Hiv Infection In Indonesia Health And Social Care Essay
Indonesia has among the fastest turning prevalence of people infected with HIV in Asiatic parts. However, the prevalence in Indonesia itself is still low: harmonizing to the Data and Information Centre from Indonesian Ministry of Health, around 0.2 per centum from the entire population.
However, since Indonesia is the universe 4th most thickly settled state, this figure means that presently there are a sum of about 200.000 people populating with HIV in Indonesia ( UNAIDS, 2007 ) .
From the informations in Indonesian Ministry of Health ( 2006 ) , we can besides see that 82 % of known people populating with HIV/AIDS is work forces and are concentrated within specific groups with specific behavior in the population: approximately 50.3 % of HIV infection instances are from shooting drug users, 40.3 % from unprotected heterosexual sex, while 4.2 % from unprotected homosexual sex. There are besides several surveies that show the HIV infections epidemic work forces who have sex with work forces communities in developing Asiatic states, including Indonesia ( Pisani et al. , 2004 ; Toole et al. , 2006 ; Wong, Zhang, Wu, Kong, & A ; Ling, 2006 ) .
To reply with the HIV infections pandemic, the authorities, with the presidential edict figure 36/1994, established the National AIDS Commission. This committee were created to forestall and to take incorporate and co-ordinated, inter-sectoral actions against AIDS in Indonesia. This committee is headed by the Ministry of Welfare and besides with the coordination of other Ministries, such as Ministry of Health and Ministry of Internal Affairs ( Presiden Republik Indonesia, 1994 ) .
It is aimed to forestall and to take actions against AIDS harmonizing to the current ordinances, in conformity with the planetary scheme set by the United Nations, and besides to increase community consciousness for AIDS and bettering the intersectoral, integrated and coordinated bar and actions against AIDS
In 2003, another presidential edict was set up to better this committee. It stated that the committee actions are organizing steps in actions against AIDS, including bar, instruction, wellness service, surveillance, and control of AIDS, epidemiological observation on vulnerable populations at hazard of infecting HIV, wellness instruction, wellness run and regional and international cooperation in forestalling against AIDS ( Presiden Republik Indonesia, 2006 ) .
3. Is it bettering the status?
The plan set up by the cardinal authorities, regional authorities, non governmental administration, and the support received from foreign givers in the signifier of HIV consciousness and bar plans throughout Indonesia have been bettering some of the state of affairs of HIV infection in Indonesia. A study on rubber usage in sex industry in Indonesia in 2004-2005 reported that 61 % of sex workers in whorehouses said that they had use a rubber in the last clip they sold sex. A prevalence of 57 % was found in sex workers who didni??t work in a whorehouse. ( UNAIDS/WHO, 2008 ) .
For shooting drug users, the plan is focused on cut downing the usage of non-sterile injecting equipment. In Jakarta and Medan, where plans such as these are making the injecting drug users, the study found out that more than 80 % of shooting drug users said that they ever used clean acerate leafs ( UNAIDS/WHO, 2008 ) . The injury decrease method, which has been set up as a theoretical account for Indonesian authorities to undertake the turning HIV infections from shooting drug users group in Indonesia, was established by the Sentani Commitment ( see Appendix ) , as an understanding between the National AIDS Commission and regional authoritiess ( National AIDS Commission, 2004 ) .
While plans to forestall HIV infections in female sex workers and shooting drug users have been demoing some grade of success, another vulnerable populations is still hold lower precedence in AIDS bar plan. A study in 2004 mentioned HIV infection degrees of 2.5 % in work forces who have sex with work forces, 3.6 % among male sex workers, and 22 % on waria ( Indonesian term for transgender ) sex workers in Jakarta, the capital of Indonesia. Almost of them are practising hazardous sexual behavior. It is stated that 65 % of the male sex workers and 53 % of work forces who have sex with work forces in Indonesia reported holding insecure anal sex with male spouses and besides 54 % of the male sex workers reported that they had sex with adult females in the anterior twelvemonth ( Pisani et al. , 2004 ) .
However, when we look at the tendencies in the undermentioned figure, we can clearly see the increasing figure of new instances of HIV infection found in Indonesia until 2006.
( Pusat Data dan Informasi Departemen Kesehatan Republik Indonesia, 2006 )
Besides we have another graph demoing the theoretical account to foretell the figure of HIV infections in Jakarta, merely from the informations taken from one population: the shooting drug users.
( UNAIDS/WHO, 2008 )
From the above graph, we can see that the state of affairs in Indonesia is still far from bettering. In add-on, although the overall HIV infection prevalence in Indonesia is still low, if we look into the parts of Indonesia, we have a figure every bit high as 2.4 % as the grownup prevalence rate of HIV infection in the Papua state ( Pusat Data dan Informasi Departemen Kesehatan Republik Indonesia, 2006 ) . The Ministry of Health vision of Healthy Indonesia by the twelvemonth 2010, which set a end of 0.9 per centum of maximal prevalence in 2010 ( Menteri Kesehatan RI, 2003 ) in all parts of Indonesia, seems farfetched. In the undermentioned subdivision, we will discourse jobs in the execution of the policy for HIV bar in Indonesia.
