TheJakartaPost
Please Update your browser
Your browser is out of date, and may not be compatible with our website. A list of the most popular web browsers can be found below.
Just click on the icons to get to the download page.
Steve Krauss: Urging a focus on AIDS
Steve Krauss
Change Size
Steve Krauss. JP/Rita A. Widiadana
There is no way to talk about HIV/AIDS in the Asia Pacific region without focusing on Indonesia, India, China, Thailand, Vietnam and Myanmar, said Steve Krauss, director of the UNAIDS Regional Support Team for Asia and the Pacific.
The AIDS response in Asia and the Pacific has seen some of the world's great successes ' and also risks of stagnating ahead of 'getting to zero', by 2015, Krauss said on the sidelines of the 11th International Conference AIDS Asia Pacific (ICAAP) in Bangkok.
'India and China account for huge number of people living with HIV because of the size of populations. Indonesia is the fastest growing rate of new HIV infection in the region,' said Krauss.
In 2012, UNAIDS estimated that 12 countries accounted for more than 90 percent of 4.9 million people living with HIV and more than 90 percent of 350,000 new infections in Asia and the Pacific: Indonesia, China, India, Cambodia, Thailand, the Philippines, Vietnam, Malaysia, Nepal, Pakistan and Papua New Guinea.
'We do understand the complexity Indonesia is now facing in dealing with HIV/AIDS given its vast archipelagic country of 17,000 islands, diverse culture, religion and language,' said Krauss.
Not to mention the regional autonomy government system that makes it more difficult to implement programs a huge country of 240 million, he added.
In 2012, UNAIDS estimated that there were 610,000 people living with HIV in Indonesia. 'HIV/AIDS is not geographically distributed equally in Indonesia or in any other countries. HIV remains concentrated among key populations and in cities.'
Indonesia must focus on key populations ' men having sex with men (MSM), drug users, young men, waria, transgendered people and female and male sex workers in both urban and rural areas, especially in Papua, he said.
In Jayawijaya, Papua, HIV prevalence among sex workers is 25 percent, while 18 of male sex workers and 30.8 percent of waria in Jakarta were HIV positive.
HIV prevalence in MSM in Jakarta and other big cities in Indonesia is particularly high ' around 15 to 25 percent, while the incidence among intravenous drug users was 36.4 percent.
'Deep-rooted stigma, discrimination, a punitive legal environment and oppressive laws have negative impacts on the rights of key populations and vulnerable groups to have access to information, health treatments and justice,' said Krauss.
'Many young men, sex workers, gays and transgenders are reluctant to have HIV tests and treatment, as they get discriminative and judgmental treatment ' both physical and verbal abuses from health providers.'
Discrimination and violence was common, he said. 'Perpetrators can be government officials, law enforcers, health providers, families, teachers, friends, the societies and some of them are religious leaders.'
In Asia Pacific, more than two-thirds of those at risk did not know their HIV status, Krauss added.
Helping people living with HIV to find out their status as soon as possible is very important. However, those in key risk populations frequently had little money information and, more importantly ' courage ' to face stigma, discrimination and violence against them, he said.
'Sex workers are women, mothers, sisters and daughters of someone. Gay people are perhaps our friends, brothers, co-workers and even our son. People who inject drugs are probably our children who need help. They are not criminals, they are not scary people and do not want to scare them. They are ordinary people who have hearts and dignity,' he said.
All was not lost, Krauss said. 'Indonesia has a lot of champions. The country has solid and active civil societies as well as policy makers. I remembered meeting a female politician, who was so articulate in promoting decriminalization of people who inject drugs, during a UN meeting.'
'The politician stood very strong in her opinion that people who inject drugs are not criminals and deserve to be treated that way. They are the people who suffer from health problems and need health treatments instead of being imprisoned in jails.'
The facts, the politician said, was that Indonesian prisons place people at risk. 'When people are released from prisons in Indonesia, many of them are HIV positive, experts in drug injection and involved in drug trade, that is the fact ' the politician told us at the UN meeting,' Krauss added.
In Thailand, extensive use of condom among sex workers has prevented more HIV transmission among the group and other members of communities including gay and transgender as well as their clients.
'Condoms, when used properly, have become one of the most effective tools to prevent HIV transmission from spreading widely. This is the case occurs in any country in the world,' he said.
The other thing, which is so crucial, is to ensure affordable access to health treatments and affordable antiretroviral (ARV) medicines.
Ensuring affordable access to treatments is an ongoing challenge for countries in Asia and Pacific, he said. Indonesia, Malaysia and Thailand have issued compulsory licenses or government-use orders for affordable antiretroviral medicines.
During the recent ICAAP, one popular session covered pharmaceutical prices and the World Trade Organization (WTO) agreement in Trade Related As Related Aspects of Intellectual Property Rights (TRIPS), he said.
Few understand the details of how the WTO and TRIPS can affect public health. 'This is very dangerous. Most negotiations between countries and WTO were done behind closed doors ' secretly,' Krauss warned.
When UNAIDS and United Nations Development Programme (UNDP) held a workshop on TRIPS flexibilities and benefits for low-middle income countries, the audience of representative of governments civil society groups marveled at the positive and negative impacts trade agreements would have on affordable HIV treatment. 'It was like giving chocolate and candies to children. They were happy to understand those critical subjects.'
UNAIDS and UNDP, he said, recommend that nations avoid entering free trade agreements (FTAs) under WTO containing TRIPS that can impact on pharmaceuticals price or availability.
Countries are facing mounting challenges to produce or procure affordable HIV drugs while international funding for AIDS response is cut back and increasingly restrictive intellectual property measures are emerging in FTAs.
'This will have huge impact on scaling up treatments for HIV and other diseases. The prices of medicines will be skyrocketing and low-middle income countries like Indonesia and other Asia Pacific countries will not be able to provide affordable health care and treatments.'
'This is a 'David and Goliath' battle. Big pharmaceutical manufacturers have all power and money to do anything to halt generic products and this is not good news for low-to-middle income countries,' he said.
Medicine and treatments are not only intended for the rich. All people must have equal access, according to Krauss. 'Without inexpensive medicines and wide access to health treatments, we will see millions of people with HIV/AIDS die soon. Don't trade the health of the people for any forms of economic gains.'
