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First-time donor RI gives a boost to global AIDS, TB and malaria elimination

Even the pandemic and ensuing economic slowdown did not stop Indonesia from becoming a first-time donor to The Global Fund. 

Elly Burhaini Faizal (The Jakarta Post)
Jakarta
Mon, January 30, 2023

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First-time donor RI gives a boost to global AIDS, TB and malaria elimination

W

ith only seven years left for Indonesia to achieve its target to end AIDS, tuberculosis (TB) and malaria, the three diseases remain major health threats in the country.

The overall incidence of HIV/AIDS infections in Indonesia was down by 50 percent from 52,990 cases in 2010 to 26,730 in 2020. Despite the decline, however, the COVID-19 pandemic has slowed the fight against HIV. Meanwhile, according to the World Health Organization’s Global TB Report 2022, Indonesia ranks as the second-highest contributor to global TB cases. Regarding malaria, Papua continues to be a real concern, in which cases are still on the rise, with a 13-percent increase in burden since 2019.

Those facts show Indonesia still needs to make a herculean effort to prevent and control AIDS, TB and malaria, three leading infectious killers with a 2030 target for elimination.

Amid the challenges, Indonesia recently announced a US$10 million pledge to The Global Fund, a move that shows the country’s commitment to helping the world combat AIDS, TB and malaria. Even the pandemic and ensuing economic slowdown did not stop Indonesia from becoming a first-time donor to The Global Fund.

Indonesia was one of five Asia-Pacific countries to pledge a combined $1.3 billion contribution to The Global Fund’s Seventh Replenishment Conference in New York, the United States, on Sept. 21, 2022. The other four are Japan ($1.08 billion), Australia ($177.55 million), South Korea ($100 million) and New Zealand ($1.47 million).

During the conference, hosted by US President Joe Biden on the sidelines of the United Nations General Assembly, The Global Fund raised a total $14.25 billion for the next three years to end AIDS, TB and malaria. The Global Fund’s target of $18 billion was not achieved, but it is expected that the latest pledges could help countries save millions of lives from AIDS, TB and malaria. It is also hoped the new funding could support countries to reinforce pandemic preparedness by strengthening health and community systems.

Health Minister Budi Gunadi Sadikin told the conference that Indonesia’s efforts to achieve the target of controlling HIV/AIDS, TB and malaria must be sustained.

But it is always easier said than done. Criminalization of key populations, poor access to HIV treatment and continued care without stigmatization remain a challenge in the fight against the virus. Based on the Health Ministry’s 2018-2020 data observation, preventive efforts to reduce the HIV transmission rate, especially in women, children and adolescents, have not yet been optimal.

As of September 2022, only 417,863 or 79 percent of people living with HIV (ODHA) knew their health status. Meanwhile, only 169,767 or 41 percent of ODHA have received antiretroviral (ARV) treatments. The Health Ministry needs to do more to fulfil its “Getting Three Zero”, zero new infection, zero HIV/AIDS-related deaths and zero stigma and discrimination, targets.

TB is another heavy burden for Indonesia’s healthcare system. The Global TB Report 2022, which was released on Oct. 23, 2022, shows an increase in the number of new TB incidences in the world, with India, Indonesia and the Philippines the top-three contributors.

An estimated 1.6 million people died from TB in 2022, up from 1.5 million in 2020 and 1.4 million in 2019, according to the report. The rise in TB deaths mostly occurred in four countries: India, Indonesia, Myanmar and the Philippines.

The report further reveals there are 30 countries with the highest number of TB cases in the world, or “the 30 high TB burden countries”. Eight of the 30 countries account for two-thirds of global TB cases. India ranks first with 28 percent of the total cases, followed by Indonesia (9.2 percent), China (7.4 percent), the Philippines (7 percent), Pakistan (5.8 percent), Nigeria (4.4 percent), Bangladesh (3.6 percent) and the Democratic Republic of Congo (2.9 percent).

In 2021 Indonesia ranked third, while in 2020 second in the world.

“We now rank second worldwide again. This shows that In TB control, we may still have a long way to go,” the University of Indonesia (UI) respiratory infection professor Tjandra Yoga Aditama told The Jakarta Post.

Regarding malaria control, some challenges linger. Although Indonesia has almost halved its malaria burden from 2010 to 2020, and about 70 percent (362 out of 514) of cities and regencies have been certified free from malaria, this vector-borne disease remains a threat in some areas, including Papua. Because of COVID-19 restrictions, for instance, malaria case findings and management were interrupted for some time, causing progress to stall.

In the September 2022 conference, leaders pinned their hopes to the new pledges that The Global Fund could end inequities that had been widely acknowledged as barriers to achieving global and national targets in AIDS, TB and malaria programs.

The Asia Pacific Leaders Malaria Alliance (APLMA) and Asia Pacific Malaria Elimination Network (APMEN) praised Indonesia’s financial pledge to The Global Fund and the government’s commitment to fighting the three major health problems.

“As first-time donor, Indonesia’s generosity, leadership and commitment are both an inspiration and a rallying cry toward global health equity,” APLMA CEO Sarthak Das told the Post.

In Asia Pacific, malaria-focused funding supported by The Global Fund has saved 1 million lives and resulted in the distribution of 21 million mosquito nets in 2021 alone, APLMA data say. The Global Fund’s support, including its Regional Artemisinin-resistance Initiative (RAI), is essential in Greater Mekong, a once-malaria-plagued subregion, which now becomes a glimmer hope for other Asia-Pacific countries working toward malaria elimination.  

Indonesia’s goal to achieve total elimination of AIDS, TB and malaria remains far-fetched. But by offering its $10 million donation, the government has shown its willingness to give a boost to global health equity, which is essential in reducing burden and transmission of the three health problems.

Hopes to end AIDS, TB and malaria elimination will remain elusive unless Indonesia and other Asia Pacific countries strengthen their health systems for the most vulnerable communities.

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The author is a staff writer at The Jakarta Post.

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