INDONESIA: Trying to solve ARV supply woes

http://www.plusnews.org/Report.aspx?ReportId=79288

JAKARTA, 16 July 2008 (PlusNews) - From the day Lenny (not her real name) was diagnosed HIV positive, she opted to get her life-prolonging antiretroviral (ARV) drugs from overseas - a vote of no-confidence in Indonesia's sclerotic supply system. "I heard from my friends that hospitals often ran out of ARVs, so I became paranoid," she said.

Years later, she still hears the same stories from people living with HIV, even in Jakarta, the capital, and considers herself lucky that she can afford to get her drugs sent directly from abroad: "The government should really fix the system [of distributing ARVs] as well as the health care system," she said.

Once treatment begins, it is vital there are no interruptions to the therapy, otherwise resistance to the medication develops and patients have to start taking more expensive second-line drugs.

Just over 8,000 people in a population of 223 million are on treatment in Indonesia, according to the latest figures. The government provides free first-line drugs - nevirapine, stavudine, lamivudine, zidovudine and efavirenz – produced under licence by the state-owned pharmaceutical company, Kimia Farma. Financing by the Global Fund to Fight AIDS, Tuberculosis and Malaria covers the costs of importing second-line medicines.

Caught up in the red tape

Supply or distribution problems have dogged the free ARV programme since it was launched in 2004. Every three months or so, the country's largest AIDS e-network, AIDS-Ina, is inundated with complaints over the latest shortages, and the situation seems to be worsening.

The supply of efavirenz recently dried up, leading to a demonstration by about 50 HIV-positive people in front of the office of the health ministry's AIDS sub-directorate. Around 60 percent of people living with HIV are thought to use efavirenz.

Dyah Erti Mustikawati, head of the AIDS sub-directorate, said complicated customs and import duty requirements had caused second-line drugs to be stuck at the airport; moreover, Kimia Farma imports the chemical compounds to produce first-line drugs, which can also be held up by bureaucracy.

Beyond the red tape, there is the issue of funding. "As the country's financial state is worsening, there has been a budget cut for ARVs. Out of Rp75 billion (around US$8.2 million) proposed in this year's state budget, only Rp38 billion (US$4.3) has been disbursed," Mustikawati said.

An AIDS activist, who declined to be named, said the main problem with ARV availability was the dysfunction of the supply-chain management system, from national forecasting and drug purchasing to the accuracy of the inventory data held by hospital pharmacies.

"Some officials at the health ministry are indeed working hard to solve these problems, but the ministry is overwhelmed with other issues, such as bird flu, dengue hemorrhagic fever, tuberculosis and malaria," he said. "Nobody gives enough attention to this ARV problem, and nobody dares to discuss it at the ministerial level."

There have been attempts at reform, such as special phone or fax lines for hospital supply requests, but stock management problems persist.

"I've heard reports that hospitals are often late in submitting their reports to the ministry, making the ministry unable to work on the exact needs for ARVs every month," said AIDS campaigner C. Supriyadi, who participated in the protest outside the ministry of health's office. "Distribution can also be stuck in many places, such as the ministry itself, or the Kimia Farma warehouse."

Indonesia, the world's largest Muslim country, has an HIV prevalence rate of 0.16 percent - roughly 250,000 people. The epidemic is concentrated in high-risk groups, such as injecting drug users, sex workers, and men who have sex with men, but the conditions exist for infection to cross into broader society.

HIV-positive activists have urged the government to work more closely with the National AIDS Commission, UN agencies and major donors to provide cheaper ARVs - drugs from Kimia Farma, for example, are more than twice the cost of those provided by the Clinton Foundation - to improve ARV supply.

