The Indonesian National Commission on HIV/AIDS recently reported that the HIV epidemic in Papua and West Papua provinces is spreading at a rate 15 times faster than the national average. Furthermore, the epidemic is now spreading among the general population, including among housewives and children, not just in high risk groups such as the sex industry, clients of the industry, the gay community and drug users.
The shifting status of the HIV epidemic in Indonesia, from "low prevalence" to "concentrated prevalence", wherein HIV is now present in over 5 percent of high-risk group members, is largely evident in Papua.
It is an irony because despite this threatening figure, a recent HIV-risk survey in Papua funded by the World Bank, the U.S. government, and U.S. nonprofit group Family Health International, found that nearly half of the province's population had never heard of HIV/AIDS.
It is true that this finding is not surprising given the province lies on a remote, mountainous island with extremely limited infrastructure and lacking educational and health care facilities. Moreover, many people there have extremely limited access to mass media such as television, newspapers or even radio, which makes it harder to access health information and education, including information on HIV.
Jakarta Post
Sudirman Nasir, Melbourne
The study strongly recommended that more funding and commitment be allocated to education programs and promoting safer behavior -- particularly that condoms be made widely available to help reduce the spread of HIV. This recommendation is justifiable as the survey indicates a very low level of condom use in Papua. The survey reported that only around 17 percent of Papuans say it is easy to get condoms, which are used to protect people from sexually transmitted diseases (STDs), including HIV.
Something urgent still lies beneath the explanations and recommendations made in the survey results. It is, therefore, important to review the results from a different and more critical perspective.
The recommendations merely tend to promote a need for individual behavioral changes to employ safer behavior (such as using condoms when engaging in risky sexual practices), but ignore the cultural and structural barriers that hinder many people in Papua from applying safer sexual practices.
This kind of recommendation is still based on a traditional paradigm of health care, which assumes that by increasing knowledge and access to technology such as condoms, then safer behavior will be spontaneously applied.
Most recent studies have critically reviewed this paradigm of health care by investigating human behavior and whether people's perception of risk is socially constructed or largely context dependent. A range of studies also maintain that most cultural and structural factors hindering people from employing safer behavior are beyond an individual's control and can no longer be simply categorized as the result of a lack of knowledge of the risks involved, a lack of personal responsibility or a lack of access.
Several scholars maintain that contextual factors such as socio-economic deprivation, poverty and discrimination are structural barriers to the routine application of safer behavior.
Such structural barriers are clearly evident in Papua and West Papua. It is, therefore, urgent that the government address the HIV epidemic beyond the traditional paradigm of health care. The most progressive paradigm, such as structural HIV prevention, is more relevant. In contrast to the paradigm of health care that tends to perceive the individual as a fully independent agent, structural HIV prevention addresses the factors that force individuals to become involved in risky behavior.
More specific to the condition in Papua, several studies found that an "intoxicating culture" in the area (indicated by a high intake of alcohol) plays a pivotal role in facilitating risky behavior such as unsafe sex. However, this culture of intoxication is only the introduction to a long-rooted story of social oppression and discrimination toward the Papuans. Current health care models tend to ignore this social suffering and are too simplistic in promoting individual behavioral changes.
It is, therefore, critical that programs covering HIV prevention and community development be coordinated in vulnerable regions such as Papua. These should address structural factors such as poverty, unemployment, under-employment, discrimination, housing and education.
Of course, this kind of approach presents a mammoth challenge that will require equally mammoth funding as well as a huge degree of political commitment to end the state's neglect of the province. It is also apparent that these comprehensive programs should be coordinated by a multitude of state agencies.
The writer was involved in several HIV prevention programs in South Sulawesi and is currently doing a PhD at the Key Centre for Women's Health at the University of Melbourne, Australia.
