Voluntarily: A resident undergoes an HIV/AIDS test during AIDS Day in Suropati Park in Central Jakarta recently.(JP/Don)

A thick crowd — families, groups of friends, dating couples, drink sellers, tourists and policemen — mill endlessly around Kota Tua’s Fatahillah Square in West Jakarta that Saturday night, undeterred by the threat of rain.

At the edge of Fatahillah Square in downtown Kota Tua in West Jakarta stands a small group of people, clustered around a face-masked nurse busily laying out syringes, swabs and vials.

They are there to hold the so-called Doktor Keliling — or roving doctor, Dokling program — a regular mobile clinic offering free HIV tests.

“Kota Tua is one of our hot spots, along with the Senen area and clubs and spas. We go there because we know there’s a certain concentration of high-risk behavior groups,” said Juna Rislon “Erik” Damanik, referring to sex workers and injected-drug users. “But we concentrate on men who have sex with men, or MSM.”

Erik is a program manager at the Inter Medika Foundation (YIM), one of the many foundations and bodies operating under the aegis of the National Aids Commission (KPA) and the Health Ministry via provincial and municipal health agencies.

The Dokling program has been underway for eight years, but has been stepped up in the last couple, shifting focus from promoting HIV/AIDS tests and treatment to helping carry them out.

Erik said the move was taken in line both with a continued rise in the number of cases in Indonesia and with increased government recognition of the scale of the problem, which constitutes an epidemic in Indonesia.

And while all at-risk groups have seen increased rates of infection, it is the MSM group that has experienced the steepest rise.

“Cooperation with the government is very good. We work with puskesmas [community health centers], which provide the health professionals,” Erik explains.

He attributed the continued rise in HIV infection to an awareness problem.

“There’s still stigma and discrimination,” he said, adding that is why, despite HIV testing and treatment being available at puskesmas and hospitals in the capital, outreach programs like Dokling are still necessary.

“But what we can do is limited. At each Dokling event, we might test 50 or a maximum of 100 patients. The human resources at puskesmas are limited too — they can only provide one nurse each time.”

Laboratory nurse Septi, from Tambora Puskesmas in West Jakarta, is on duty in Kota Tua and enthuses about the program.

“We want to find out who has HIV and treat those who do. Even when it rains, we keep going. Last week, at Senen, we moved under a bridge,” the 40-year-old nurse laughed while waiting for the program’s staff to find prospective patients.

Working together: Inter Medika Foundation (YIM) staff members pose for the camera on a wet and hectic evening in Fatahillah Square, Jakarta.(Joshua Kirby)

They do this by scouring the crowds for likely candidates, approaching them and ascertaining whether they engage in behavior considered “risky”.

Then, if they’re willing, the nurse takes a blood sample, which is tested for the HIV virus, as well as other sexually transmitted diseases. The results are ready in around half an hour.

Septi’s experience with the program bears out the figures.

“I’ve been involved with this program for around three years, and there’s been a definite increase in reactive results. Early on, of 30 patients, perhaps one or two [tested positive]. But now, for example, last week, of 40 patients, 17 were reactive.”

On a personal level, she said the finding was saddening.

“Many of them are very young: 16 years old and already reactive. I myself have a child in senior high school, so I find it very worrying,” Septi said.

Reactions to positive results, she adds, are mixed. “Some are resigned, others are shocked at first. But we explain that there are solutions, there’s treatment. We don’t just tell them they’re positive, we also show them that there’s a way forward.”

It doesn’t take long for the Dokling field staff to work up a steady stream of patients, without exception young men in their teens and early twenties, largely in groups of friends.

Most are visibly nervous and unwilling to answer questions, but one,

Oky, 22, who has just had a blood sample taken, says he feels calm as he did not have the results yet. He named promiscuity and drug use as his risky behaviors. “If it’s negative, Alhamdullilah,” he says.

Dokling field coordinator Albin believes the program’s major benefit is its instantaneity. “We can invite [patients] to take tests here and now,” he says.

He and his fellow YIM staff say it remains difficult to persuade people to take the time and effort to undergo testing at puskesmas or hospitals.

Counselor Sandy puts this down to the continued stigma and discrimination surrounding HIV/AIDS. “Through this program, we reach out proactively to those who are reluctant or ashamed to take HIV tests [...] If you go to an HIV clinic at a puskesmas, you’re very visible,” he explains.

Early detection: A number of young people participate recently in the HIV/AIDS test conducted by Buton regency in Southeast Sulawesi during World AIDS Day at the Hotel Indonesia traffic circle in Central Jakarta.(JP/P.J. Leo)

Erik had earlier specified the MSM group targeted by YIM encompassed men who did not identify as homosexual, but who nonetheless engaged in sex with men, including many with wives and children.

Surely, though, by targeting certain self-identifying “communities”, Dokling and similar programs will necessarily struggle to reach such men?

“That remains one of our biggest challenges,” he agrees. “We have launched a campaign on social media to that end, but our work remains focused on key communities. It’s not like in Papua, where the general population is targeted for testing. It’s a challenge for us.”

The drizzle falling on Fatahillah Square gets heavier and the revellers scuttle for cover under awnings and trees, many crowding around the Public Order Agency (Satpol PP) post where the mobile clinic is set up, drawing sharp comments from the uniformed men.

Erik said the program has so far never attracted unwelcome attention, mainly because they are working in the field of health.

“We’re under the authority of the government, and in Kota Tua, for example, we have permission from the Taman Sari district authorities. And if there were any trouble, we have the Satpol PP right here.”

The rain continues and the square slowly empties. The Dokling staff decide to call it a night, having processed 20 patients, of whom four tested positive for HIV. They’re given the results by a dedicated counselor from YIM, who, in case of bad news, explains the next steps of treatment at a hospital or puskesmas, a process through which the foundation’s staff accompany each patient.

Oky, meanwhile, is jubilant — he was one of those who tested negative. “Alhamdullilah, there’s no problem. I can continue to live healthily,” he grins.

When asked whether he would amend his high-risk behaviour to lower the risk of future infection as advised by YIM’s counsellors, he smiled. “Maybe,” he says. “But probably not.”