Mustikawati said the ministry was working on a proposal to secure additional funding for drug purchases, and to decentralise distribution. "In the near future, we will also reduce central government's burden, and health ministry offices in the region will be in charge, particularly on buffer stock provision so that hospitals can have easier and faster access to the medicine."

hd/oa/he

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INDONESIA: HIV spreads among IDUs despite campaigns

http://www.plusnews.org/Report.aspx?ReportId=76589

JAKARTA, 5 February 2008 (PlusNews) - Tanjung Priok District, where the port is located in Jakarta, capital of Indonesia, is said to have three suns above it instead of one because of its extreme heat in an already hot city. Aside from the climate, the district is also known for its high levels of crime, especially drug dealing.

Eep*, 24, started using heroin when he was in junior high school while Fendi*, 21, had easy access to drugs because his uncle was a dealer and used drugs in his parents' living room. Similar stories are plentiful here.

There used to be few programmes for drug users in Tanjung Priok with activists often describing the District as too dangerous to operate in, but in the past few years clean needle programmes have been introduced, and a methadone [drug substitute used for treating heroin addicts] clinic opened in 2007.

Drugs are a major problem in Indonesia and injecting drug use is particularly rampant. In 2006 the Ministry of Health estimated the number of injecting drug users (IDUs) at between 190,000 and 247,000.

Injecting drug use is also the primary cause of HIV infection: the health ministry estimated that nearly half the 10,384 HIV/AIDS cases reported by September 2007 were IDUs. In "hot spots", like the capital, 72 percent of HIV/AIDS patients are IDUs; in West Java that number climbs to 80 percent.

Inang Winarso of the National AIDS Commission (NAC) said the government had scaled up efforts to prevent HIV infection among IDUs, mainly by adopting a 'harm reduction' strategy.

Harm reduction can be broadly interpreted to mean anything from safer sex counselling to condom distribution, but in the Asian context it usually means programmes providing clean needles and substitute drugs.

Clean needle programmes only reached 20 percent of IDUs in 2004, but according to the NAC they now reach 80 percent. There are 24 clinics providing methadone maintenance therapy (MMT) at hospitals, community health centres and prisons around the country, with plans to open more in the near future.

A study by the University of Padjadjaran in Bandung, about 100km southwest of Jakarta in West Java, found methadone effective in keeping drug users away from heroin and crime.

Despite the scaled-up efforts, the number of HIV infections among IDUs continues to rise. Recent research found HIV prevalence among Indonesian IDUs ranged between 40 and 90 percent, depending on the area. A study of teenage IDUs by the University of Indonesia's Public Health Faculty revealed that 62 percent of the teenagers reused needles, with one needle being shared by up to 18 people.

Winarso admitted that current efforts were not sufficient: limited facilities, human resources and supplies of methadone, which has to be imported, meant one MMT clinic could only serve up to 150 clients. Another challenge was the lack of available treatment for HIV-positive IDUs. He said many doctors refused to treat IDUs who kept on injecting.

However, Joyce Djaelani Gordon, an activist with the Harapan Permata Hati Kita Foundation, which runs programmes for drug users, said only a few doctors refused to treat HIV-positive IDUs.

"The problem with doctors is an old story," she said. "The [bigger] problem is the IDUs who continue to inject drugs with dirty needles, in dirty places ... so they are easily exposed to infections and other diseases, like Hepatitis C. That's why the progress to AIDS is fast."

Djaelani Gordon said there was an urgent need to scale up clean needle programmes and to provide IDUs with information about how to avoid sexual transmission. "We face an alarming fact, as the IDUs are young and sexually active, and even having kids, so we cannot just talk or focus on clean needles or methadone."

UNICEF estimates that thousands of Indonesian women have been infected with HIV through sexual contact with men who inject drugs.

Sekar Wulan Sari, from the Stigma Foundation, a community-based organisation set up to empower drug users and combat stigma and discrimination, slammed the government's focus on drug users rather than drug dealers. "There have been programmes and campaigns, but the HIV infection rate among IDUs continues to increase because the programmes started late and have been sporadic."

She said the harm reduction policy had been introduced without first conducting a proper assessment to ascertain the different rates of infection in different places, and suggested that "There should be good assessment and regulation before we continue with all the programmes and campaigns."

