Jenny Munro, Els Rieke Tieneke Katmo, Yustina Wambrauw – HIV is rife in West Papua. The Indonesian province is reported to have the highest levels of infection outside of West Africa, with Indigenous peoples particularly affected.
Rampant social inequality, militarisation, and stigma magnify the impact of the disease. Research has shown that disease follows, and worsens, social inequalities, with West Papuan women in particular facing triumvirate barriers of economic disenfranchisement, sexism, and racism.
Further, in rural areas, a largely unregulated frontier economy based on extractive industries restricts effective intervention, whilst the healthcare responses that do exist struggle to manage.
This would be an imposing suite of challenges at the best of times. The COVID-19 pandemic, however, has made things even worse.
The Joint United Nations Programme on HIV/AIDS has been raising the alarm for some time, with its executive director saying recently "progress in AIDS, which was already off track, is now under even greater strain as the COVID-19 crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence prevention programmes and more."
This assessment has been reinforced by locals in West Papua's Bintuni Bay, who across a range of interviews conducted by Dr Els Rieke Tieneke Katmo and Yustina Wambrauw, indicate that HIV prevention has stalled for the last two years.
Public health regulations directed at the pandemic diverted resources and restricted health workers' mobility. This left them unable to conduct HIV outreach activities in settings like schools, healthcare providers, and entertainment venues.
Concerningly, this overworking and diversion of health workers has also affected HIV reporting, meaning the true scale of the epidemic remains unknown. As such, the deterioration of health and social conditions, esepically in rural Papua, has been largely invisible to urban-dwelling researchers and policymakers.
In equally troubling news, some community and government leaders have maintained that HIV is not a problem in their areas, and even that there are no cases of the disease. However, the vast majority of health workers believe that given limited testing and unreliable reporting, the cases they are aware of are just the tip of the iceberg. This has long been the case in West Papua, where historically most infections have not been detected.
Health workers believe most new cases are in young people and married women – often via their husbands. This unfortunately adds another barrier to detection, as many women see seeking out a HIV test as an admission that they themselves are engaging in extramarital sex.
The structure of local economies in West Papua are also a factor contributing to the spread of HIV, along with sexually transmitted infections and violence. Frequently, local male employees of mining companies maintain multiple sexual partners, whilst government disbursements of 'village funds' have allowed widespread transactional sex and alcoholism – as well as domestic violence – to flourish.
Moreover, the pandemic has disrupted young people's education, leading to many dropping out of school. Our informants said that the number of visibly drunk or drug-affected young people in their towns has increased.
Young people in the province often travel back and forth from their towns to larger cities, accelerating the spread of HIV. Crucially, sex education for youth in West Papua is overwhelmingly abstinence-focused, despite the fact most are sexually active and vulnerable to exploitation.
Whilst these interviews could not give a full overview of how widely HIV has spread during the COVID-19 pandemic, they do show that West Papuan locals are increasingly concerned. On a small scale, pilot programs for new HIV prevention activities are being developed with local people, but it is clear that the problem demands far more attention and resources. If there is genuine interest in addressing inequality in West Papua, Indonesia, and the region more broadly, community-based HIV prevention must return to the top of the policy agenda.