4. Problem in plan of HIV bar
Although the authorities already put up a committee accountable straight to the president, we can see that the job with HIV infections in Indonesia is still turning. In the undermentioned, I would wish to discourse several points why the policy against HIV in Indonesia is still unable to accomplish its end ( such as in the Healthy Indonesia by 2010 ) . There are 4 chief jobs that I would discourse, two related to the mark of the plan, in covering with the sexual transmittal of HIV infection, and besides transmittal in shooting drug users. The others two related to the decentralization procedure in Indonesia and on support.
4.1. Extensive sex web and geographical difference
Sexual activity industry in Indonesia itself is extended even though their legality is questioned. A study on 1994-1995 found that there were 71,281 sex workers in Indonesia ( Endang, Ivan, Walter, Noni, & A ; et al. , 2002 ) , even though the existent figure should be higher. Prostitution is non allowed in Indonesia, and sex workers who were caught beging in the streets can be sent to a rehabilitation cantonment. Nonetheless, whorehouses are slightly recognized particularly in the large metropoliss: they are non illegal, there are no regulations sing this, the illegality of harlotry merely concern on those who sell sex on the street. Therefore the local authoritiess have regulated sex works in these whorehouses, supplying wellness installations and put certain restrictions. However, this ill-defined position for whorehouses can present a job for keeping sustainable wellness plan in forestalling HIV infections.
The huge parts in Indonesia besides made an obstruction in the plan to forestall HIV infections. In most Indonesian states, such as in Java, Bali, Sumatra, and others, the common transmittal of HIV infections is through shooting drug users. However, in Papua state, we have a different transmittal form.
Papua is equaling Jakarta in footings of HIV infections prevalence: a prevalence of 2.4 % for overall grownup HIV prevalence, and this could make to every bit high as 3.2 % in distant Highlandss of the Papua state ( UNAIDS/WHO, 2008 ) . In this part, unprotected sex is the chief manner of transmittal. Based on informations from the UNAIDS/WHO, therei??s a high proportion of work forces engaged in bad sex, with 25 % reported that they had sex with non regular spouse ( over half of it were paid sex ) and 20 % had more than one sexual spouse. From this study we can besides see that the usage of rubber is uncommon. It is reported that merely 14 % who said that they use rubbers for paid sex, and even merely 3 % said that they had usage rubber every clip in old month. Another job with the Papua state is sexual force. It was mentioned that 12 % of adult females has experience sexual force, even from their domestic spouse. Therefore, to forestall increasing HIV infection in Papua, the chief concern is to supply better sex instruction and besides to advance and to administer rubber throughout Papua part. ( UNAIDS, 2007 )
4.2. Harm decrease policy for shooting drug user
Even though the term of injury decrease itself is still controversial, whether it is a wide term of steps embracing schemes of restricting supply and minimising injury, merely like in Australia, or merely purely merely a portion of the scheme to undertake drug maltreatment specifically to understate the injury of utilizing drug ( Ball, 2007 ) .
Harmonizing to Beyrer, Kumarasamy and Pizer ( 2005 ) , the jobs with the execution of harm decrease policy in Asia, including Indonesia, can be categorised into three classs. The first 1 is this policy is considered as a manner to state that it is wholly right to hold people who abuse drugs and that this behavior is merely an look from several people that tend to take hazards. The focal point of the injury decrease ( at least in the narrow definition ) so is to understate the injury from utilizing drugs irrespective whether the position of utilizing drug is right or incorrect or wherever the drug comes from, since it is the wellness sector itself would bear the brunt if HIV infections ( and besides Hepatitis B and Hepatitis C infections ) spreads from shooting drug users. Whether drug dependence itself pose a serious wellness job to the community, where increasing drug user would besides means increasing figure of neurologic disablement and psychosocial job, would be tackled by the restriction of supply of drugs, non by the injury decrease system. I think that if Asiatic states, particularly Indonesia, want to to the full implement harm decrease policy, both understating the supply and pull offing the injury of drug maltreatment should set into pattern. Therefore, the injury from bad pattern of shooting drug users ( for illustration needle sharing ) can be minimised while effects of drugs to single and society itself can besides be minimised through controlling/ cut downing supply of drugs in the black market.
However, it is interesting to see in Iran, another Asiatic states with high Muslim population, merely like Indonesia, that the caput of Persian Judiciary declare, sing on this quandary between public wellness and drug control, after sing the Islamic rule of i??doing no injury to oneself or othersi?? and i??the worst injury is eliminated by a lesser harmi?? , that the public wellness is more of import in commanding the spread of HIV infections ( as the worst injury ) instead than command on drug maltreatment ( which considered as a lesser injury ) ( Ball, 2007 ) .