*Not their real names

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Labels: HIV/AIDS

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INDONESIA: Female condom programme falters

http://www.plusnews.org/Report.aspx?ReportId=73983

JAKARTA, 28 August 2007 (PlusNews) - Ningsih [not her real name], 22, was taken aback when she was handed a pack of two female condoms in Jakarta, capital of Indonesia, but was even more surprised when she opened one. Measuring 17cm long and 7cm in diameter with a sponge attached inside, the female condom is indeed large compared to a male condom.

"My, it's so huge. Will it be painful using it?" asked the self-professed freelance sex worker, who was hanging out at a sidewalk stall in the Pramuka area of East Jakarta, a well known pick-up spot.

She told IRIN/PlusNews she was not willing to try the female condom; she was fine with a tri-monthly contraceptive injection, which kept her from getting pregnant.

What about sexually transmitted infections (STIs)? "I heard condoms might prevent that, but most of the clients don't want to use them, and I don't dare to insist, although I sometimes provide them," she said. "If a client ejaculates inside me I wash with Betadine," she added, referring to a popular feminine hygiene product.

Indonesia has worked hard to increase condom use but, hampered by a strong patriarchal culture and a sporadic approach to promoting them, the results have been disappointing.

Data from the nonprofit public health organisation, Family Health International, puts Indonesia at the bottom of a list ranking condom usage in Asian countries.

According to official statistics from June 2007, the country's HIV infection rate has reached around one percent, with 5,813 recorded cases of people living with HIV and another 9,689 people living with AIDS, but experts estimate that the real number of HIV-infected Indonesians is between 90,000 and 250,000 out of a population of 223 million.

While HIV infection rates are highest among injecting drug users (IDUs), sex workers and their clients, government officials estimate that 20 percent to 30 percent of infections occur during unprotected sex.

"We've done campaigns to increase [male] condom use and failed. We're facing an alarming situation at the moment, with the general population becoming infected," Sri Kusniyati, deputy secretary of the National AIDS Commission, told IRIN/PlusNews

HIV infections have already become generalised in the easternmost province of Papua. In this remote mountainous area, where levels of awareness are low and condoms difficult to access, more than two percent of the 2.5 million population are estimated to be HIV-infected.

Some encouragement

The government ran a trial of female condoms in selected areas of Papua in August 2006. According to Kusniyati, women who tried the condoms said they and their husbands enjoyed using them.

Encouraged by the positive feedback from the trial, the government launched a national female condom programme in February 2007. Six months later, however, the programme has been criticised for poor distribution and supply, the high price of the condoms (15,000 rupiahs, or US$1.60 for a pack of two), and even for discriminating against women.

"It has been a year since the female condom was distributed in Papua but, until today, not even one condom can be accessed by our group and we're based in the provincial capital [Jayapura], not in a remote area," said Robert Sihombing of the Jayapura Support Group, a local organisation that provides food packages, financial assistance and emotional support to local people living with HIV/AIDS.

Activists have slammed the programme for, once again, putting the burden on women. "The campaign against HIV/AIDS in this country is often discriminatory," said activist Mukhotib MD from Magelang, a city in Central Java Province.

"In East Nusa Tenggara Province [in the eastern portion of the Lesser Sunda Islands, consisting of 550 islands], for instance, fishermen are called on not to have sex with sex workers without using a condom, but there's no mention in the campaign of not having sex with their wives without using condoms," he said.

"We're afraid that 10 years from now, if HIV infections remain uncontrolled, then women will be blamed, when in fact it's the whole problem of social construction which positions men with the rights to sex and women with the duty to serve them," Mukhotib added.

Kusniyati, of the National AIDS Commission, said the female condom programme was launched to give women more options and to empower them, not to discriminate against them. The Commission was currently training campaigners in six provinces, not only to promote female condoms but also to increase knowledge of HIV/AIDS.

The price of female condoms remained relatively high because they had to be imported, Kusniyati admitted. "We need to push for cooperation with the state Family Planning Coordinating Body, which provides contraceptive products, including condoms, for poor people ... [but it] will only launch a female condom programme some time in 2008."

