The question that needs to be asked here is: Why is the Indonesian Health Minister shocked by the UN World Aids Day Report that documented the country’s dismal success rate (or high failure rate) in HIV prevention over the past decade.
Why was the minister shocked over something that has been happening over the past 10 years? Does she have a nervous preposition? Has she no clue as to what’s happening on the ground where HIV prevention is concerned? Does she not read newspapers? Do her people brief her only honeyed reports of what’s happening out there?
All very disturbing but Unspun is no expert on HIV prevention. Would like to hear from the very vocal and opinionated expert Elizabeth Pisani, an epidemiologist who worked in the field of HIV prevention in Indonesia and then went to write the fascinating book Wisdom of Whores on the shocking state of the minister and HIV prevention efforts in Indonesia.
Health Minister embarrassed with UN report on HIV/AIDS | The Jakarta Post
Health Minister Nafsiah Mboy said that the newly published 2012 World AIDS Day Report, which revealed Indonesia’s low success in HIV prevention over the last 10 years, was embarrassing.
“It [the report] really shocked me,” she said during a workshop on HIV-sensitive social protection held by the International Labour Organization (ILO) on Wednesday.
The report by the Joint UN Program on HIV/AIDS (UNAIDS) published on Tuesday, disclosed that the rate of new HIV infectios in Indonesia increased by more than 25 percent between 2001 and 2011. The report said that HIV prevention programs for the gay community and commercial sex workers only reached less than 25 percent, which was considered low
Several other countries like Bangladesh, the Philippines, Vietnam and Sri Lanka have similarly poor records.
“We have spent million dollars of HIV/AIDS prevention programs, yet, we still have such a low success rate. I don’t know what mistakes we’ve made,” Nafsiah said.
While highlighting Indonesia’s poors achievement, the report recorded success stories from other countries.
The report showed that 25 low and middle income countries, more than half of them in Africa, had successfully reduced new HIV infection by more than 50 percent.
Disappointed with the report, Nafsiah said that the government must move forward and keep providing universal access to HIV prevention, treatment, care and support.
“People must learn how to be responsible and to defend themselves against HIV by avoiding risky sexual behavior and having only safe, protected sex,” she said. (lfr)
Unspun 
I see you’ve posted this in “ask the right question”, so my question, relating perhaps more to reporting standards than to HIV, is this: how can the Jakarta Post write this story without even mentioning that Nafsiah Mboi was, for the six years directly preceding her recent appointment as Minister of Health, head of the KPA, the National AIDS Commission?
Here are more questions: is an increase of more than 25% in HIV incidence (i.e. new infections) over 10 years really so shocking? Is the rate of new infections still increasing today? How do we know?
1) How shocking is an increase of 25%? It rather depends on what the original rate was. The fact is, Indonesia had virtually no HIV epidemic in 2001, except in drug injectors and waria sex workers. In other words, the baseline rate of new infections in the largest risk populations (female and male sex workers, their regular clients, and gay men) was extremely low. If you go from four new cases a year to five new cases a year you increase by 25% but add only one new infection. If a high prevalence country goes from 10,000 cases to 11,000 cases, it has increased by only 10% but added 1000 cases.
2) and 3) Is the rate of new infections still increasing? How do we know? The fact is, we don’t. Indonesia, which in the early 2000s built up quite a strong surveillance system, has seen that system break down rather badly, in part because of the effects of decentralisation and in part because of the stupidity of some of the donor-funded NGOs inaccurately referred to as “development partners”.
That there has been an increase of over 25% in new infections over 10 years in Indonesia is indisputable. It was totally unecessary, but absolutely inevitable given what happened. When infection rates were still low we measured very high levels of risk behaviour in key groups. We did very little about it, and what we did was more often driven by institutional needs and development fashion than by the needs of the people at risk. We kept measuring risk and infection, saw that risk was not falling and infection was rising, spent lots of time and energy getting more money, then threw the money at the same failed approaches. By 2009, three years into Nafsiah Mboi’s tenure as head of the KPA, Indonesia has sucked 60 million dollars into its HIV coffers, just for that year alone. How much of that was spent on prevention for gay men, a sizeable group in whom infection rates had rocketed from under 3% in Jakarta when I did the first study in 2002 to over 8% in 2007? A princely US$ 23,000. Now that’s shocking!
Even more shocking: UNAIDS chief Michel Sidebe was in Jakarta just a couple of months ago. What did he talk about? Not the gay men, junkies, waria, rent boys and clients of hookers that make up four fifths of the Indonesian epidemic (the majority of other cases being in female sex wokers). No, he talked about the importance of protecting innocent women and babies through sexual education for young people, most of whom are at practically zero risk. (Reminder, you can’t get HIV by having sex, even unprotected sex. You can only get HIV by having unprotected sex with an infected person. As long as they stay away from the trade, most young heterosexuals in Indonesia can have as much sex as they like without risk of HIV infection.)
The highest UN official for HIV comes to Indonesia and stresses the importance of prevention for people who are not at risk, and Ibu Naf wonders why infections continue to rise in the groups that are at risk. Please deh! Someone should write a book about this.
Oh wait, I already did….
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