HIV Awareness in Papua

by on Wednesday, 27 March 2013 Comments

Socio-economic inequalities and the spread of HIV/AIDS in Indonesian Papua

The small wood and corrugated iron shack is dark, the only light coming from a hole in the wall above the fireplace. In a corner, Tarius* (23) lies on a thin mattress. His face is gaunt, his gaze empty. Every so often, a rumbling cough shakes his chest. He seems oblivious to the lively family discussions around him. One of his cousins recently died after an unknown illness and his funeral is to be held later in the day. But the family is worried about Tarius' own condition, as he has been unable to keep food down for over ten days and is rapidly losing weight. Tarius' father came across an NGO worker talking about sexually transmittable diseases (STDs) and HIV/AIDS at the market a few days ago and although he has not shared his worries with the rest of the family, he fears his son's symptoms are those of AIDS.

In their 2012 report, UNAIDS highlighted the recent successes in combating HIV/AIDS around the world. Everywhere countries are making historic gains and 25 low- and middle-income countries showed a 50% reduction in the rate of new HIV infections in 2011 compared to 20011 . In Swaziland, which has the highest HIV prevalence in the world, new HIV infections have dropped by 37%. While most national epidemics appear to have stabilized, HIV incidence, however, rapidly increased2 in two Southeast Asian countries, Indonesia and the Philippines.

Across the more than 17,000 islands that encompass Indonesia (with a population of over 242,000,000), more than 380,0003 people have been tested HIV positive. The worst affected regions are the two most easternmost provinces of Papua and West Papua, where a generalized epidemic is underway. With only 1,5 percent of Indonesia's population, the two provinces account for over 15 per cent of all Indonesia's new HIV cases in 20114 . The HIV prevalence rate is 11 times higher than the national average and has reached 3.5%5,6 . In 2006, AusAid expected 3.61% of the population in Papua to be HIV positive by 20257 . In fact it has reached this level more than ten years earlier than predicted.

The development of poverty and social inequalities

Home to the world's second largest rain forest, and some of the greatest natural reserves in gold, timber gas and fisheries, the two Papua provinces remain Indonesia's poorest region. Ever since Indonesia controversially 'integrated' Papua in 1969 under the auspices of the UN, it has implemented an aggressive modernization campaign that maximizes resource exploitation. Apart from a small elite who could be said to have both participated in and reaped the benefits of this development, the majority of indigenous Papuans have remained at its margins.

From 1969 to 2000 the Indonesian government implemented large transmigration programs funded by the World Bank and the Asian Development Bank, officially aimed at alleviating the population density of other Indonesian provinces. For the Indonesian government, these programs also conveniently altered the ethnic balance of the province and diluted concentrations of indigenous resistance. Transmigration on a smaller scale still occurs today, but is no longer state funded. These population movements have effectively transformed indigenous Papuans into a minority and have increased their marginalization. Over 30% of Papuans now live below the poverty line8 compared to 12% nationally9 , this number including the relatively prosperous migrant groups.

In an attempt to ease Papua's desire for independence and rectify some of the past abuses within the province, Special Autonomy (Otsus) was granted in 2001. Although this has greatly increased the funding to the region, very little progress has been made in crucial areas such as health and education and Papuan civil society seems to agree that it has failed to bring about the sweeping changes it was aimed to inspire. Development has profited to a select few and has further increased social stratification. Many communities still lack basic infrastructure such as clean running water, sanitation and electricity and people in remote rural locations, where roughly 75% of all indigenous people live, have been largely left out by development. Access to quality health and education is a problem for large sections of the indigenous population, especially outside of urban centers.

HIV awareness Papua 1

Cultural practices and sexual health awareness

Tarius lives in Jayawijaya regency, one of the most populated (over 200,000 inhabitants) but also one of the most affected areas of Papua. In September 2012, 250410 people had tested positive for HIV. But these numbers are not representative of the full problem. The number of HIV carriers unaware of their condition is much higher and can only be guessed at. Local NGOs estimate there are at least 6000 undetected cases in Jayawijaya and surrounding areas.

The prevalence rate among ethnic Papuans is almost twice as high as among the Indonesian newcomers11. Contrary to the rest of Indonesia where the epidemic is mainly concentrated among high risk groups such as injection drug users and sex workers, in Papua transmission is almost entirely through heterosexual relations (97,1%)12 and has very much spread to the low-risk population. Indonesian health officials often blame cultural sex practices such as 'wife swapping' for the rapid spread of HIV in Papua, but transmigration and large resource extraction projects have fed the sex industry, which has also been a major driver of the spread of the disease. The exclusion of large parts of the indigenous populations from development and access to the market economy has led increasing levels of Papuan women to engage in prostitution. Poverty is such that transactions often take place in unregulated open air or street dwelling sites with no safety precautions. One NGO worker said that some very young girls sell their bodies for less than 50 cent, for which you cannot even buy a packet of cigarettes or condoms. In semi official prostitution establishments, immigrant prostitutes (usually wearing condoms) charge 20 Euro upwards.

Sexual health awareness is extremely low, not only among Papuan prostitutes but among the Papuan population as a whole. When senior high school students were asked about HIV/AIDS modes of transmission during one of the rare awareness-raising workshop by a local NGO, a majority of them stated that the virus was transmitted through mosquitoes and were not aware that no cure for the disease has yet been found. A worrying amount of youngsters also believed that the virus could be transmitted through kissing and shaking hands13.

