In Indonesia, HIV carriers aren't talking
By Evelyn Rusli International Herald Tribune
FRIDAY, JULY 1, 2005
JAKARTA As he waited in a hospital in Bali for doctors to operate on his
broken leg this spring, Dhayan Dirgrantarra, 31, concluded that there was
something he was obliged to acknowledge. "I'm HIV-positive," Dhayan said he
told them.
The doctors canceled the operation. "They said it was an unnecessary
procedure and not worth the risks," Dhayan said. "But it was discrimination."
In Indonesia and across Southeast Asia, discrimination in the health care
field against people with HIV appears to be spreading. It threatens to drive
AIDS underground as people with HIV choose not to disclose their status and as
people in high-risk groups, like drug users, refuse to get tested.
The silencing effect of discrimination is troubling in Indonesia, where
the government is scrambling to identify and treat those with HIV or AIDS.
In a report Indonesia plans to submit Friday at the International
Congress on AIDS in Japan, the government says it estimates that there are as
many as 130,000 HIV cases in the country, but that fewer than 7,000 have been
identified.
AIDS groups say the number of HIV cases in Indonesia is far higher.
"We've only hit the tip of the iceberg," a leading AIDS activist, Baby Jim
Aditya, said. The number of people infected is "close to one million," she
said.
Discrimination against people with HIV is prevalent in Southeast Asia,
according to the Asia Pacific Network of People Living with HIV and AIDS, a
consortium of nongovernmental organizations. In the first regional study of
AIDS discrimination, released in May, the group said that more than half of the
respondents reported discrimination in the health care field.
The groups interviewed 700 HIV-positive people in Indonesia, India, the
Philippines and Thailand.
Discrimination in the health care field hinders governments from knowing
the full extent of HIV, because many people in high-risk groups avoid HIV
tests, worried that positive tests would lead to discrimination, AIDS groups
say. Also, many of those who have HIV do not disclose their status because
doctors may refuse or delay treatment or charge extra fees.
This reluctance of people infected with HIV to tell their doctors also
creates a dangerous situation for health care workers who do not take measures
to protect themselves.
The unspoken policy of "don't ask, don't tell" highlights society's
desire to "throw a blanket over the issue of AIDS," said Aditya, the AIDS
activist. And as doctors and patients deny the problem of AIDS and the risk of
transmission, the virus continues to spread silently, she added.
The government says discrimination is not a big problem. "We've never had
a policy of discrimination," said Nyoman Kandun, head of the communicable
diseases division at the Ministry of Health.
In comparison with other Asian countries, Indonesia has taken many
progressive steps toward combating AIDS and helping those with HIV, said Jane
Wilson, a senior officer at Unaids, the United Nations program for HIV and
AIDS.
There are now screening centers in all 24 provinces, training for health
care workers and free antiviral treatment for anyone.
But Parwati, a doctor and provincial AIDS official, who founded the
country's first AIDS group, said that there was still a "disjunction between
policy and practice" at medical centers.
The government has been "very aggressive" in HIV training for health care
workers, but many workers are still wary of people who are infected because
medical centers lack basic supplies, including gloves and syringes, Parwati
said.
The solution to discrimination is more complicated than refilling
hospital stockrooms, according to local AIDS groups, because the problem is
largely psychological and societal. Indonesia, the most populous Muslim
country, has a culture of religion and conservatism that continues to dictate
social perspectives.
"When people see HIV patients, they immediately think of irreligious
acts, drugs and sex," Frika Iskandar, an AIDS counselor, said. "It's hard for
people to disconnect these ideas."
Within the HIV community here, there has been a growing debate over
whether people should tell doctors they are HIV-positive. While most AIDS
groups encourage people to inform health care workers that they are infected,
many feel the pressure to remain silent.
Iskandar advises those with HIV not to disclose their status. "I tell
them to tell doctors that they have hepatitis C, so that the medical workers
will take some precautions," she said. "Otherwise, doctors might not want to
treat them at all."
Almost two months after he broke his leg in a motorcycle accident, Dhayan
is still looking for a doctor who will operate. Dhayan, who is also an AIDS
counselor and who encourages people with HIV to disclose their status, may
eventually go against his own advice.
"If it comes to it," he said, "I just won't say anything."
[Non-text portions of this message have been removed]
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Berdikusi dg Santun & Elegan, dg Semangat Persahabatan. Menuju Indonesia yg
Lebih Baik, in Commonality & Shared Destiny. www.ppi-india.org
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