Erenlai - Social Changes and Challenges 變動中的華人社會
Social Changes and Challenges 變動中的華人社會

Social Changes and Challenges 變動中的華人社會

Here are materials that examine and assess the current issues that are influencing the Pacific-Asian culture and society.

經濟發展所產生的變動已經全面衝擊了人們的生活型態與觀念。

 

 

 

週三, 27 三月 2013

HIV Awareness in Papua

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.

 

 

 

週五, 17 二月 2012

China's Challenges in the Year of the Dragon

Benoît Vermander comments on challenges that China needs to face in 2012, the Year of the Dragon.

週三, 26 十月 2011

佔領台北


最近在紐約舉行的「佔領華爾街」行動,點燃了台北人對資本主義的不滿和憤怒,因而也有幾百人於10月15日圍繞著「台灣資本主義的陽具式象徵」──台北101,參加「佔領台北」遊行。他們關注的議題包括:高的失業率、加班費、臺灣高等教育的現況等等。在下可以觀看e人籟的訪問:

週一, 25 四月 2011

Religions and Charities in China

The religious growth that China currently experiences is leading towards a most interesting trend: the organization of faith-based charities.  For sure, such trend is still hampered by a number of factors, but it does express the growing assertiveness of China’s civil society and of its religious groups.

一個國家,兩種公民?

陸籍配偶在台灣社會屢遭歧視,多半被認為是民族主義惹的禍。然而透過對香港陸配問題的觀察,或許更能讓我們瞭解歧視背後的真正原因。


週四, 09 十二月 2010

Is China's civil society truly on the rise?

If the emergence of a civil society in China is inevitable, the condition and the form of its development can be questioned as a space for public debate still to be defined.

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週五, 29 十月 2010

從安平追想起——十七世紀荷蘭人與平埔族的婚姻

「身穿花紅長洋裝,風吹金髮思情郎……想起情郎想自己,不知爹親二十年,思念想欲見,只有金十字,給阮母親做遺記,放阮私生兒,聽母初講起,愈想不幸愈哀悲,到底現在生亦死,啊,伊是荷蘭的船醫。」

週一, 18 十月 2010

楊富閔:「台客」文學新未來

楊富閔是一位閃耀的年輕文壇新星,近來出版了短篇小說集「花甲男孩」--- 包括駱以軍及施淑等多位著名作家與評論家,皆對此書大表讚賞。


週一, 04 十月 2010

Reducing the digital divide in Taipei County

Jason Wang, Chairman of the Research, Development and Evaluation Commission for the Taipei County Government, elaborates on their policy to bridge the digital divide in their area.

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週三, 30 六月 2010

照顧,不只是一種責任

一個人的失能就是全家人的責任,以平均家戶人口四人計算,目前台灣約有四成人口正承受長期照護的負擔;而讓照顧者在照顧他人時,也能擁有自我與尊嚴,則是社會與國家的共同責任。


週四, 13 八月 2009

The Challenges of China Road Traffic Safety

Road traffic accidents are global public health problems that account for an estimated 1.2million deaths annually. Without increased efforts and new initiatives, the total number of road traffic injuries and fatalities worldwide is forecast to rise by 65% between 2000 and 2020, while in low and middle-income countries, road traffic fatalities are expected to increase by as much as 80% over the same period.

A World Bank working paper released this August states that China should constitute a priority for the World Bank Global Road Safety Strategy. According to China’s Ministry of Health (MOH), they had the highest number of road traffic fatalities in the world in 2003 (220,000), accounting for 18% of global road traffic fatalities, despite having less than 5% of the global vehicle fleet. Road Traffic Injury (RTI) is the primary cause of injury related death in China (2007).

The Chinese government has taken strong measures, such as the establishment of the Inter-Ministerial Road Safety Forum (October 2003), and the implementation of the Road Traffic Safety Law (May 2004). These measures helped to decrease, from 2005, the per capita rate of road traffic fatalities which account for 28% of all injury related deaths.