Awareness means life

This lack of knowledge about the modes of transmission, coupled with the long running political conflict and the climate of mistrust and fear it has borne, has led to many misconceptions and a number of conspiracy theories. The suspicion that HIV has been introduced specifically to decimate the indigenous population is widespread. A common belief among highland Papuans is that chicken served in restaurants (mostly run by non-Papuans) is injected with the HIV virus to intentionally infect them. These misconceptions about the virus have a direct impact on the lives and welfare of people living with HIV/AIDS.

Tarius' father eventually called the NGO worker he had met at the market to visit his son at home. Despite the funeral, the young man was rushed to hospital where blood tests revealed he was indeed HIV positive. The NGO worker accompanying him didn't tell him right away. The family was present and "if people in his community knew of his status, horrible things could happen", he said. People are not at risk of being burned alive anymore like some years ago, but the stigma is still strong. Some priests claim during mass that AIDS is a punishment from God to those who have sinned. Churches are slow to tackle the problem, and it can still be a problem to find a priest who buries someone who openly died from AIDS related diseases. A young NGO worker who studied theology complains that he sometimes spends many days looking for priests to perform funerals for HIV patients, knocking on many closed doors and being turned back. The fear of stigmatization in the community stops people from sharing their experiences and makes them reluctant to get tested for the disease. Despite the influx of large amounts of money to combat the epidemic, only a very small number of local NGOs are actually working on the ground and fighting the stigma associated with HIV.

Stigma also has an impact on patients' proper medication, as they must take it secretly. Others do not take their medicine at all and try curing the disease with traditional remedies such as buah merah, the fruit from the Pandanus tree, or perform traditional rituals. Others start taking the medicine but don't take it regularly, or stop taking it once they feel better, as for many treatment equals cure. Others take their medicine regularly as long as they are in town, but stop once they return to their village, as they have to return to town to resupply but cannot always afford the transport fee.

An inadequate response to an ever-growing problem

testingThe fact that HIV infection is higher among ethnic Papuans is representative of greater socio-economic inequalities. Much remains to be done to reach the United Nations Political Declaration on HIV/AIDS and the Millennium Development goals. In Papua, the severity of the situation has been completely underestimated by the authorities and so far, their response to the epidemic has been completely inadequate. In order to decrease dissatisfaction with their rule, a general attitude of the Indonesian government has been to provide local governments in Papua with large amounts of money. It is then assigned to various programs without proper preliminary research and subsequent monitoring. The actual causes of the problem are however rarely tackled. The poor standards or complete lack of health services and education throughout the region not only facilitate the spread of the disease, they also severely impede any efficient response to the epidemic. Indeed, although the provincial governments have made HIV testing and treatment free, many Papuans do not have access to health care or education and are unlikely to be reached by awareness-raising campaigns any time soon. In the meantime, the virus continues its deadly advance into the highlands.

Article and photos by Antoine Lemaire and Carole Reckinger

More photos here: www.carolereckinger.co.uk


1.UNAIDS Report on theglobal AIDS epidemic (2012) www.unaids.org
2. By more than 25%
3.http://www.unaids.org/en/regionscountries/countries/indonesia/
4.http://www.unicef.org/indonesia/A4-_E_Issue_Brief_HIV_REV.pdf
5.Variables used: Papua and West Papua census 2010 (3,593, 803) HIV statistic 2012 13.196 = 3,7 %. Taking into account population growth since 2010, we took the number down to 3,5%
6. Over 13,000 people have tested HIV positive in both provinces
7.AusAID, February 2006, Impacts of HIV/AIDS 2005–2025 in Papua New Guinea, Indonesia and East Timor, final report of HIV epidemiological modeling and impact study 8.http://papua.bps.go.id/yii/9400/index.php/post/95/Jumlah++penduduk+miskin+Papua+pada+bulan+Maret+2012+sebesar+966%2C59+ribu.
9.http://www.indexmundi.com/g/g.aspx?c=id&v=69
10.Papuapos (14 November 2012) Semua Elemen di Jayawijaya Diminta Komit Menanggulangi HIV/AIDS, http://www.papuapos.com/index.php/warta-daerah/kab-jayawijaya/item/242-semua-elemen-di-jayawijaya-diminta-komit-menanggulangi-hiv-aids
11. ASCI Research Report No. 12, September 2008: “AIDS, Security and Conflict Initiative. Indigenous welfare and HIV/AIDS risks: The impacts of government reform in the Papua region, Indonesia”, http://asci.researchhub.ssrc.org/working-papers/ASCI%20Paper%2012-Claire%20Smith.pdf
12.Tabloid Jubi (20 December 2012), HIV dan AIDS Provinsi Papua Per 30 September Capai 13.196 Kasus, http://tabloidjubi.com/?p=7440
13.Authors were present during 9 workshops organized over a two week period by a local NGO.

 

 

 

Antoine Lemaire and Carole Reckinger

Antoine: graduated from SOAS, University of London, in 2007, with a BA Social Anthropology.
Since then, I have lived extensively in Indonesia and West Papua. I'm passionate about Indonesian and Melanesian cultures.
Preparing a photo project in Taiwan for end 2013.

Carole: graduated from SOAS with an MSc in International Politics. Photographer reporting on social justice issue. Passionate about West Papua.

Website: www.carolereckinger.co.uk

Help us!

Help us keep the content of eRenlai free: take five minutes to make a donation

AMOUNT: 

Join our FB Group

Browse by Date

« November 2017 »
Mon Tue Wed Thu Fri Sat Sun
    1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30      

We have 3176 guests and no members online