Hera Diani

Labels: HIV/AIDS, women's right

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Redefining peer pressure with 'MTV'

Monday, December 19, 2005
Hera Diani, The Jakarta Post, New York

At a skateboard park somewhere in New York, three young men confronted a peer, pressuring him to do something.
"So, did you do the deed or not? I've done it, he's done it ... It's a part of being a man, man," said one of the boys.
The cornered boy claimed that he had done it that afternoon, but the others asked for proof. He then rolled up his sleeve, showing a plastered arm, which was welcomed by cheers and high-fives.
The advertisement was one of a number of public service announcements about HIV/AIDS produced by America's MTV. The clip closed with the tagline "Redefine peer pressure. Get tested."
While the content on the music television network may have become increasingly sexual during past years, the channel has also been praised for its groundbreaking programs to raise awareness about HIV/AIDS among youth.
In a recent interview with the channel, the United Nations Secretary-General Kofi Annan credited MTV for doing positive, preventive work with its target audience.
"Other channels came onboard a bit later, but you have made a real contribution in educating the young. And it is important because when you look at the statistics there's a high proportion of the young getting infected today, particularly between 14, 15 to 24, 25, and that is really the age group your station touches most," Annan told the MTV news correspondent John Norris.
There are an estimated 40 million people worldwide now living with some stage of HIV or AIDS.
Of all the new cases in the world, more than half of them are between 15 and 24 years old.
MTV first launched its "Staying Alive" campaign in 1998 that seeks to help prevent the spread of HIV/AIDS by empowering youth to protect themselves and fight the discrimination against people living with HIV/AIDS.
Partnering with several well-known sexual health organizations as well as other media, the Staying Alive campaign included long-format programming, such as documentaries, concert events, news specials, and discussion programs, public service announcements, sexual behavior polls, a website in 10 languages (www.staying-alive.org), and off-air marketing and grassroots promotion.
There is also MTV's "think:Sexual Health", the Emmy-Award winning campaign that encourages young people to make informed choices about the issues surrounding HIV/AIDS, other sexually transmitted diseases and unintended pregnancy.
According to research conducted by the U.S-based Kaiser Foundation for family health in 2002 and 2003, more than two out of three of the campaign viewers are now more likely to use condoms, nearly half of the viewers have talked to their partners about having safe sex, and almost one in four have been tested for HIV or other STDs.
MTV vice president for strategic partnerships and public affairs, Ian V. Rowe, said more than one million people had called the toll-free hotline (1-888-BE-SAFE-1) and there had been a 30 percent increase in HIV testing. Just less than two thirds of people surveyed said they had personally learned something new from the campaign, Rowe said.
"We have reached a one billion audience through the network, and hope for more."
MTV plays in more than 412 million households in 164 territories in the Asia Pacific region, Europe, Latin America, North America and Russia.
For more information on MTV AIDS campaigns, programs and booklets, visit www.think.mtv.com.

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Finding an AIDS vaccine 'a marathon, not a sprint'

