THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 90
THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 91
A further challenge for the GoI is the changing nature of population distribution. There is an emerging trend towards increasing urbanization of the population, as demonstrated in Figure
3.2.8. At present, half of Indonesia’s population is urban and this is expected to increase to 60 per cent by 2025, along with the challenge of developing essential water, sanitation and hygiene
WASH infrastructure and services.
118
Along with this, is the growing size of slum areas in some of Indonesia’s larger cities see Figure 3.2.9. If this trend continues, there will be even greater
pressure on water and sanitation facilities. Recognising these trends and developing strategies to ensure there are adequate water and sanitation facilities for the urban poor in particular requires
the urgent attention of policymakers.
Figure 3.2.8: Projected changes in percentage of urban and rural populations, Indonesia 1990- 2015
Source: BAPPENAS, National Action Plan Study, 2009 Note: Kota = cityurban areas; Desa = villagerural areas
Figure 3.2.9: Slum areas in Indonesia, by hectare Ha over time, Indonesia 2004-2009
Source: BPS - Statistics Indonesia, based on Village Potential Data Collection PODES 2004-2009
118 World Bank 2009 Urban sanitation in Indonesia: Planning for progress
3.3 HIV AND AIDS
According to Indonesian National AIDS Commission’s ‘Country Report on the Follow-Up to the Declaration of Commitment on HIVAIDS’ the ‘UNGASS’ report, Indonesia has one of the fastest
growing HIV epidemics in the region.
119
In 2006 it was estimated that there were 193,000 adults living with HIV in Indonesia, 21 per cent of whom were estimated to be women.
120
By 2009, the estimated number of people living with HIV PLHIV increased to 333,200, 25 per cent of whom
were estimated to be women.
121
These figures indicate a feminization of the AIDS epidemic in Indonesia.
Since the first case of AIDS was reported in Indonesia in 1987, the number of reported cases has increased steadily. By 2006, 8,194 AIDS cases had been reported Figure 3.3.1.
122
According to the Indonesian National AIDS Commission KPA, Komisi Penanggulangan AIDS Nasional, the
number of reported cumulative AIDS cases in 2009 was 19,973 cases, 25 per cent of whom were women.
123
It is important to note that these are only reported cases and the data may be showing not only increased infection rates but also improved reporting tendencies and methods.
Figure 3.3.1: Cumulative AIDS cases reported over time, Indonesia 2000-2009
Source: Ministry of Health MoH, Directorate General of Communicable Diseases Control and Environmental Health CDC and EH, 2000-2009
By 2009, 15,608 of reported cases 78 per cent were for people of productive age 15-49 years. Between 2004-2009, the number of provinces reporting cases of HIV infection also increased, from
16 to 32 out of a total of 33 provinces.
124
Whilst, the ‘UNGASS’ report 2009 points towards a relatively low national adult prevalence of AIDS, at 0.22 per cent,
125
concentrated amongst high-risk populations injecting drug users, men who have sex with men, sex workers and their
clients, and the sexual partners of all of the members of these groups, the general trend towards increases in the numbers and prevalence of HIV and AIDS cases is a source of concern.
119 Komisi Penanggulangan AIDS KPA, Indonesian National AIDS Commission 2009 Country report on the follow-up to the Declaration of Commitment On HIVAIDS UNGASS
, National AIDS Commission KPA, Republic of Indonesia: Jakarta pVIII; See also UNAIDS WHO 2009 AIDS Epidemic Update, available at: http:www.unaids.orgenKnowledgeCentreHIVDataEpiUpdateEpiUpdArchive2009
default.asp Last accessed 1 September 2010 120 Komisi Penanggulangan AIDS KPA, Indonesian National AIDS Commission 2009 UNGASS report, p13
121 Ibid., p13 122 Komisi Penanggulangan AIDS KPA, Indonesian National AIDS Commission 2010 National HIV and AIDS strategy and action plan
2010-2014 , KPA: Jakarta, p14
123 Komisi Penanggulangan AIDS KPA, Indonesian National AIDS Commission 2009 UNGASS report, pvii 124 Ibid., pvii
125 Ibid., p2
1990 10
20 30
35 65
42 46
54 50
50 53
47 58
70
30 40
50 60
70 80
Kota Desa
Years
1995 2000
2005 2010
2015
Percentage
Slums Area in Indonesia
Years
2004 52,000
53,000 54,000
55,000 56,000
57,000 58,000
59,000
54,000 54,000
55,500 56,250
57,000 57,800
2005 2006
2007 2008
2009
Slums Area Ha Years
2004 5000
10000 15000
20000 25000
452 671
1016 1371
2682 5321
8194 11141
16110 19973
2001 2002
2003 2004
2005 2006
2007 2008
2009
Number
THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 92
THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 93
Since the year 2000, HIV prevalence has been consistently over 5 per cent in several key populations including injecting drug users IDUs, sex workers, transgenderists waria, and men who have sex
with men MSM, leading to classiication of the epidemic in Indonesia as a ‘concentrated’ one.
