AIDS IN INDONESIA

ANCIENT APPROACHES TO NEW PERILS © Duncan Graham 2006

You have to watch your language in the lexicon of the deadly disease AIDS. ‘Cure’ is out, along with ‘solution’, ‘antidote’ and ‘remedy’.

Instead try ‘treatment’ and ‘therapy’. For as yet there’s no vaccine to prevent the scourge and no drug that will return the patient to full health.

In direct language – AIDS is a death sentence.

Offsetting that bleak diagnosis are medicines that can hamper the progress of the disease. They’re known as antiretrovirals, or ARV. They come from the laboratories of Western science, require heavy use and can have some nasty side effects on the skin, joints and stomach. They’re also expensive.

Is there anything else? Traditional therapists think they may have some helpful suggestions, and they’ve just been sharing their ideas at the 8th ASEAN Congress of Traditional Chinese Medicine in Surabaya.

One of the organisers, acupuncturist Putu Oka Sukanta said complementary alternative medicines (CAM) could help the body fight the disease and soften the downsides of the conventional drugs.

However they were not a substitute. Patients with AIDS should continue taking their prescribed medication.

It’s believed that only in Indonesia are hospital doctors using conventional medicines along with traditional therapies. These include acupuncture, acupressure, nutritional supplements, massage, breathing exercises and meditation.

“CAM tries to balance the yin and yang in the body through an holistic approach so the body can retain its natural functions,” Sukanta said.

“The problem is that AIDS is a political disease. By that I mean it involves human rights, religion, discrimination and the right to treatment.

“Part of our job is to empower AIDS patients to they can exercise their rights and obligations, and help them lead productive and fulfilling lives in society.”

There’s no let up in the warnings and predictions of awful times ahead unless heavy-duty measures against the disease are taken now. Activists use the term ‘epidemic’. At this stage that seems hard to justify as the official numbers of people suffering are miniscule when measured against the population, and put alongside an estimated 500,000 deaths annually from tobacco use.

Sukanta said the main hot spots are Papua where the disease has been spread through heterosexual contact amongst tribespeople, the big cities where intravenous drug users operate, and the sex industry where prostitutes with HIV pass the disease to their clients who then infect their wives. Once in the family HIV can get into the children and the wider community.

“There’s been a lot of ignorance about AIDS,” said Sukanta who has been working since 1997 with patients who have the disease. “At first there was denial that it could occur in a religious country like Indonesia.

“It was seen as God’s damnation and a Western affliction. Now things are changing. Government policy is getting better. (See Sidebar).

“Some Muslim teachers and women in jilbab (Islamic headscarves) have become infected, so religious leaders have had to face the facts and widen their horizons.”

Getting an accurate count is impossible in a country where many people don’t consult doctors, while those who do may be misdiagnosed. Post mortems don’t always follow unexplained deaths. But somewhere between 90,000 and 130,000 Indonesians are officially believed to be living with HIV.

Activists say these are just the obvious early shoots above an enormous underground root structure of undiagnosed sufferers, with an estimate of four million druggies nationwide. Not all inject, but those who do are taking terrible risks if they don’t use clean needles. Around 50 per cent of new HIV cases are mainliners.

The worst-case scenario has around 300,000 dying of the disease by 2025.

HIV (Human Immunodeficiency Virus) damages the body’s immune system and lets in AIDS (Acquired Immune Deficiency Syndrome.) You can only get it only through the transfer of body fluids – usually by sharing syringe needles or having unprotected sex with an infected person.

It was first identified in 1981 and since then an estimated 25 million people have died of AIDS, most in Africa.


AVOIDING SOCIAL UNREST

In a bid to halt the disease some countries are running high profile campaigns. These include frank sex education in schools, condom use promotion and needle exchange programs for intravenous drug users.

In Indonesia these are all contentious, so a prime role is educating lawmakers, educators and religious leaders of the dangers of AIDS and the need for action.

A few weeks ago Presidential Regulation 75 (2006) came into force, restructuring the National AIDS Commission. (NAC) Its predecessor was the National AIDS Control Commission. Note the significance of the change.

Part of its task is to disseminate accurate information “in such a way as not to result in social unrest”. The wording is a good indicator of the continuing sensitivity.

Australian psychologist Dr Jane Wilson, the country coordinator for the Joint United Nations Program on HIV / AIDS, believes the new authority is a major move forward.

“The estimates of Indonesians with AIDS were first made in 2002. They’ll be updated this year,” she said.

“The NAC is a serious bid to do something constructive. It’s very genuine and includes representatives of the community, non-government organisations and people who’ve tested positive with HIV / AIDS.

“I’m not sceptical at all. The people involved are committed and know what’s happening. So does the Coordinating Minister for People’s Welfare, Aburizal Bakrie. We’ve never had leadership like this.

“There’s a growing awareness of AIDS. It doesn’t just involve fringe groups. Housewives are now getting infected. Up to 100 referral hospitals (hospitals which have ARV drugs and special training) are now taking HIV/AIDS patients.

“However only 3,500 people – that’s less than two per cent of suspected cases - are actually getting ARV drugs.

“Traditional therapists are often the first contact that sick people make with any health care provider.

“Antiretrovirals are very effective, but they’re a life-long treatment. I’ve had friends die from AIDS, so anything like traditional Chinese medicine and therapies, along with prayers, which might improve the quality of life and ease suffering, has to be welcomed.”

(First published in The Jakarta Post 27 September 06)
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