Monday, December 19, 2005
Hera Diani, The Jakarta Post, New York

In the history of infection, the only way to control a viral epidemic has been through the creation of a vaccine.
The same thing is true for HIV/AIDS -- a vaccine is seen as the best long-term solution to end the epidemic. This is particularly true because the current treatment systems, although they have advanced over the years, still remain unable to cure the disease and are financially unsustainable.
Yet, 24 years after the first HIV diagnosis -- the worst viral epidemic since the 14th century -- there has been only one vaccine type that has been fully tested to see if it works.
HIV/AIDS, meanwhile, continues to infect five million people a year, or 14,000 people daily, and the virus claims around three million lives annually.
Top AIDS scientist Seth Berkley, of the International AIDS Vaccine Initiative, said researchers faced huge challenges in creating a AIDS vaccine -- scientific ones mainly, but also economic and political obstacles.
Scientifically, Berkley said, the virus' genetic variabilities made it extraordinary difficult to deal with its separate strains.
"We know that on average people get infected, they have the virus circulated in their blood, and then that virus is held down until about a decade later until they get sick. So, we know that most people can control the virus, and the challenge is how to make that type of control more robust," he said at a workshop recently in New York.
With other vaccines, such as measles or polio, the alive, attenuated vaccine is given to people to give them a mild infection that does not make them sick but instead protects them.
"Nobody wanted to give weakened HIV to people. But we gave weakened HIV to monkeys and they actually were protected. Why does it work, what's the mechanism, and can we get the mechanism by some other means? The answer today is we don't know," Berkley said.
According to Berkley, there are more than 30 candidate vaccines in the pipeline and there is a lot of important science going on across the world. Vaccine trials are not only being conducted with animals but also with a small number of healthy human volunteers.
"If there are no side-effects, we'll move to a larger number of volunteers, including some people at high risk. But we will have to wait two to three years to see the reaction," he said.
Aside from the scientific challenges, there was also the market's failure to produce a vaccine, Berkley said.
While vaccines have extremely high social value, they have low economic value, which results in few parties being interested in investing in them.
"If you think of the economic value of creating new drugs, pharmaceuticals have a huge market and (drug companies) make a lot of money on AIDS as people have to take the drug every day of their lives.
"But with vaccine, you only give it once or a few times. And you can't charge a huge amount of money because otherwise people won't take it. We know that for HIV, the largest place that needs vaccines is in developing countries. So it ends up in a very small market," Berkley said.
AIDS is still a controversial disease and questions are frequently raised about should be vaccinated. There are ethical issues associated with vaccinating teenagers and adolescents let alone some elements of the high-risk population, sex workers and injecting drugs users.
"With all the combinations, the company says, 'I'd better stay away from this'," Berkley said.
Vaccines like the one for hepatitis B, used to be expensive but with increased production and better science they have dropped more than 100-fold in price. However, the hepatitis B vaccine has only been offered in developing countries during the past 11 years/it took 11 years to give the vaccine to developing countries.
Similarly AIDS drugs used to be very expensive but are now tracking down in price. However, they are still out of reach of some of the people who need them most.
Global access to these drugs had to be assured, Berkley said. Production must be dramatically stepped up, and systems needed to be created to reach sex workers and drug users, along with a regulatory framework that spans nearly 200 countries.
"Can you get developed countries to accept the fact that we would make the vaccine available at (an affordable) price in developing world? Say, it is OK to charge US$50 in the U.S., but 50 cents in developing world?"
Berkley said political support and leadership was needed to develop a vaccine, in what needed to be a global effort.
"The vaccine would be a small component in global health spending, only less than 1 percent, and in developing countries even smaller.
"We need to build a comprehensive agenda all the way, on all levels, with all the support. It takes long time financing. It's a marathon, not a sprint."

Labels: health, HIV/AIDS

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Rich nations leaving the poor to die of AIDS

Monday, December 19, 2005

In November, The Jakarta Post's Hera Diani joined 21 journalists from 17 countries at a one-week HIV/AIDS reporting workshop in New York, under the auspices of the Reuters Foundation. Below are reports from the workshop, which featured a number of high-caliber speakers, including top HIV/AIDS vaccine scientist Dr. Seth Berkley and economist Jeffrey Sachs, HIV/AIDS activists and health journalists, as well as MTV US producers who presented an HIV/AIDS awareness campaign directed at young people.

