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RI must step up efforts to eradicate HIV/AIDS
The IAC, using an estimate of 640,443 people with HIV/AIDS, found that only 54 percent of them were aware of their status, 21 percent had undergone ARV therapy and 3 percent had seen their viral load suppressed.
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his year's World AIDS Day has prompted calls to reflect on what Indonesia has been doing wrong in its efforts, or lack thereof, to tackle the epidemic as the country falls far behind screening and treatment targets.
In 2016 Indonesia joined other countries in committing to the United Nations General Assembly’s Political Declaration on Ending AIDS to reach the 90–90–90 targets by 2020; 90 percent of people with HIV/AIDS being aware of their HIV status, 90 percent of them getting ARV treatment and 90 percent of them having their viral load suppressed.
This is part of a global effort to end AIDS with zero new infections, zero deaths and zero stigma and discrimination by 2030.
However, the Health Ministry's director for direct infectious diseases, Siti Nadia Tarmizi, said during a press briefing on Monday ahead of World AIDS Day, which falls on Dec. 1, that only 63 percent of people with HIV/AIDS were aware of their status, 26 percent had undergone treatment and 4.5 percent had seen their viral load suppressed.
Nadia calculated the figures by using the 2018 estimation of 543,100 people living with HIV/AIDS in the country, a decline from a 2012 estimation of some 630,000 people.
"This is a moment where we should reflect on our mistakes and failures that have made us unable to achieve the 90-90-90 targets in 2020," Indonesia AIDS Coalition (IAC) executive director Aditya Wardhana said during a separate press briefing on Monday.
The IAC, using an estimate of 640,443 people with HIV/AIDS, found that only 54 percent of them were aware of their status, 21 percent had undergone ARV therapy and 3 percent had seen their viral load suppressed.
Aditya said this situation would probably stay the same, or become even worse, in the coming years if the government kept to its current approach of focusing HIV/AIDS policy on morality and health, instead of seeing it also through social, educational, workforce and economic lenses.
Aditya also attributed the government's sluggish progress in tackling HIV/AIDS to the vague leadership of its programs, especially after the abolition of the National Commission on AIDS in Indonesia in 2016. As a result, HIV/AIDS mainly became the concern of the Health Ministry, when in fact a variety of ministries should work alongside communities.
"If there's no improvement in the leadership, I'm quite certain that we won't see the desired results. In 10 years, we'll be complaining about the same issues; ARV for children is still difficult to access, viral load tests are difficult to access and at-risk populations are still being chased off and imprisoned," he said.
Baby Rivona Nasution of the Indonesian Positive Women Network (IPPI) said that this should act as a warning that HIV/AIDS handling had seen a setback at a time when the country had ambitious goals.
"HIV/AIDS hasn't been a priority for the government, in terms of funding, response and programs because many of the programs are donor-driven," she said during the IAC press briefing.
By solely relying on donors, program targets would only focus on figures being reached, instead of seeing people with HIV as lives to be saved. Viral load tests, which are mainly available in cities and are costly, also relied on donors' funding to be able to reach more people, she said.
Baby said that efforts should no longer be based on a business-as-usual approach and should no longer perpetuate the stigma surrounding HIV/AIDS, but rather see it as an issue of human rights and education. For instance, women and young girls must be educated on their sexual and reproductive health and rights, Baby said.
Housewives continue to test positive for HIV, Nadia revealed, with 32,000 new HIV/AIDS cases found this year, a decline from the 52,000 new cases found in 2019, but HIV groups questioned whether this smaller number was due to reduced testing amid COVID-19 fears and whether screening efforts had targeted the right at-risk populations.
The COVID-19 epidemic has disrupted HIV/AIDS screening and treatment, which were not running well in the first place, mainly attributed to stigma surrounding the latter condition. However, since the outbreak, people have avoided visiting healthcare facilities. Medical workers have suspended outreach programs and disrupted global supply chains affecting ARV availability.
For instance, the number of pregnant women undergoing HIV screening declined to only 1.7 million by September this year, from 2.5 million last year. This meant only 33 percent of 5.2 million pregnant women this year went through such screening, and among those who did, 0.34 percent of them tested positive. Such screening was essential to suppress transmission from mothers to their children.
Nadia said that there had been a 100,000 loss to follow-up cases, or HIV people no longer taking the ARV therapy.
Aditya said that providing affordable and friendly treatment to HIV people was not a government priority; 61 percent of ARV users still consumed the previous combination of drugs rather than the fixed dose combination of tenofovir/lamivudine/dolutegravir (TLD), which is more affordable and less toxic to patients. This meant limited access and fewer subsidies, especially as the latter was mainly available only in the capital city of Jakarta.
"Countries around the world including Indonesia have committed to ending the AIDS epidemic as a public health threat by 2030 [...] unfortunately the latest global data show that we're not on track to meeting global targets. And with COVID-19, we're [going] way off course," UNAIDS Indonesia country director Stuart Watson said during the Health Ministry's press briefing.
Stuart said the targets had been reset to 95 percent by 2025, acknowledging that while these were ambitious targets, they were "the only way to get back on track to achieving the goal of ending AIDS by 2030".
