December the 1st is World AIDS Day. A good time to reflect
on your awareness of what’s going on in your part of
the world in regards to this tragic global problem. Indonesia’s
initial response to the AID’s warnings over a decade
ago was one of arrogance and ignorance, but it seems that
now they are finally coming to the party, in fact they have
to. A conservative report in 2005 estimated the HIV positive
rate here in Indonesia to be 170,000. My guess it is probably
more than double that now. But why does this country have
such a problem? The bottom line is still ignorance. There
is still the “it won’t happen to me” attitude
even in those living in high risk situations. Many still believe
it to be a “gay’ disease, or one of those things
that “foreigners have / get”. (Yes I do believe
that AIDS must have been brought to this country / island
by a foreigner but I do think it’s time we got over
that oughtn’t we?). HIV is now present in Bali, East
Java, Jakarta, Papua, West Java, West Kalimantan, North Sumatra,
North Sulawesi, Riau, West Irian Jaya, and West Kalimantan.
A huge number of the HIV positive population are drug users
(injected). HIV prevalence as high as 48% has been found in
drug injectors at rehabilitation centers in Jakarta. Most
of these drug users are young, relatively well-educated and
live with their families. Surveys have found that although
most injectors know where to get sterile needles, close to
nine in ten (88%) of them still use non-sterile injecting
equipment. Many injectors are reluctant to carry sterile needles
with them for fear that police would treat this as proof that
they inject drugs (which is a criminal offence). Drug users
are also more likely to use prostitutes, which compounds the
problem.
Commercial sex work is widespread in Indonesia, both male
and female. There are an estimated 190,000-270,000 female
sex workers, and clients of sex workers number approximately
7-10 million, with condom use estimated at less than 10%.
Male sex workers also have sex with women, and sex workers
are also more likely to inject drugs, and so the plot thickens.
Other less common methods of transmission are unsafe medical
or dental practices, tattoo studios, acupuncture clinics.
Think also about beauty salons that are using metal instruments
to excise blackheads or pimples, and the common local practice
or “kerok” (rubbing a coin across the skin to
cause abrasion and release heat from the body).
So what is the answer to stemming the rapid growth and spread
of this disease? Education on every level, from the village
to the universities; drug awareness and rehab programs with
clean needle supply and disposal units; condoms, condoms,
condoms! (I am really shocked when I hear stories from local
woman who cannot get family planning assistance if they cannot
produce a marriage certificate! Oh please! Someone tell them
they sell condoms at Circle K!)…and please, please,
please teach your children well. Don’t rely on schools
to give adequate education on this here. Some do, but some
don’t. Find out what your child knows and fill in the
gaps.
The good news is of June 2005, 60 sites provide HIV counseling
services for local people, and of these, 25 hospitals also
provide HIV testing services. HIV counseling services are
included in services related to the management and treatment
of sexually transmitted infections. Indonesia also initiated
a project to introduce drug substitution therapy (methadone)
for injecting drug users in two government hospitals ( Fatmawati
Drug Dependency Hospital / RSKO in Jakarta, and Sanglah Hospital
in Denpasar, Bali.
If you would like to be tested for HIV, most laboratories
will perform a blood test for you. The cost is between Rp
200,000 and Rp 300,000, and you may need more than one test
if it is suspected positive. You might also want to use an
alias as confidentiality can sometimes be an issue.
Kim Patra is a qualified registered nurse and midwife who
has been living and working in Bali for almost 20 years. She
now runs her own private practice and medical referral service
from her Kuta office. Kim is happy to discuss any health concerns
with you and she may be contacted via e-mail at info@chcbali.com
or Hp. 081 2366 0000.
