23 Bengkulu

6

1

7

0.17

24 Bangka Belitung

0

3

3

0.07

25 Central Sulawesi

0

2

2

0.05

Indonesia has also statistics on the methods of HIV transmission. It was found that the pattern of HIV transmission in Indonesia is similar to that in South Africa -- mostly through unsafe heterosexual sex. The above table provides us with interesting information. In Indonesia HIV/AIDS is not a disease mostly found in gays, especially more recently. Of the people living with HIV who have full-blown AIDS, 28.8% have been infected through homosexual and bisexual sex. They were infected between 5 and 10 years ago. Considering there are not many gay people in Indonesia, the number is outstanding, but it does not comprise onethirds of people living with AIDS. Within the recent 5 years, out of HIV-infected people, the proportion of homo and bisexuals has decreased drastically to 5.1%.

On the other hand, the infection of HIV through heterosexual relation tends to 26 Aceh 1 0 1 0.02 increase. Approximately 59.7% of the 27 Banten 0 1 1 0.02 people long living with AIDS were infected 28 Unknown 8 0 8 0.20 through heterosexual relation, while 77.4% Total 2720 1371 4091 of people newly living with HIV were also infected in the same manner. This Table 2: HIV/AIDS case by province demonstrates that the HIV infection pattern is similar to that found in South Africa in which 79% of the people living with HIV/AIDS were infected through sexual intercourse with their opposite sex. Other means of infection do not seem significant. In fact in recent period, there have been no cases of the infection of HIV by means of blood transfusion, while the infection through needle

2

because of hemophilia and through mother to child decreases if comparing HIV column with AIDS column. Considering the increase abuse of narcotic and drugs, it is imperative to monitor the spread of HIV among narcotic and drugs addicts. But the data from this table is not accurate enough to make a conclusion. As the percentage of cases with unknown sources of infection is significantly high, in particular among people living with HIV (16.2%), it is imperative to monitor such cases. But the facts that cases of people get infected through homo and bisexual intercourses are decreasing and through heterosexual intercourses are in the increase are certain.

1600

Sex HIV+ Men 1466 Women 872 Unknown 382 Total 2720

AIDS 1071 285 15 1371

Total 2537 1157 397 4091

% 62.01 28.28 9.70

1400

HIV+

1200

AIDS

1000 800 600 400 200 0

Men

Women

Unknown

Table and chart 3: HIV/AIDS cases by sex.

Data on HIV/AIDS cases by sex demonstrates that the male persons living with HIV/AIDS outnumber female person living with HIV/AIDS: male 62.01% of the total, male: 28.28% (unknown sex 9.7%). It means that HIV/AIDS is `male disease’. It becomes more obvious if we compare the number of people living with HIV and the number of people living with AIDS. Out of people living with AIDS who certainly have been infected with AIDS 5-10 years ago, less than 1/5 (19%) are females. While out of people newly infected with HIV who has not reached AIDS stage, more than 2/5 (41.9%) of them are females. In other word, females are at increased risk of getting HIV recently. If the trend continues, in short term, females having HIV/AIDS will level the number of males with positive HIV. The increase of absolute and relative numbers of infected females confirms the conclusion made on the basis of table 6 that the infection of HIV through homo and bisexual intercourse is in decrease, while the infection through heterosexual intercourse is increasing.

1600 1400 1200 1000 800 600 400 200 0

3

Unknown

0.10 3.84 26.11 14.45 4.79 1.20 0.32

>60

4 157 1068 591 196 49 13

50-59

4 78 596 411 151 41 12

40-49

0 79 472 180 45 8 1

AIDS

1800

30-39

5-14 15-19 20-29 30-39 40-49 50-59 >60

HIV+

2000

20-29

% 0.12 0.46

15-19

Total 5 19

5-14

AIDS 4 17

1-4

HIV+ 1 2