The economic cost of RTI was estimated by the Ministry of Health to be 0.40% of GDP in 2003, approximately 30% of this overall cost of injury. Despite this injury has not yet been established as a priority either by the Ministry of Health or the World Bank Health Sector. So the priority of injury should be included within the agendas of the WB, other International Organizations and the Chinese ministry of health alongside the current areas of Health Sector Reform, Emerging Infectious Diseases (e.g. Avian Flu) and Non-Communicable Diseases (e.g. Cardiovascular Diseases).

The World Bank should prepare for the upcoming Five-Year Plan period where they could take the lead in partnership with the WHO, working together with the Chinese Government to implement a more rapid response to the projected burden of road traffic fatalities and injuries.
Download the report on the World Bank website

Attached media :
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週三, 20 五 2009

新流感来了─公卫体系武功已废,如何防疫

本文亦见于2009年6月号《人籁》论辨月刊


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H1N1新流感疫情在全球造成恐慌,曾经过SARS「洗礼」的台湾,如今是否更有能力对付传染疾病?面对疫情,我们真正该担忧的是什么?
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站在防疫前端的公卫体系
H1N1新型流感疫情来势汹汹,勾起人们2003年SARS肆虐的惨痛集体记忆。许多人问:万一新型流感在台湾大流行,当年人心惶惶、社会无所适从的乱象会不会重演?经过整整六年的磨练增进,今天台湾是否能应付新流感的大流行?

SARS、新型流感或任何其他传染病,都是公共卫生的问题。为成功防治传染病,公卫体系必须及时做好比医疗还要更前端的、与社会力量结合的、有组织的社区防疫、卫生教育、疫情监测通报、调查、检验、居家隔离等等预防性防治工作。

前端的防治工作若没有做好,末端的医疗工作就会异常沉重。2003年SARS肆虐台湾之时,公卫体系无法及时防治,其根本原因乃在:台湾公卫体系已经废了原有的武功,它轻公卫重医疗、过度医疗化,医疗部门过度市场化及私有化。

那么,台湾的公卫体系在过去这六年中,是否已经恢复了它失去的武功?


轻公卫重医疗
首先,许多的变化显现,「轻公卫重医疗」与过度医疗化的问题不仅没有改进,实际上是不断恶化。

在SARS流行之前,台湾投入医疗保健的五千多亿资源中,仅有3%用在预防性公卫工作,其他90%以上都花在医疗。2003年SARS流行后,经费比例稍微上升到将近5%,但是之后又逐渐下滑:2007年,台湾投入医疗保健的经费多了将近八千亿,但还是只有3%左右是预防的经费。

2003年台湾的医疗人力是公卫人力的三十三倍,而2007年增加到三十六倍!因此,无论在经费及人力资源层面,两者简直有如侏儒与巨人!公卫体系最基层、最前线的机构──卫生所,这几年来虽然业务继续增加,人力及经费却不增反减。


过度市场化的医疗产业
其次,在医疗体系过度市场化、私有化方面,问题亦是变本加厉。2003年之前,私立医院无论是医院数、病床数或医事人员数都高高凌驾公立医院,这个差距在2003年之后继续扩大;财团不断的投入医疗产业,谋求利润。

而国家给与公立医院的补助额不断的大幅下降,逼迫公立医院自负盈亏,必须与私立医院争市场、搏利润。结果,公立医院形同私立医院,政府甚至乾脆将许多公立医院委托给财团或私立医院经营。

SARS的经验告诉我们,私立或是市场化的医院以利润为考量,而非以社会大众的健康维护为考量。在SARS流行期间,私人医疗院所为维护其利润而不接受疑似病患,或隐匿疫情,对防疫工作造成很大的阻力。

以此观之,我们对于台湾应付新型流感的能力,真是无法乐观。诚然,有关当局对此次新流感威胁的反应十分敏捷,他们的努力与辛苦有目共睹,而且台湾社会经历了SARS与禽流感后已经变得比较成熟。但是,如果上述体制性问题没有真正改进,我们实在担心现有的公卫体系,无法从容应付新流感的大流行。



更多关于新流感,请看

附加的多媒体:
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