The 2nd obstruction of harm decrease policy, as in many Asiatic states, is the legal system ( Beyrer et al. , 2005 ) . The current legal system in Indonesia still considers that the maltreatment of drugs is illegal and can be punished. The job arise with this is that the harm decrease policy is normally set up several topographic points for shooting drug user to entree clean acerate leafs and besides topographic points to dispose them decently. Injecting drug users besides need topographic point for them to acquire some intervention, instruction, and referral. If puting up these topographic points can present a menace in the security of the community and besides put on the lining the injecting drug users being caught by the constabulary, there should be some via media between the rights of shooting drug users and besides the rights of community for security. Therefore if we want to put up a safe oasis for shooting drug users so that they can safely derive entree of clean acerate leafs, intervention, instruction and referral, the supplier of such topographic point must be able to supply legal protection for their client from being arrested in that topographic points. Obviously we should merely set safe sphere for shooting drug users everyplace, but we must understand foremost where shooting drug users needed largely.
Another facet of the legal system is related to the position of possessing injection equipment: eg syringe. Although in Indonesia it is non illegal to transport needle syringe, nevertheless, it is regulated under prescription merely. In several states, there are Torahs that prohibit people to possess injecting equipment, but finally experience from developed states shows that if this ordinance is abolished, it truly removes the pattern of needle sharing between shooting drug users while does non truly hold much consequence on the prevalence of new user ( Deany, 2000 ) .
In add-on to that, if the legal system can work to suit the injury decrease system, the constabulary can besides move an of import portion in HIV bar among shooting drug users. Police so should mention drug users for intervention instead than imprison them.
Finally, the last obstruction is on fiscal support and coverage of harm decrease plan. Other than supplying a safe topographic point for shooting drug users, a plan on harm decrease of drug maltreatment must supply a continued supply of clean acerate leafs. They besides need human resources to run the plan such as checkups and paramedics, counselors, and others. Possibly it is difficult to set some money from the budget merely to i??satisfyi?? the demand ( or rights? ) of shooting drug users, nevertheless, this is needed to forestall farther job in public wellness. And this job in support will be discussed in the following subdivision.
From this we can see that the job is much clear: whether the society accepts such behaviors and trades with the injury caused by it and whether the authorities is willing to carry on such plan.
4.3. Problem in regional execution
In 2007, 23 provincial authoritiess reduced their HIV budget by a sum of 5.72 billion rupiahs, to be put toward the outgo of regional election, even though President Susilo Bambang Yudhoyono called for an addition in the statei??s budget for HIV/AIDS during a cabinet meeting in July. In Papua, for illustration, the provincial authorities allocated Rp 10 one million millions for its regional AIDS committee in 2007, but merely 1 per centum of the budget was realised. The authorities did non see HIV/AIDS a precedence because the figure of septic people remained little compared to patients of other diseases. In December 2007 the Ministry of Health recorded 6,066 people with HIV and 11,141 with AIDS. The National AIDS Commission said it needs more than Rp 1.5 trillion in 2008 to cover with the virus, which most of the budget would be spent on bar plans, but the cardinal authorities has promised to supply Rp 1 trillion merely. The committee estimated the figure of people with HIV/AIDS would make 400,000 in 2010 and one million in 2015 across the state. ( The Jakarta Post, 2008 ) .
4.4. Problem on support and sustainibility
In relation to the old treatment on regional execution of the policy, we can see that it was expected for the regional authorities to increase their disbursement on publicities against HIV infections. This is because Indonesia is still depending on foreign givers to undertake the issue of HIV infections. Foreign givers provide up to 70 per centum of financess to forestall HIV infections in Indonesia ( Pathoni, 2008 ) . However, givers such as the United States and Australia are expected to diminish AIDS-related aid partially because they now consider Indonesia a middle-income state. This means that plans on HIV bar in Indonesia should stress on sustainability. We shall look at one illustration: the Aksi Stop AIDS plan.
The Aksi Stop AIDS plan is a plan of HIV bar where USAID, in cooperation with the Family Health International and working together with the authorities of Indonesia through the National Commission of AIDS ( Family Health International, 2007 ) . This plan is aimed to cut down incidence of STI/HIV/AIDS in most-at-risk groups ( MARGs ) thereby assisting to forestall a generalize epidemic and decreased incidence of STI/HIV/AIDS within the general population of Papua ( Family Health International, 2007, p. 5 ) .
The plan itself were late came to an terminal in September 2008, where it was expected that we have ( Family Health International, 2007, p. 5 ) :
i?? Increased coverage of most-at-risk groups with trim intercessions and improved utilizations of hazard decrease behaviors, patterns, and entree to and usage of services ; and
i?? Increased ability of implementing bureaus to on a regular basis supervise, evaluate and better plan public presentation, therefore accomplishing expanded coverage.
We can see that from this illustration that sustainability of the plan is really of import. After the plan ended, and we have the end product of improved implementing bureaus in HIV bar, therefore we can anticipate the result is the continuity of the HIV bar plan.
In decision, we can see that although Indonesian policy on HIV bar is already set, they have to cover some of the issues which are different from other states: the extended sexual web, the geographical difference in HIV infection prevalence and chief method of transmittal, jobs in implementing the harm decrease policy for shooting drug user, jobs arose with decentralization, where regional authoritiess doni??t prioritise HIV bars, and besides the job with support and sustainability. In covering with the increasing figure if HIV infections in Indonesia, therefore we need to develop a better scheme which turn toing these issues.