When he talked about his first professional encounter into AIDS issues in the mid-1990s in Africa, economist Jeffrey Sachs had a look of shock and bewilderment on his face.
"One of the things that I couldn't understand, truly, was how it seemed the disease had been de-medicalized, outside of the rail of medicine and public health," he addressed the workshop.
There was almost no spending for sick people, he said, and people were dying without any access to public health care whatsoever.
"What amazed me is that a lot of speeches have been given about AIDS, from the UN, World Bank and so on. I thought someone was doing something about it other than just giving speeches. And I found that wasn't the case," Sachs said.
The middle class was hardest hit at that time; doctors, nurses and farmers were lost to the disease and millions of children were orphaned.
"There was also the paradox of no spending at all to do something about it," he said.
Sachs and his team calculated the cost of health access for poor people and came up with the figure of US$3, which was being given for each infected individual per year in Africa in 1999.
The demand for more funding sparked anger from rich countries, which said it was not cost-effective.
"As if leaving 30 million people to die is cost-effective. The whole thing was a scandal. And it remains a scandal from top to bottom. Because rich people leave people to die on the planet," Sachs said.
Next year will mark 25 years since HIV was first diagnosed, and the epidemic continues to infect five million people a year, claiming three million lives annually. There are an estimated 40 million people worldwide now living with some stage of HIV or AIDS.
Sachs said that AIDS is part of a much general health crisis, which is part of a more general poverty crisis.
There is no effective health system in poor countries. The disease does more damage sooner because widespread hunger and undernutrition makes the body more susceptible to infection.
Some countries do not make the maximum effort with their meager budgets to provide an effective health system, but for most poor countries, the financial constraints are huge.
The health sector is deeply underfinanced and understaffed, with often one doctor for every 25,000 to 30,000 people, and one nurse for a ward of 70 to 100 patients.
According to Sachs, the cost of rich countries helping poor countries improve their health sector is about $25 billion per year. The figure, calculated in 2000/2001, is one tenth of 1 percent of the Gross National Product (GNP) of the rich world.
"That means if the rich world gave 10 cents out of every $100 of the GNP, that would translate not just into AIDS control, but malaria control, TB control, clinics, doctors, community health workers ... and we would save about eight million people per year from dying early of disease," Sachs said.
"Only 1/10 of 1 percent of the rich world's income."
Seems like a pathetically small amount of money, he said, but it is very, very hard politically because the rich countries are very strongly girded against helping the poor countries.
Many countries have not even carried out their promise to spend 0.7 percent of their gross domestic product (GDP) on AIDS, which means 70 cents of every $100 of GDP.
"There is strong resistance, particularly from the United States, and also from some other parts of the world. Europe is better, most tend to honor the obligation of 0.7 percent. The U.S. gives the smallest share of their national income to aid of any rich country. Just 0.16 percent of the GNP, while we spent 0.7 percent of the GNP on the war in Iraq," Sachs said.
With bird flu sparking a global bid to prevent a human pandemic, concerns have been raised over double standards in handling AIDS and avian influenza.
American Laurie Garrett, a leading medical journalist and Pulitzer Prize winner, said that while both avian flu and HIV/AIDS were pandemics, they were not treated in the same way.
"Suddenly Bush said it takes $7 billion for an avian flu pandemic, with half of that for pharmaceuticals and incentives (for the industry). There has never been such a big amount of money given for HIV/AIDS. Whereas we deal with a chronic disease phenomena, a contagious and ever-expanding disease. We've never been in a state of emergency for four decades," she said.
Top HIV/AIDS vaccine scientist Seth Berkley said that for every penny spent on avian flu, 10 times more than that should have been spent.
"It's too late, you should have done that 10 years ago. But the fact is we're going to buy Tamiflu for the United States and not worry about the rest of the world..
"While if the flu goes crazy in Africa, for instance, chances are the rest of the world is going to have it even if you do not care about Africa," he said.
Berkley pointed to the period right after Sept. 11 when there was an anthrax attack in the U.S., with four or five people infected. The U.S. government then stood up and said there should be compulsory licensing for every drug.
"Here was South Africa, sued by a different manufacturer because they said they wanted to provide antiretrovirals (ARV) to tens of thousands of people dying of AIDS. That's the kind of stuff that drives me crazy. That double standard is really a problem," Berkley said.

