Social taboos spur Aids in Indonesia

Unsafe sex is said to be the leading cause of HIV in a country where men shun condoms because of cultural and religious disdain.

A HIV-infected mother holds her 10 month-old-baby girl, who is free from the affliction, in a shelter house in Jayapura, Indonesia.

JAKARTA // Faced with the bleak task of telling his family he was HIV positive, Arsen, who goes by one name, knew simply this: he could not tell them how he got it. "I lied to my parents, I told them I got HIV because I was injecting drugs," the 21-year-old said. "In Indonesia being gay is regarded as something low and dirty. It's better that they think that I got this disease because of drugs habits rather than because of my gay life."

Such sensibilities are just one reason why Indonesia is losing the fight to contain the spread of HIV and Aids. Religious leaders and politicians continue to deny the reality of the archipelago's sexual landscape. Figures released this week by Indonesia's National Aids Commission - to coincide with World Aids Day, which was on Monday - suggest that unsafe sex will soon be the leading cause of HIV infections. Already 46 per cent of new infections result from unprotected intercourse. In the isolated eastern province of Papua this figure rises to 94 per cent.

International health experts agree that condoms are the most effective way of halting the spread of HIV. But a pervasive cultural, religious and political disdain for using them means that fewer than two per cent of Indonesian men use condoms. Religious leaders and officials have rejected condom campaigns in male prisons - considered one the highest risk communities - fearing it will promote homosexuality.

Similarly, plans for public condom machines have been shelved. Speaking at a Condom Conference on Monday to mark World Aids Day, Aburizal Bakrie, the minister for social welfare, said condoms were for those who sin outside the confines of traditional marriages. Indonesia then has many such people: more than nine million Indonesian men regularly use prostitutes. Nafsiah Mboi is the secretary of the National Aids Commission, established by presidential decree in 2006. She has a direct line to the ministries of health and social welfare and is considered a heroine by many for hounding politicians and religious leaders. She tells mullahs and priests that condoms should be provided to sailors and male prisoners.

Under her stewardship, more than 100 methadone clinics have been opened and HIV/Aids budgets have increased by nine-fold at the district level. Ms Mboi said while politicians may agree with her projects privately, few are willing to expend their political capital on them. "It takes time to change the mindset of people," she said. "Minister Bakrie himself, personally, does understand. But he has political considerations, let me say that."

The United Nations estimates that more than 270,000 Indonesians have HIV or Aids, representing about 0.3 per cent of 15 to 49 year olds. These figures are small compared to many parts of Africa but most cases are undiagnosed and the rate of infection among women and children is increasing, prompting concerns that it is becoming a generalised epidemic. In Papua, prevalence rates are 20 times the national average. Latest figures suggest that as many as 70,000 people are HIV positive, out of a population of 2 .5 million.

A combination of isolation, underdevelopment and discrimination is undermining efforts to create awareness about the virus. Rumours circulate that you can catch it by hugging or sharing food. "Some of the stories I have heard is that people who are very sick from HIV or Aids are put in a drum and then taken into the jungle and left to die," said Iskandar Nugroho, an HIV/Aids activist who has worked on internationally funded projects in the province.

"All this is because of a lack of understanding about what it is and what causes HIV/Aids." John Manangsang, a member of Papua's provincial assembly, recently proposed that HIV and Aids sufferers be implanted with microchips so the movements of "sexually aggressive" carriers could be monitored. He appears undeterred by the fact that such technology does not yet exist and said he had the numbers to push the bill through the provincial parliament by the end of the year. The proposal has been condemned by HIV/Aids workers and representatives from the central government as preposterous and against human rights. Papua's governor has indicated the bill will not be ratified if passed.

Papua's booming mining industry combined with traditional migration for employment and trips to the market has increased the demand for prostitutes who are shipped in and out of port and tourist cities across the archipelago. Men and women trek the virus back to their families and villages. There are little if any health care facilities and most people will never know they have the virus. A culture of promiscuity among some tribes and young people means that men and women brazenly seek out multiple partners.

In the capital of Jakarta, Arsen has found a refuge for his secret. An independent support group called Pita. The group was established by Jacky Maharja, whose quest for support and information after a positive diagnosis in 2004 proved futile. "I was turned away from three hospitals," he said. "They all said 'we don't know about this illness, we don't have the facilities to treat you'." With occasional private grants and scant government funding, Pita provides vital outreach for young people living with HIV and Aids.

Pita provides advice on how to manage uncomfortable and complicated negotiations with a health system that struggles even to manage everyday illnesses. Supplies of vital antiretroviral treatment are frequently interrupted. Mr Maharja and his friends have been forced to abandon treatment, sometimes for months at a time. But they are still lucky. It is estimated less than 10 per cent of sufferers have access to any sort of treatment.

"I've taken people to get tested and the doctor said 'why do you want to know?' " Mr Maharja said. "There's nothing we can do. You're just going to die." @Email:[e-mail]