KangGURU Radio English is funded by AusAID,
the Australian Government's Overseas Aid Program.

November 2000 
The Indonesia HIV/AIDS, STDs Prevention and Care Project
(English)

Bahasa Indonesia

Top left: Ellie and Wahid from the Rifka Annisa Women's Crisis Centre in Yogyakarta
Top center: Village midwives with from the Healthy Mothers Healthy  Babies Project, Kendari
Top right: Jo and Lisa are Australian Volunteers International in Makassar
Bottom left: Dr. Firman Lubis and his team, Prevention and Intervention of Alcohol and Drug Problems Project in Jakarta
Bottom Center: Australian Volunteer International, Ingrid,  with volunteer workers against HIV in Manado
Bottom right: Australian Development Scholarship holders studying at IALF, Bali

Australia and Indonesia have been partners in development for many years. A growing development cooperation relationship has been one factor in the strengthening connections between Australia's and Indonesia's governments, businesses and people.

Total development assistance to Indonesia for the financial year 2000 - 2001 will be  $102.5 million. This represents a more than 15% increase since the onset of the economic crisis.

Kang Guru Radio English is proud to give you up to date information on the wide variety of AusAID projects in Indonesia. Each month we will feature a different AusAID project. Information will be taken from the radio programs.  Photographs will provide a more comprehensive view of the projects and their activities.

KangGURU AusAID
Project of the Month for November 2000

The Indonesia HIV/AIDS, 
STDs Prevention and Care Project

Topics of interest include:

What is high-risk behaviour?

How do you know if a person has HIV/AIDS?

AIDS - the myths

Australia and Indonesia working together for AIDS prevention

If you would like further information on AIDS transmission and prevention, the following AusAID funded NGOs can help you.

NGOs in Sul Sel
NGOs in NTT
NGOs in Bali

Who says religion and AIDS prevention don't mix?

Decreasing risky behaviour

Prevention in the community

“The first response to HIV education was embarrassment; people were uncomfortable. One peer educator was punched in the face.” - Baharuddin Solongi, program director, Yayasan Peduli Indonesia, Makassar.

“I didn't know what AIDS was. Learning about it has changed my life. I recognise it is a threat to my life and my friends.” - Ade, a waria, or transvestite, in Makassar.

“We have to convince people that sex education is not a Western concept but a universal one.” Dr. Wimpie Pangkahila, founder, Indonesian Institute for Family Welfare, Denpasar.

“People living with AIDS now have a good chance of living - and dying - within society as acceptable members.” Chris Dureau, institutional strengthener, Indonesia HIV/AIDS and STD Prevention and Care Project, Denpasar.

“Before the AusAID program, we thought HIV was a curse from God. We had problems letting go of the idea that it was sinners who caught the disease.” - Rawaden, a 17-year-old high school student , Makassar.

“Sex outside marriage is still a sin, but doing it without a condom is a bigger sin”, has become an acceptable compromise between religious teachings and AIDS prevention for Muslims, Catholics, Protestants and Hindus involved in the Aus-AID sponsored AIDS prevention project.

Who says religion and AIDS prevention don't mix?

The call to prayer rings out through the loud speakers as the faithful wind their way along the streets to the mosque, prayer mats slung over their shoulders. It is Friday, the Islamic day of religious observation where mosques throughout Indonesia often fill to capacity as millions of Islamic faithful observe their religious obligations. In the Indonesian province of South Sulawesi, however, the faithful attending their Friday prayers may not always leave with just a deepened understanding of their faith, but many are also learning about AIDS prevention.

In what may be a world first, AusAID is piloting a unique AIDS prevention tool by mobilizing religious networks in several Indonesian provinces to educate the community about AIDS prevention.

Mr Ridwan, whose agency IMMIM (an Islamic preachers' coordinating agency based in the provincial capital Makassar) was tasked with training Islamic preachers in South Sulawesi.

“After the Muballig (Islamic preachers) completed their five-day training course, however, there were only two preachers out of the 312 that we trained who refused to change their views.”  The results show that with effective training Islam, as with other religions, can compromise in the interest of community welfare. “The condom still remains controversial, however, while the Muballig continue to preach that sex outside marriage is a sin, they also emphasize that sex outside marriage without a condom is a bigger sin.” The condom controversy has in effect been neutralized, as have other controversial subjects such as mass blood testing, and labeling all HIV/AIDS positive people as sinners, thereby also reducing the stigma and discrimination associated with this still controversial illness.