126
Speciically, the Integrated Bio-Behavioral Surveillance IBBS on HIV
127
among key populations found HIV prevalence as follows: direct sex workers 10.4 per cent; indirect sex workers 4.6 per cent;
waria 24.4 per cent; clients of sex workers 0.8 per cent
128
; MSM 5.2 per cent; and IDUs 52.4 per cent.
129
IDU and sexual transmission remain the main modes of HIV transmission in Indonesia.
130
However, there are indications of changes in the types of infected populations, with growing numbers of women - particularly the partners of IDUs and of male clients of sex workers - being
increasingly exposed to HIV infection.
131
Reported cumulative AIDS cases among women up to 31 December 2009 indicate that housewives make up the highest proportion of infected women
58.8 per cent.
132
Nationally, the transmission of HIV infection is also rising among MSM Figure 3.3.2, an alarming trend, according to the ‘UNGASS’ report 2009.
133
Analysis of the trends in the development of the AIDS epidemic in Indonesia demonstrates the present pattern of infection
and the projected future course of the epidemic Figure 3.3.2. Improving the use and reliability of condoms amongst the population most at risk of infection remains a key priority as current figures
indicate the use of condoms is worryingly low: 35 per cent amongst female sex workers, 35 per cent amongst waria transgenderists, 30 per cent amongst IDUs and only 15 per cent amongst MSM.
134
In order to tailor the response to the epidemic it is important to monitor trends in HIV transmission in all settings.
Figure 3.3.2: HIV trends and projections in Indonesia, 1980-2025
Source: Indonesian National AIDS Commission KPA, National HIV and AIDS strategy and action plan 2010-2014, 2010
126 Komisi Penanggulangan AIDS KPA, Indonesian National AIDS Commission 2010 National HIV and AIDS strategy and action plan 2010-2014, p14
127 Carried out by the Ministry of Health and BPS - Statistics Indonesia, in 2007. Ministry of Health and Badan Pusat Statistik BPS - Statistics Indonesia 2008 Integrated Bio-Behavioral Surveillance on Most at Risk populations in Indonesia IBBS-MAR 2007, BPS:
Jakarta 128 Data from a survey conducted in six cities among clients of sex workers including truck drivers, ship crews, longshoremen and motor
taxi drivers with prevalence ranging between 0.2-1.8 per cent 129 KPA 2010 National HIV and AIDS strategy and action Plan 2010-2014
130 Ibid. 131 BAPPENAS National Development Planning Board, KPA, UNICEF and UNAIDS 2008 Mathematic model of HIV epidemic in Indonesia
2008-2014 , UNAIDS: Jakarta p17
132 Ministry of Health 2010 ‘Cumulative AIDS cases among women up to 31 December 2009, by type of work’, Presentation by the Directorate General of Communicable Diseases Control and Environmental Health Dirjen P2PL, Ministry of Health: Jakarta
133 BAPPENAS, KPA, UNICEF and UNAIDS 2008 Mathematic model of HIV epidemic in Indonesia 2008-2014; see also KPA 2009 UNGASS report, p18
134 Ministry of Health and BPS - Statistics Indonesia 2008 IBBS-MAR 2007
Projections from the Ministry of Health MoH based on modelling of the HIV epidemic in Indonesia 2008 estimate that the projected HIV infection prevalence in the population aged 15-49
years would increase from 0.22 per cent in 2008 to 0.37 per cent by 2014.
