Afifan Ghalib Haryawan, Jakarta – Indonesia is one out of three countries that has seen an increase in HIV/AIDS along with the Philippines and Russia. While the world trend is decreasing, Indonesia failed to reduce the transmission of the human immunodeficiency virus and mitigate the harm.
Thus far, it has only managed to diagnose 47 percent of people living with HIV from an estimated 640,443 HIV positive cases; only 32 percent of people living with HIV received antiretroviral drugs from 301,959 diagnosed HIV positive cases and less than 1 percent of people living with HIV has been successfully treated and exhibited undetectable HIV in their blood.
This gap is immense compared with 90 percent of the target for each indicator as urged by the United Nations Agency on AIDS (UNAIDS), which aims to eliminate HIV as a public health threat by 2030.
Stigma and discrimination against people with HIV/AIDS remain strong in Indonesia. Such stigma elicits an irrational or fear-driven negative attitude, behavior, and judgment toward people living with HIV and those perceived to be living with HIV. Recently, students living with HIV in Samosir, North Sumatra, and Tulungagung, East Java, feared being expelled from their respective schools.
Such stigma and discrimination or fear of being stigmatized and discriminated against cause anxiety, depression, guilt, isolation, low self-esteem, disruption of family dynamics, physical and emotional violence, intensification of grief, and loss of social support.
Self-stigma bundled with discrimination prevent people from accessing education and information on preventive behavior, refute risk, refuse to test, not seeking health assistance, delay treatment, and not adhering to therapy. This health-avoiding behavior results in the increasing HIV rate of transmission, declining of patient's quality of life and a higher risk of AIDS-related death.
This year's World AIDS Day on Dec. 1, which was its 30th anniversary, addressed this issue with the theme "Know your Status". Those afraid of being stigmatized may avoid even testing, let alone seek treatment.
According to the Basic Health Research (Riskesdas) 2018, 65.2 percent of Indonesians have a poor understanding of HIV/AIDS. Misunderstanding or lack of knowledge about HIV/AIDS has contributed to public fear, stigma, and discrimination. People must understand that HIV/AIDS can be prevented and managed so that people living with HIV can live as healthily as normal people.
Health workers have the credibility to inform society and convince them to destigmatize HIV/AIDS. Thus, health facilities are pivotal to help put an end to stigmatization and discrimination. They must be strengthened to empower people living with HIV. There are three important messages for health workers to circulate in society.
First, with the advent of antiretroviral therapy, HIV is now a manageable disease. We can prevent HIV from becoming AIDS, a very dangerous late stage of the disease. AIDS-related deaths dropped dramatically from 11 per 100 persons per year in 1992 to 0.144 in 2006. HIV infection is no longer a death sentence as newer and safer drugs are available as the government provides free drugs to people living with HIV.
Second, HIV transmission can be prevented by abstinence from sex with a high-risk partner, using condoms, and avoiding communal syringes. Transmission from mother to child can also be prevented during pregnancy as long as the mother takes her daily pills.
Moreover, not all people who are HIV positive transmit the virus. Recent research shows that people living with HIV who take medication regularly and have undetected HIV in the blood (the virus is suppressed by the drug) do not transmit the disease.
Third, this disease is not dependent on morality. Most patients (28 percent) are housewife and her vertically infected children, medical staff accidentally punctured by needles from patient and blood transfusion recipients. Our stigma-producing society makes such people suffer more.
UNAIDS has identified that reducing stigma and discrimination is a critical part of the national HIV/AIDS program. Countries with low stigma and discrimination towards HIV/AIDS program have been more successful in their prevention and treatment program. As HIV infection rates are rising, Indonesia must destigmatize HIV/AIDS to reduce its transmission and HIV-related mortality in Indonesia.
[The writer is a physician who graduated from the University of Indonesia (UI) with experience in West Papua and Jakarta. He is working on the LINKAGES project to improve HIV continuum of care in Indonesia.]