Similar activities are being conducted in East Nusa Tenggara where boththe Catholic and leading Protestant church - the Timor Evangelical Church - have also trained preachers to provide outreach tocongregations both during church services as well as in other forums such as Bible discussion groups, marriage counseling, and youth groups. The Catholic Church has even produced a special Catechism for AIDS prevention, which is much in demand in Catholic diocese throughout the country.

As youth are the most vulnerable to AIDS infection, district youth leaders are also trained and tasked with conducting peer education both within their own religious youth groups as well as in more informal settings such as gatherings of school friends, or families and neighbours.

The provincial IEC (religious) models, implemented by the AusAID funded Indonesia HIV/AIDS Prevention and Care Project, aim not only to reduce the spread of AIDS by conveying basic AIDS facts to the general community, but they also recognize the influence that religion and religious groups still have in developing countries, not only for the community but also key government decision-makers. In addition they provide a comprehensive network down to the neighbourhood level, of trusted, educated personnel and volunteers who are familiar with local culture and languages, often one of the main obstacles to AIDS prevention education in multicultural and multilingual countries such as Indonesia. On top of this, they are sustainable as they rely on independent funding.

Prevention in the community
The Project has devoted resources to enhancing existing systems and institutions to promote HIV/AIDS prevention and has identified mechanisms by which information can reach the target community, for example through the use of peer educators

Sex Industry
The Project supports outreach programs, encouraging a greater awareness of the risk of HIV/AIDS infection among female and male sex workers and their clients.

Mobile Population
Many Indonesian cities have significant populations of migrant workers without strong connections to the local community and lacking access to information about prudent sexual behaviour. The Project works with organisations that include transient and part-time workers in the education process.

Seeking STD Treatment
The Project has measured high rates of STD infection rates in severalpopulations and is assisting with the establishment of dedicated STD treatment services. It also works with community institutions to helpprovide information to the community about awareness of STDs and the importance of seeking appropriate clinical treatment.

AIDS - the facts!	You can protect yourself from AIDS ... it's easy if you know how.
Anyone can get AIDS if they practice high-risk behaviour. What is high-risk behaviour? · having more than one sexual partner and not using a condom · sharing needles ... either for injecting drugs, tattoos, body-piercing

You can protect yourself from AIDS

                · abstain from sexual intercourse if you are not married

                · be faithful to one partner

                · wear a condom if you have multiple sexual partners

· always request a new needle for injections at health centers -     this is your right - or for tattoos or other forms of body piercing, and don't share needles when injecting drugs.

· if you need a blood transfusion ask your doctor to check the blood supply is AIDS free - it is your right.

AIDS is not easy to transmit as the virus has to enter the blood-stream. You cannot get AIDS from general social activities such as:

· sitting beside others
· eating or bathing together
· holding hands and cuddling

How do you know if a person has HIV/AIDS?

· People who are HIV positive (ie the first stage of the AIDS virus) have no symptoms, often for many years

· There is only one way to know whether a person is HIV positive ... through a HIV virus blood test.

It is better to be safe than sorry!

Remember ... YOU are responsible for your own health

AIDS - the myths

There are a myriad of myths associated with AIDS that can in fact contribute to the spread of the virus. One positive impact of the AusAID-sponsored community interventions to date can be seen in changing attitudes over the past three years, particularly in undermining the common myths associated with AIDS, such as:

Our religion/culture protects us - it's a curse from God - only sinners/women/sex workers/foreigners/sexual deviants/(ie “... others, not us") get AIDS ... praying to God will protect us .. it's the Government's problem not ours ... kill or evict people with AIDS ... the solution is simple “just give them a moral lecture” or “blood test everyone”. AIDS can spread from holding hands ... or mosquito bites ... if they look healthy they can't have AIDS ... I can tell from looking at a person if they have AIDS.

Don't gamble with AIDS ... know the facts!

