Ian Timberlake, Jakarta – On paper Indonesia doesn't have much of a problem with HIV and AIDS. But the huge country's relatively low adult HIV infection rate belies a rapidly escalating level of infection among prostitutes, their customers, injection drug users and prisoners, an AIDS worker said.

"Indonesia has one of the fastest growing epidemics in the world now," said Elizabeth Pisani, an epidemiologist with Aksi Stop AIDS, an AIDS prevention and care group. The World Health Organization and UNAIDS warned in a report this month that HIV in Indonesia, along with China and India, is in danger of leaping from the high-risk groups and into the mainstream.

Based on government figures, there are about 130,000 Indonesians currently living with HIV/AIDS, up from 110,000 last year, Pisani said in an interview with AFP. According to the UNAIDS agency, Indonesia's overall adult HIV prevalence is a "relatively low" 0.1 percent of the adult population. Pisani said the figure is low because of Indonesia's huge adult population of 115 million, a relatively small proportion of whom – about 14 million – engage in risky behaviour.

For the injection drug users, prostitutes, their customers and others in that high-risk group, the figures are alarming. "Around one in two injectors in Jakarta is already infected with HIV and around 90 percent are sharing needles," said Pisani, whose agency is a joint project of Indonesia's Ministry of Health and USAID, implemented by Family Health International.

Citing government data, she said 13 percent of clients of female prostitutes used a condom in all their encounters over the past year, "which compares very, very poorly with some of Indonesia's ASEAN neighbours." Among female prostitutes the rate of HIV infection is still low compared with other Asian countries but is growing extremely rapidly, Pisani said. The rate is more than eight percent in Riau province, whose red-light district is a popular destination for some Singaporeans.

Merauke in Papua province also has an infection rate of more than eight percent. Another Papua town, Sorong, has the country's highest level of infection at 16 percent, she said, again citing government figures. "These have all gone from zero in basically the last three or four years," she said, adding that among transvestite and transsexual prostitutes in Jakarta the infection rate is 22 percent. By comparison, more than a quarter of adults aged 15-49 have the virus in southern Africa.

In a speech to mark the launching of "Indonesia's National AIDS Strategy" last May, Peter Piot, executive director of UNAIDS, said Indonesia could forestall the devastation seen elsewhere if it seized the opportunity to "deal a decisive blow" against the epidemic. "But that will require full-scale prevention efforts – reaching every schoolgirl and schoolboy, man and woman across the country, and full-scale care accessible to all who need it," he said.

"However, if there is no change to the intensity of the response to AIDS, then the epidemic will inevitably grow," Piot said. Pisani said drug addiction and prostitution, driving factors behind HIV infection in Indonesia, were behaviours the government found difficult to address particularly with an election next year. Indonesia is the world's largest Muslim nation and President Megawati Sukarnoputri, a moderate, cannot risk losing support from Islamic-based political parties, political analysts say.

However, Pisani said there were increasing signs of political awareness about the extent of Indonesia's HIV threat. "I think we've really come quite a long way," she said. "But turning awareness into policy and action in Indonesia has always been a great challenge".