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Remote Timika fights AIDS in its own way

Sunday, September 10, 2000

TIMIKA, Irian Jaya (JP): Behind Timika Community Health Center, there is a small house measuring five square meters.
A billboard outside says "Reproduction Clinic, Timika Community Health Center" and beneath it are posters about the dangers of HIV and AIDS.
Inside, there are two counseling rooms with beds and medical equipment. Brochures, condoms and a wooden penis are strewn about the front desk.
"We've been running this clinic for three years now," said Nurlan Silitonga, who, with four staff, is in charge in the clinic, five laboratory technicians and two field staff.
Nurlan's appearance is not one of a typical doctor. Tall and slim, her straight hair falls to her waist. She wore a bright red blouse and miniskirt, complete with red lipstick and high heels.
She said she was afraid of reporters.
"I'm afraid they will twist the facts. HIV and AIDS are very sensitive matters, especially here in Irian Jaya," she said.
This easternmost province has the highest number of HIV and AIDS cases inIndonesia.
The Ministry of Health recorded from 1996 to July this year, 393 cases ofHIV and AIDS in Irian Jaya, 19 more than Jakarta.
Irian Jaya, which has an area of 421,981 square kilometers, is three times larger than Java, and has a population of only 2,098,310, or almost aquarter of Jakarta's population.
Eighty-five percent of the people there live in rural areas which are difficult to reach.
Similar to general opinions about HIV and AIDS, many Irianese still thinkthe condition is related to sexual behavior.
"Many also think it's a curse, or worse: they think some people deliberately spread the (HIV) virus to cleanse the Irian people," Nurlan said.
An hours' flight from the capital of Jayapura, Timika is ranked third in the incidence of HIV and AIDS after Merauke and Fakfak, according to the Ministry of Health's provincial office.
Up to July this year, there have been 43 cases of HIV and four AIDS casesin Timika, which has an area of 19,592 square kilometers and a population of over 100,000.
Timika is a stopover for employees of giant mining company PT Freeport Indonesia, located in the mountainous Tembagapura, some 70 kilometers from here.
It is a developed town, providing visitors with a shopping mall, five-star hotel and an international airport. All of which are similar to those in Jakarta, or even better.
"Every weekend, there are buses full of Freeport employees who came down here from Tembagapura. The residents here call the bus bis kerinduan (longing bus)," Nurlan said.
Some employees visit their families, but some just have a good time in bars and the red-light district.
"These people are at a high risk of being infected with HIV," Nurlan said.
That's why Nurlan, in cooperation with the local administration and non-governmental organizations here, conducts a safety program to give information to Freeport employees and people in Timika.
The clinic provides brochures and comic books which illustrate the dangerof HIV/AIDS, and also gives out free condoms -- 16,500 so far.
Nurlan and her staff have also trained some 150 residents, including midwives, to inform the community.
"We haven't surveyed the program's effectiveness. But there are more people coming to our clinic for checkups or simply to ask for condoms. There has also been about a 16 percent decline in the number of people withsexually transmitted diseases in the past three years. We take that as a good indication," she added.
In the past three years, the clinic has been visited by about 19,000 people, with an average 600-700 visitors a month, ranging from prostitutes to employees and housewives.
"We also conduct AIDS awareness activities every year," Nurlan said.
What makes her worry is the high demand from local residents to close thered-light district and bars.
"It will be hard for us to control the prostitutes as they will work on the streets," she said, adding that most of the prostitutes come from otherislands, such as Java and Sulawesi.
The ministry's Director General of Communicable Disease Control and Environmental Health Umar Fahmi Achmadi also expressed his concern.
"These areas help control the condition. Prostitution is a matter of people's behavior. How can we control people's behavior? It's a very personal thing," Umar said.
An official of the local Ministry of Health office, Didik Irawan, said itwas unlikely that HIV and AIDS patients in Irian Jaya would survive more than a year, like in other provinces.
"The combination of poor health conditions and bad nutrition makes way for opportunist diseases that lead to AIDS and a quick death," he said.
-- Hera Diani

Labels: health, HIV/AIDS

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