Australia and Indonesia working together for AIDS prevention In 1992, five years after the first HIV case was reported in the nation, the Indonesian government asked the Australian government, through its international aid agency, AusAID to help implement its medium-term plan for HIV/AIDS control. In 1993, the two governments developed a $20 million project, for which nearly 90% of the funding came from Australia. It became known as the Indonesia HIV/AIDS & STD Prevention and Care Project. The Project works with the National AIDS Commission in Jakarta and with government and non-government organisations in the provinces of Bali, South Sulawesi and East Nusa Tenggara. Goals The major aim of the project is to support and strengthen Indonesia's effort to combat the spread of HIV/AIDS. It is also designed to: educate Indonesians about what AIDS is and how it is and is not transmitted; to influence behavioural changes to limit its spread; and to help develop a model for the care of people living with HIV/AIDS. The project is divided into the following strategic areas: National support: To strengthen the Indonesian government's capacity to develop and co-ordinate HIV/AIDS and STD prevention and care activities at the national level in accordance with the National AIDS Strategy. Provincial support: To assist the Provincial HIV/AIDS Commissions to develop a program of HIV/AIDS and STD activities in Bali, South Sulawesi and East Nusa Tenggara provinces Community mobilisation: To strengthen and develop non-government organisations in the three designated provinces and support them in undertaking HIV/AIDS and STD prevention activities. Management of STDs: To assist the Indonesian government to develop improved HIV/AIDS and STD management programs, such as health-service delivery, laboratory support and training in diagnosis and patient management. Social, cultural and behavioural research: To improve HIV/AIDS and STD prevention and care by enhancing existing knowledge of the contributing social, cultural and behavioural factors.

NGOs in SULSEL

NGOs in NTT

NGOs in BALI

Community-based approaches

Religious Dialogues
A cornerstone of the Project has been the support of the religious community. The province of South Sulawesi has a strongly Islamist heritage. “Islamic law operated here, as in Aceh and West Java, until 1971,” says Ridwan Abdullah, director of IMMIM, a Muslim organisation based in Makassar. Recently, Islamic scholars undertook workshops to review Islamic literature and identify principles supporting HIV/AIDS and STD prevention activities. From those, the scholars prepared a policy document urging the teaching of HIV/AIDS awareness, promoting responsible, safe sexual behaviour and advocating tolerance and compassion for people living with HIV/AIDS.

Muslim clerics preach HIV/AIDS awareness in their sermons and provide education in mosques, schools and community halls. Although they primarily promote abstinence and fidelity, they also offer advice on condom use in specific circumstances. “That shows how far we've come since then,” adds Ridwan.

In Christian-dominated East Nusa Tenggara, similar sentiments prevail. When AIDS was first reported in the province in 1996, Rev. Mesach Beeh, general secretary of GMIT, a Protestant church organization based in Kupang, realised his church faced a serious problem. He says he saw a "moral obligation" to address the issue, and if that meant rethinking what he was teaching his congregation, so be it. The Projectprovided financial support for an education program but, moreimportantly, it offered information about HIV and AIDS. As a result he was able to develop an education program for his ministers. The church's basic three-point program for sexual health is ABC: Abstinence, Being Faithful, Condom Use.

The Roman Catholic Church in East Nusa Tenggara has developed a similar approach. “That community chose to examine cultural and religious values to find the motivation to tackle a totally new social problem,” notes Chris Dureau, the Project's institutional strengthener. They have also developed a special Catechism to promote AIDS awareness among the Catholic community.

Empowering Young People
Programs funded by the Project have reached Indonesian youth. Perkumpulan Keluarga Berencana Indonesia (PKBI - the Indonesian Family Planning Association) has been promoting family planning and providing sex education since 1957. The Project supported the development of AIDS-related publications and training materials, and PKBI now has a nationwide peer-educator program. “Before AusAID, there were just seminars,” recalls Sukri, PKBI's Makassar director. “Now we have an education program for youth about STDs.” High-school students say the program has taught them all they know about HIV/AIDS. PKBI encourages dialogue between children and their teachers, parents, families and religious educators. “PKBI provided a basis for our knowledge that was strengthened by religious education at home,” says 17-year-old Nurtaqwa, a student at a Makassar high school.

National Media Campaign
The Project has also supported a multi-phase National Media Campaign with television and radio ads and supporting print media that have been distributed by NGOs. The campaign has been directed primarily at young people and has moved from a general awareness campaign to one increasingly aimed at high risk behaviours such as unprotected sex and sharing needles among injecting drug users.

Improving Health Care
The Project has been working in the following areas:

• Helping to improve management and care services for STDs
• Developing a model for STD care for maternal and community
  health centres.
• Research into STD prevalence
• Providing equipment and supplies at two major laboratories in each
  of the three provinces.
• The government continues to work towards improving the standard of public medical care.

“The provinces have problems with facilities: there are limited staff and equipment,” acknowledges Mohammad Nuhrahim, executive secretary of the South Sulawesi Provincial AIDS Commission. The Project is funding and undertaking reliable measurement of the prevalence of a wide range of STDs. Researchers are studying sex workers and their customers, women in the general community and changing social attitudes towards HIV/AIDS. Laboratories are being provided with a wide range of material from major apparatus such as refrigerators and sterilisers to essential clinical supplies such as beds, syringes, medicines and reagents. Even medical workers themselves require education. “I'm constantly reminding medical staff to take precautions when operating on HIV+ patients,” says Dr. Tuti Parwati Merati, an infectious disease specialist at Udayana University in Denpasar, Bali. “Not many doctors have seen an AIDS patient,” she observes, as to date only 60 HIV+ cases have been officially reported in the province.

