The AIDS TSUNAMI that threatens Papua Papua HIV analysis working group Jayapura 29 April, 2005

You need three things to spread HIV: 1.One person infected with HIV 2.One person not yet infected with HIV 3.An exchange of body fluids between them It helps also to have An “open door” into the body

So who is already infected in Papua?

If that’s the situation in brothels, imagine what it is like on the street, where the “open door” is wide open

Who comes next, after sex workers?

The “low risk” populations aren’t so low risk after all

What’s going on with young people in Papua?

When it comes to sex, Papuan lads are “HOT”

There’s no difference between boys and girls… All young people in Papua seem to be “HOT”, compared with Java city kids

What’s fuelling all this risky sex in Papua, then?

When we say risky, we mean risky….

With this kind of risk behaviour, can we really expect HIV to be confined to sex workers? Needless to say…

HIV is already well established in the general population in Papua Population Year General Population (Jayapura) 0%1%2% General Population (Nabire) 2% Pregnant women (Mimika) 1% Housewives (VCT) (Merauke) 4% High school children (Enarotali) 0,5%2% HIV PREVALENCE IN NON-SEXWORKER POPULATIONS IN PAPUA Source: Papua Department of Health

Housewives have already overtaken sex workers among newly reported HIV cases

And it’s clear that HIV is not an “outsiders’ disease”

We estimate more than 8,000 indigenous Papuans are already living with the virus

So what are we doing about it ?

HIV prevention among sex workers 1.Support and information at the workplace 2.Distribution of condoms, and promotion of 100% condom use 3.Routine STI screening and treatment.

After high volume of new contacts at start-up, sex worker programmes report steady service provision

Where industry-wide approaches exist, sex workers come for screening even without individual outreach

Start with the basics: What’s the point in asking people to use condoms if there aren’t any condoms around?

Happily, we’re not seeing the same problems in red-light districts

It’s encouraging to confirm that condoms are effective

Successful screening and treatment programmes for sex workers will cut STI among clients, too

It looks like the sex worker programme is doing OK. So why is HIV still rising among sex workers ?

We’re still not reaching enough of the sex workers 58% 29% 61%

What about the Youth programme……………..?

HIV Prevention programme for YOUTH 1.Information and life-skills programmes through teachers and schools 2.Involvement of religious leaders in HIV prevention activities 3.Promotion of Abstinence

Are teachers, NGOs and religious leaders really engaging with young people ?

What are they telling them? Even those who have heard of HIV don’t know much about it

Young people who rely on religious leaders for HIV information are not top of the class in knowledge

Do young people let knowledge get in the way of sex?

Most of the young people who choose risky sex are not doing it out of ignorance

What other prevention programmes are going on in Papua? We’re trying to educate the population through outreach, and to get people to take HIV tests

If we want to reach the general population, we need to think big

How many people really want to know their HIV status?

Men who go through VCT do at least report less risk

But it’s not enough to make a big difference overall

Summary: Commercial sex 1.Programmes in red light districts are doing well 2.Programs for street sex workers and those in bars are still lacking, except in Merauke which works with establishments, not individual sex workers 3.It is essential to make sure the basics, such as condom availability, are assured over time Recommendations 1.Red light district programmes should be expanded 2.Merauke’s structural approach should be adopted in other cities, and outreach workers should focus on street based sex workers 3.Condom distribution must be assured

Summary: General population 1.Knowledge about HIV is incomplete, and in any case does not seem greatly to influence behaviour 2.The “low risk” population actually engages in a lot of high risk behaviour, and ethnic Papuans are especially at risk 3.Alcohol is a major factor fuelling risk behaviour among young people in Papua 4.Without action, an AIDS tsunami will swamp Papua Recommendations 1.Information for young people has to be more complete, and include information about condoms 2.We need to work with the right messenger. For young people, religious leaders may not be most appropriate 3.Young people need reproductive health services, as well as just information 4.HIV/AIDS prevention in Papua needs attention from leaders, funding, and people to deliver services on a large scale

We’re ready to prevent the AIDS tsunami in Papua. Are you?

Notes about this presentation This presentation is the work of a working group of staff that included department of health and statistics bureau staff from the province of Papua as well as from five districts in Papua. Two NGOs involved in service provision to groups at risk for HIV also participated. The presentation grew out of a discussion of the characteristics of the HIV epidemic in Papua, how it differs from the epidemic in other parts of Indonesia, and whether the current response is appropriate. Participants in the working group used data from the national second generation surveillance system, as well as programme records. The behavioural surveillance data had been previously cleaned, combined and coded at the central level. Participants in the working group were trained in the logic of programme analysis and in analysis itself (using Stata software), as well as in making graphics, building up a story and in presentation skills. The four day training was provided by ASA/FHI with the help of staff from the Central Bureau of Statistics and the national Ministry of Health, and was funded by USAID. The presentation, which is entirely that of working group participants, was given on the final day of the training to the Deputy Head of the provincial health department as well as the Provincial AIDS Control Board and several journalists, and resulted in front page coverage in local papers the following day. Translated from the Indonesian by ASA staff.