Elly Burhaini Faizal – A survey shows that HIV positive people and AIDS victims are still being denied access to social security schemes needed to help mitigate the impact of the epidemic.

Organized by the HIV/AIDS Research Center at the University of Atmajaya, the survey conducted this year in four cities – Jakarta, Pontianak in West Kalimantan, Semarang in Central Java and Yogyakarta – reveals that most social insurance providers both public and private have no social security arrangements for people with HIV/AIDS.

Octavery Kamil, National Coordinator of the Institute of Research and Community Service at the university, said that no social security providers were providing healthcare specially designed either for people with HIV/AIDS or family members affected with the disease.

"We have examined health coverage program mechanisms provided by state-owned social security providers, including Askes, Taspen, ASABRI and Jamsostek, as well as private insurance companies. Unfortunately, all of those insurance providers have a clause in their insurance policy saying that the insured is not allowed to receive the benefits if the insured contracts the disease," Octavery told a media briefing held by the International Labor Organization (ILO) last week.

Jamkesmas community health insurance scheme is the only healthcare coverage that explicitly offers HIV/AIDS treatment coverage. "In reality, however, not all HIV/AIDS-related medical treatment can be covered by the Jamkesmas," Octavery said.

Providing proper healthcare is critical to preventing the spread of HIV/AIDS because medical treatments needed by people with the illness are much more than antiretroviral therapy only, the study shows.

Having steady increases of annual budgetary allocations for tackling HIV/AIDS epidemics, the government is providing HIV/AIDS victims antiretroviral therapy, including treatments for HIV/AIDS-related opportunistic infections, free of charge. Yet many patients cannot afford other necessary treatments such as viral load and CD4 tests nor can they get medical consultations from doctors, as the expensive treatments are not covered by the government.

The report says that health insurance sponsored by the provincial administration – be it Jamkesda or Jamkesos – do not explicitly offer HIV/AIDS coverage due to the shortage of resources. "Even in a region that can deliver HIV/AIDS treatment, most HIV/AIDS patients should contribute part of the cost of either medical treatment or drugs," Octavery said.

Husein Basalamah, who lives with HIV/AIDS, has experienced the difficulties in acquiring healthcare. Though he could have his treatment covered by Jamkesmas, complicated and terracing procedures applied by the healthcare scheme were daunting.

"We cannot keep our HIV status a secret because we have to attach necessary documents, including ID card and relief letter (SKTM) each time we need to have our treatment covered by Jamkesmas. Such complicated procedures, at the end, force us to reveal our HIV status," he said.

Most HIV/AIDS-infected people in Indonesia work in the informal sector, forcing them to seek coverage from private companies. However, many companies offer no coverage for people living with HIV/AIDS in their security schemes.

"I've encountered difficult situations several times in which I have to lie about my HIV/AIDS status on the insurance application," said Husein, who is also an activist in the Indonesian Network of HIV-Infected People (JOTHI). Even if the insurance application is approved, he could still be denied coverage by the insurance company in the HIV/AIDS referral hospitals since they required a clear statement of the status of their illness, he added.

Such bitterness, he said, showed that HIV and AIDS-related stigmas and discrimination persisted. "Please, don't discriminate against us. We need you to see us as human. We really want social justice and equality in this country," he said.

Stronger protections for people with HIV/AIDS is higher need, as the figures are continuing to increase. ILO data shows that the number of HIV/AIDS-infected people in Indonesia will increase to 501,400 in 2014, up from 227,700 in 2008.

The HIV incidence rate among people 15-49 years old will increase to 0.37 percent in 2014, up from 0.22 percent in 2008. "We need more HIV/AIDS-friendly social security schemes," said Risya A. Kori, National Program Officer for HIV and AIDS at the ILO Jakarta Office. Nancy Fee, Country Coordinator of UN AIDS Indonesia, said it was a challenge now to make sure that HIV/AIDS-infected people and their families are protected.

"It's an issue now how they can have access to health insurance, so they can continue to live, to be healthy, and to keep working to support their families," she said.