Minimizing Discrimination
The Project has sought co-operation to ensure patient confidentiality. Research funded by the Project into people living with HIV/AIDS has documented many instances of stigmatization and discrimination. The Project has funded support services for those with HIV and AIDS as well as programs to allow those living with HIV/AIDS to live prejudice-free lives in their communities. "There is a more sympathetic attitude,” notes Dureau . “A more socially acceptable image has replaced the 'Dracula' one.”

Nowhere is this more apparent than in the medical community. Tuti cites the case of a pregnant HIV-positive woman who went to a public hospital in Bali. Medical staff realised they had an excellent opportunity to study HIV in the long term with a patient who was interested in participating in her own case management. “Follow-up has been excellent because the doctors wanted to learn,” Tuti says. The child, now three years old, is HIV-negative while the mother is an HIV support group activist.

Decreasing risky behaviour

Using Condoms
Promoting behavioural change has been difficult. Recent surveys supported by the Project estimate that fewer than 20% of commercial sex acts take place using a condom. In the wider community, religious institutions traditionally opposed the use of condoms except in family planning. Project-funded education programs have done much to breakdown those barriers and promote interventions for specific groups with risky behaviour. Dialogue with religious and educational organisations has helped create an environment where condoms are regarded as an essential tool in the fight against AIDS.

There is still resistance to condom use, but the barriers are slowly being broken down. “Education about condoms is working,” insists Agustinus Agun, a coordinator with Bina Yusada, an NGO that operates a diagnostic clinic for sex workers in Kupang, West Timor.

Injecting Drug Users
The economic crisis of 1997-99 created mass unemployment and societal dislocations. Indeed, the effects of the crisis are still felt . One manifestation has been the increase in the number of users of injecting drugs, a major contributor to the spread of HIV/AIDS. Studies have shown that once the virus enters an IDU community it can spread very rapidly, with infection levels rising to above 50% within a year. At the moment, HIV infection among IDUs is reported at about 3% but many experts fear a sharp rise. As a result, the Project has conducted a rapid assessment and response study in collaboration with the USAID HIV/AIDS Prevention Program, the World Health Organisation, the Ford Foundation and PATH in eight Indonesian cities.

Unsafe Sex
Sex workers say they are constantly warning their colleagues and customers of the dangers of unsafe sex. When clients don't want to use condoms, women who have participated in peer education programs supported by the Project will remind them of the suffering their families wi ll endure if they are exposed to HIV infection. “That often changes their mind,” says Pur, a female sex worker in Kupang's Karang Dempel red-light district. Nevertheless, there is widespread resistance to safer sex. “Education alone doesn't appear to influence behaviour,” notes Wimpie Pangkahila, director of Lembaga Kesejahteraan Keluarga Indonesia (LEKKI -- the Indonesian Institute for Family Welfare).

As part of a strategy of increasing male participation in HIV/AIDS prevention, the Project is supporting research on clients of sex workers to develop more effective programs targeted at these men. Assisted by t  Project, two organizations in Bali and Makassar have effective.outreach programming, increasing awareness and promoting safer sex among the gay population. “Gay male sex workers have a better knowledge of HIV/AIDS than their female counterparts,” observes Tuti who, besides being a physician, is also a founder of Yayasan Citra Usahda Indonesia, working in outreach with youth and sex workers.

Reinforcement
The mobility of some sections o Indonesia's populations requires efforts to promote maintaining responsible behaviour and educating larger segments of the population. “Intensive follow-up is important,” explains Ketut “Suki” Sukiarta, an outreach worker with Yayasan Citra Usadha Indonesia, which helps men and women in Bali's sex and hospitality industries. “We need to make contact with the new workers and educate them and send them back into the community to educate others,” he adds.

The Future
Indonesia remains at considerable risk of an increasing HIV/AIDS epidemic. The Project identifies its future tasks as:

• Evaluating its activities to focus on the most effective means of education, communication and collaboration.
• Consolidating its considerable gains in the fields of prevention awareness, STD management and working to change risky behaviour.
• Expanding its activities to a wider cross-section of the community, such as injecting drug users and clients of sex workers.
• Continuing to work with government and non-government organizations to identify ways to minimise the transmission ofHIV/AIDS