Indonesia accelerates HIV response

The Indonesian government is scaling up its HIV interventions nationwide in an attempt to reverse the growing trend of new HIV infections.

"We have launched a comprehensive HIV continuum of prevention interventions and care services targeting key populations at risk. This includes expanding HIV testing, counselling and treatment services," said Tjandra Yoga Aditama, director general of the Ministry of Disease Control and Environmental Health during a presentation at the 11th International Conference on AIDS in Asia and the Pacific, which ended on 22 November in Bangkok.

In 2012, the Joint UN Programme on HIV/AIDS (UNAIDS) listed Indonesia as one of nine countries globally where HIV continued to rise, with new infections increasing by more than 25 percent between 2001 and 2011.

The report also noted that the country's HIV programmes for the gay community and commercial sex workers reached less than 25 percent of these groups, despite health ministry recommendations circulated to provincial health officials in 2012 to boost HIV testing, counselling and treatment services. According to 2012 statistics, there are 591,823 people living with HIV in Indonesia.

An estimated 9,000 health clinics nationwide have launched provider-initiated testing and counselling (PICT). "The provider is trained to look for signs that this may be a person at risk and suggests getting an HIV anti-body test," said Aditama. Any person who wishes to do so can initiate voluntary counselling and testing.

According to figures shared by Aditama, 800,000 people (in a population of 270 million) were tested for HIV in 2012, and the goal is to test three million people in 2015.

In brothels located in cities, especially tourist destinations such as the resort island of Bintan in Riau Province, "100 percent condom use" programmes have been introduced, and brothel managers and owners must provide condoms to sex workers.

"If they fail to provide condoms, they will be closely monitored by a supervising committee [made up of local officials] and run the risk of being closed by the local government," said the city's mayor, Khazalik, who has only one name, the custom in parts of Indonesia.

Early treatment

Indonesia offers antiretroviral (ARV) treatment regardless of a patient's CD4 count - a cell count that determines the strength of the immune system - to people living with HIV, including pregnant women and serodiscordant couples (in which only one person is HIV-positive).

The World Health Organization recommends ARV treatment when the count falls below 500 cells per cubic millimetre of blood.

Local health authorities are absorbing the costs of HIV testing, as well as CD4 tests and testing to determine the viral load, with help from the national health budget and international donors.

Indonesia is working toward providing health care for all, including HIV treatment, by the year 2019.

Activists welcome the new interventions but say more is needed. "I am so happy to see there are new efforts on HIV prevention, but there needs to be more focus on the young people. The government's HIV messages are based on biology or science. Young people need fun messages to be engaged," said Muhammad Reysa, a local coordinator of the NGO Independent Young People Alliance, based in Makassar on Sulawesi Island, the largest city in east Indonesia.

According to the United Nations Children's Fund (UNICEF) people in the age group 15-24 years accounted for 18 percent of reported new infections in Indonesia in 2011.

Reysa said youths' access to condoms is part of the problem. "Condoms are still a taboo. Even if we know that it can prevent HIV transmission, we are ashamed to buy it [from commercial establishments]."

In Indonesia, youths constitute 30 percent of the people most at risk of HIV infection, including sex workers, sexual minorities and people who inject drugs.