PAPER:The current situation of the HIV/AIDS epidemic in Indonesia

Reference:
Riono, P., & Jazant, S. (2004). The current situation of the HIV/AIDS epidemic in Indonesia. AIDS education and prevention, 16(Supplement A), 78-90.

Abstract

The Current Situation of the HIV/AIDS Epidemic in Indonesia Pandu Riono and Saiful Jazant Until 1999 the known prevalence of HIV in Indonesia was low, except for isolated geographic groups exposed to Thai fisherman. Since then, the prevalence among injection drug users in rehabilitation centers in Jakarta has risen rapidly to approximately 45-48%, according to surveys in 2001. By 2002 the prevalence had risen to 8-17% among female sex workers, 22% among transvestite sex workers, and 4% among other male sex workers. Condom use is low in all groups, and there is considerable sexual mixing between risk groups. Surveys suggest that an increasing proportion of adolescents use drugs and have had sexual intercourse. Thus, although the epidemic in Indonesia is currently in the World Health Organization-defined “concentrated stage,” all the ingredients for rapid spread are present. Intensive effective intervention strategies—condom use and clean needle use promotions—need to be implemented, especially in the high-risk groups, if a more serious epidemic is to be averted.


pp 80

The high rate of HIV transmission among IDUs is understandable, given the rather high numbers of users of illicit drugs, including injection drugs, and the fact that HIV spreads very easily through the use of unsterilized needles.

A study of IDUs in Jakarta, Surabaya, and Bandung by the Center for Health Research of the University of Indonesia shows that the majority of IDUs live with their families and have at least a high school education. Although they are all aware that the use of needles that have not been sterilized can lead to HIV infection, a large percentage of them nevertheless persist in sharing.

lves the younger generation in urban areas who wish to experiment and are susceptible to the influence of their peers. As access to illicit drugs becomes progressively easier, the number of users is on the increase and is spreading through all levels of society. The results of a behavioral survey conducted in Jakarta show that about 30% of high school students have tried illicit drugs (Figure 4).

pp 81
Moreover, IDUs practice unsafe sexual behaviors, such as buying sexual services but not using condoms (Figure 5). Given that almost half of all IDUs are infected with HIV, such unsafe practices will result in the spread of HIV to noninjectors. It is only by avoiding the sharing of unsterilized needles and by using condoms during all sexual activity that the spread of HIV can be prevented, not only to fellow IDUs but also to noninjectors.

Parallel with the increase in the number of people addicted to illicit drugs, there is also an increase in HIV infection among people in detention centers and prisons/correctional institutions (Figure 6). HIV infection is also continuing to increase in detention centers and in other correctional institutions. Because facilities are very limited, the sharing of needles that have not been sterilized will continue to increase the risk of infection.

Until now, very limited prevention and treatment activities have been implemented to decrease the risk of HIV infection among prisoners. The risk of infection will be even greater if unsafe sexual behavior without the use of condoms is practiced in prisons and detention centers.

pp 82

RISKY SEXUAL BEHAVIOR IN INDONESIA Commercial sex is growing very fast in all corners of the archipelago and varies widely in scale. Women who sell sex can be classified into two categories, those who sell sex directly and those who do so indirectly. Direct sex workers are those who sell sex services in red-light areas, brothels, or on the street; indirect sex workers generally work under the cover of recreational and fitness enterprises, such as bars, karaoke, massage parlors, and so on. There are an estimated 190,000 to 270,000 female sex workers in Indonesia and approximately 7 million to 10 million men who are clients of sex workers. More than 50% of these male clients have regular partners or are married. Unfortunately, fewer than 10% of them consistently use condoms to avoid being infected with STIs, including HIV.

pp 83
ADOLESCENT RISK BEHAVIORS Behavioral surveillance survey results from high school students in Jakarta indicate that 8% of male students and 5% of female students have had sexual relations. About 30% of male students and 6% of female students have tried illicit drugs (see Figure 4). About 2% have used injection drugs.

THE DYNAMICS OF HIV TRANSMISSION IN INDONESIA

HIV transmission has picked up speed, and more people have become infected. There is full awareness that the spread of HIV continues to expand, due to the interaction between groups that are vulnerable to HIV, as well as their interactions with society in general. In fact, members of society in general are also now at risk.

pp 88

Taking into consideration the fact that there is also a risk of HIV transmission in detention centers and prisons/correctional institutions, efforts are needed to increase the understanding of the ways in which HIV spreads, as well as ways of preventing it among prisoners.

Young people need to receive comprehensive information on the means of HIV transmission and its prevention, as well as skills in avoiding risk behavior. Such knowledge and skills need to be disseminated as early as possible, both in schools and outside. It is hoped that in this way, a significant proportion of the young generation in Indonesia will be able to reject unsafe behavior.

Given the fact that male clients of sex workers can play a very important role in reducing transmission by always using condoms during risky sexual activity, high priority should be given to providing information that motivates a change of behavior among these men. In Indonesia, where there is inter-high-risk group transmission, as well as transmission to low-risk groups through sexual relations, the use of condoms would not only prevent transmission between at-risk groups but also prevent further transmissions to low-risk groups, namely, their regular partners or wives, as well as their children

pp 90
CONCLUSIONS

Obvious efforts that can be put into action immediately are needed. We need to increase and widen HIV prevention efforts, we need support from all sectors, and we need concerted action that is not limited either to the government sector or the community. This is the only way that the spread of the HIV epidemic in Indonesia can be prevented. It is hoped that prevention efforts will be able to avert new cases of HIV. However, if prevention efforts are not stepped up intensively, and in a way that can reach groups that are vulnerable to HIV, it will be difficult to avoid new infections.