HIV/AIDS tests needed to save lives: Doctors

Mariani Dewi ,  The Jakarta Post ,  Jakarta   |  Tue, 05/06/2008 9:40 AM  |  National

With many Indonesians dying of HIV/AIDS -- undiagnosed and untreated -- doctors are calling for a better monitoring and treatment system for HIV/AIDS patients.

Since 2004, more than 3,000 people with HIV/AIDS have been admitted to Cipto Mangunkusumo General Hospital alone.

"Many more must have died without knowing they died from HIV/AIDS," Zubairi Djoerban, a doctor at the hospital and a professor at the University of Indonesia's School of Medicine, said Saturday.

"Their deaths could have been averted because there are free treatments available."

Indonesia has been using a voluntary counseling treatment system, whereby people can opt for counseling before taking an HIV/AIDS test.

But the system has not been enough to encourage people to take the test.

There are 20,000 recorded cases of HIV/AIDS in Indonesia, but experts estimate there were at least 190,000 cases in 2006. The disparity means many sufferers are denied access to the free anti-retroviral treatment that can prolong life, although it cannot cure the disease.

HIV infection has also been growing among groups that traditionally had low exposure to the virus.

"Many women have contracted it from their husbands. I never saw this in the past, but this year alone I have met 30 women who were infected.

"Ironically, usually the pregnant wife accompanied her sick husband to the hospital. Some of the husbands then died shortly afterward, leaving behind a sick wife and child," said Dyah Agustina Waluyo, a doctor at Kramat Hospital.

The hospital has handled at least 150 babies born with HIV/AIDS.

"We need a more proactive approach such as compulsory tests for pregnant women and sick people, as is done in other countries. Early detection reduces the number of transmissions and deaths," she said.

The risk of mother-to-child transmission (MTCT) can be halved to around 20 percent if the mother receives treatment during the early months of her pregnancy.

MTCT drops to 5 percent if the mother is on medication before conception.

Zubairi said the MTCT rate in the United States is around 3 percent. The system of testing mothers is used in many countries including Uganda, Malaysia and Thailand. It is applied most rigorously in the United States, where even dental patients are tested.

Dyah, who visited Uganda with nurse Angela Lamalanato for a CARE5 meeting organized by pharmaceutical company Roche, said she found Indonesia's approach to the illness was inferior in many ways.

HIV testing equipment is not available in every province, meaning samples must be sent to Jakarta or other major cities. It can then take between three days and three weeks to get test results, compared to Uganda's standard of three to seven days.

Indonesia does not even have national operational standards.

"Hospitals have different processes and approaches. We should have nationally standardized programs and medical procedures to handle the cases," she said.

"This is urgently needed considering the increasing number of undetected infections. We can learn from Uganda."

The main challenge in tackling the epidemic in Indonesia is not the budget but the priority and coordination of programs and procedures for detection, treatment, counseling and medical staff training, Zubairi said.

Treatment for each patient costs the government Rp 380,000 (US$41) per month. Tests cost between Rp 50,000 and Rp 100,000 for the initial detection test and up to Rp 850,000 for advanced blood count tests.

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