135
The MoH estimates that without increased efforts to expand and strengthen prevention, treatment, care and support
services across the country, Indonesia will have almost twice the number of people living with HIV and AIDS in 2014 as compared to 2008, rising to 541,700.
136
Furthermore, it is estimated that of this figure a cumulative 185,700 people will die of AIDS, or an average of 23,000 per year.
137
Based on the projections in Figure 3.3.2, the MoH expects that aside from the rising levels of infection amongst the 15-49 year age group, and MSM, new HIV infections will increase among
women leading to a rise in infections among children. Therefore, special attention is needed to the potential for an increase in HIV infections among sexual partners intimate partners of people
in key high-risk populations. The MoH also expects that without the interventions mentioned above, the need for antiretroviral therapy ART will increase from 50,400 2010 to 86,800 people
2014.
Furthermore, in the two worst affected provinces of Papua and West Papua, the epidemic, which is driven almost completely by unsafe sexual intercourse, is categorised as a low level
generalized epidemic with HIV prevalence of 2.4 per cent among 15- to 49-year-olds in the general population.
138
The prevalence rate for the 15-49 year age group is almost 11 times the national prevalence rate of 0.22 per cent.
139
There are some plausible explanations for the severity of the epidemic in that region, but as the 2010 ‘UNGASS’ report conceded, “It is not entirely clear why
the infection is so much higher than elsewhere.”
140
The case of Papua will be reviewed in detail in the Section 4, but the root causes of the high rate of infection in that region are complex and rooted in a converging set of mutually reinforcing
structural, social and behavioural factors. The patterns of HIV transmission are somewhat distinct in Papua, with over 90 per cent of HIV transmission taking place through unprotected sex and
the frequent changing of partners.
141
The early onset of sexual activity in those provinces, lack of knowledge about reproductive health, sexually transmitted infections STIs and means of
protection, accompanied by a low usage and a low availability and accessibility of condoms, all play a part in the rapid spread of the infection.
142
Various studies also point to gender status issues - notably that women and girls tend to lack information and lack a voice in sexual decision-
making, which increases their vulnerability to infection.
143
Finally, the broader development context in Papua also provides a fertile ground for the spread of infection. The provinces of
Tanah Papua have experienced a rapid and uneven pattern of development, where widespread poverty remains the norm in the midst of an accelerated expansion of the explanation of
natural resources. The GoIUNICEF Education Sector Response report on the problem of HIV in Papua and West Papua 2009 also highlights the problems of poverty, levels of education and
knowledge about HIV, isolation in rural highland communities and the decreasing age of sexual debut as some of the root causes and challenges for tackling HIV and AIDS infection in Papua.
144 135 BAPPENAS, KPA, UNICEF and UNAIDS 2008 Mathematic model of HIV epidemic in Indonesia 2008-2014
136 KPA 2010 National HIV and AIDS strategy and action plan 2010-2014, p11 137 BAPPENAS, KPA, UNICEF and UNAIDS 2008 Mathematic model of HIV epidemic in Indonesia 2008-2014, p18
138 BPS - Statistics Indonesia and Ministry of Health 2007 Risk behavior and HIV prevalence in Tanah Papua, BPS: Jakarta. Data for this report were collected in 2006.
139 KPA 2009 UNGASS report, p2 140 Ibid., p24
141 UNDP 2005 Papua needs assessment: An overview of findings and implications for the programming of development assistance, UNDP: Jakarta Indonesia, cited in: KPA 2009 UNGASS report, p25
142 KPA 2009 UNGASS report, pp24-24 143 Ibid.
144 GoIUNICEF 2009 Averting new HIV infection in young people in Papua and Papua Barat: An education sector response, January 2010-December 2013
, GoIUNICEF: Jakarta
1980 1985
19990 1995
2000 2005
2010 2015
2020 2025
25000 50000
75000 10000
125000 150000
175000 200000
225000
New Infection of HI V
Female low risk Male low risk
MSM IDUs
FSW Male sex workers
Client of sex workers
