Jakarta – Even though the Indonesian province of Papua sits on the sprawling nation's remote, far-eastern frontier, it has been placed squarely on the frontlines of the fight against HIV/AIDS.
Experts say the small province, with about 2.5 million people, has the highest prevalence of HIV/AIDS rate in the archipelago – some 30 times the national average – ranking just behind Jakarta as the province with the highest number of total cases, more than 1,700.
These same experts say a change in tribal cultures and values in Papua has contributed largely to the mushrooming infection rate since the first case was diagnosed in the province 10 years ago.
"In the last 10 years, there have been many, many changes," said Gunawan Ongkokusumo from the Papua office of Family Health International. "Many new things have come."
"There's so much alcohol, so many porno vcd's [video cd's]. More people have more money and are looking to have more fun," Gunawan said. "This new culture is the biggest cause of the problem." Among such strong cultural influences as pornography and alcohol has come a sharp increase in the number of sex workers, which experts say has been paramount in trying to cope with the problem.
Some 96 per cent of HIV infections in Papua are caused by sexual transmission, with AIDS activists saying most of these cases can be traced back to the commercial sex industry.
Gunawan pointed to studies showing that more than 95 percent of HIV/AIDS carriers in Papua were people having frequent sexual contact with commercial sex workers, were spouses of people who often had sexual contact with those living in high-risk communities, such as commercial sex workers, or were sex workers themselves.
Intravenous drug users were less than 2 per cent of HIV/AIDS cases, while homosexuals made up less than half of one per cent. Researchers say the increased availability of commercial sex in Papua has been coupled with a sharp rise in demand.
The development of the country, which has been hastened by an influx of such industries as mining, fisheries and timber, has brought with it more money and mobility, changed perceptions about sex, and fewer traditional rules by which to abide.
"Where development occurs, there are a lot of men who are separated from their families who have a lot of money," said Nafsiah Mboi, senior consultant for the government's National AIDS Commission. "It's there that you also see a lot of commercial sex and sex among the population." "A lot of the protective tribal environment is lost when they move to the cities," said Nafsiah Mboi, senior consultant for the government's National AIDS Commission. "And the cities are growing very fast." Researchers say that even within tribes, laws have often slackened. Members of some tribes who previously would have been beaten, expelled or sentenced to death if caught having premarital sex or extramarital sex are now often only fined.
The incentives fueling the increased demand for sex are in addition to what researchers say is a historically highly-sexual population.
An American researcher, Leslie Butt, found in a survey that more than 30 percent of male Papuan respondents admitted they had at least 10 sexual partners during the course of their lives, with 25 percent saying they had more than 50 partners, according to the Jakarta Post. The majority of respondents acknowledged they had experienced sexual contact before the age of 15.
"Alcohol and pornography and more liberal views have probably influenced the rate of HIV infection, but there's also a long history that has put them at risk," said Dr. Stephen Wignall, country director of Family Health International.
Aids workers say the increased rate of sexual activity has not seen a corresponding change in the frequency of condom use, and awareness among Papuans about condoms and sexually-transmitted disease, in general, remains very low.
Butt's study also found that of 175 respondents, 149 said they never used condoms.
A low education rate and access to media, poor physical infrastructure and the rugged terrain of the area contribute to the problem of getting the word out.
"It's a logistics nightmare there," Wignall said. "That makes it [fighting HIV] a huge challenge." NGOs are engaged in education campaigns and local officials are considering passing new regulations to raise people's awareness and use of condoms, but some AIDS workers say their biggest hope comes from the new government, which they expect will take a more vigorous approach to the problem.
"There's hope that there will be more government leadership and talking openly about the problem," Wignall said. "Tackling this problem is going to take real attention and acknowledgement on the part of the government."