CONTRIBUTING FACTORS TO THE GROWING RATES OF HIV INFECTION IN PAPUA PROVINCE

THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 238 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 239 schooling. Also, teachers do not carry out their functions and duties properly as educators and instructors. Even worse, some of them are violent towards children, which could lead to children themselves being violent in the future. Views on sexual practice and HIV transmission: • What goes on in the neighbourhood has a huge inluence over children’s way of thinking and lifestyle, like drinking, smoking and ‘free sex’. The greatest amount of inluence comes from peers. • Pregnancy out of wedlock is a common thing in Papua since in local customary norms there is no burden of sanctions or paying fines to the pregnant woman’s family. Moreover, ‘free sex’ is also perceived as a prevalent thing, so that HIV is easily transmitted. • HIV and AIDS is commonly known as the ‘three letter disease’ HIV or ‘seven letter disease’ HIV-AIDS. It is a common disease in Papua. Its transmission is uncontrolled since it is dificult to control and monitor people and children who engage in ‘free sex’. Perceptions about problems with government assistance: • Assistance through health initiatives has been implemented well enough, but progress in education is less monitored. Funding comes from higher levels of government through so many levels of the bureaucracy that by the time it arrives at the school, the funds ‘have been cut a lot’. As a result, the students don’t feel the benefit of the assistance. Schools only ask the students for their signature without giving the money directly. • Monitoring and supervision of this assistance doesn’t really happen. Corruption cases are difficult to investigate. • Child forums, which are supposed to be a way for children to help themselves, have not functioned very well. Lots of children are not active in these forums and prefer to focus on their social life, with all its negative effects. • Political conditions don’t really help children. The main problems are the complicated bureaucracy and corruption. Source: Four FGDs conducted at a local church in North Jayapura 17, 18, 20 and 22 September 2009. Participants were four boys and four girls, both indigenous and non-indigenous Papuans, aged 12-15 years. During the multiple discussions with children during the FGDs and the in-depth interviews, they explained that HIV and AIDS could be spread by ‘free sex’ and switching partners, not using protection during sex, blood transfusions, and by injecting drugs with needles. However, almost all children argued that the largest contributing factor is ‘free sex’. They said that ‘free sex’ does not violate cultural norms in many but not all communities, and many customary communities adat communities consider pregnancy out of wedlock hamil di luar nikah to be something that doesn’t incur heavy customary sanctions. Usually, they said, men might need to pay a customary ine. Children who are most likely to engage in ‘free sex’ are those from broken homes, they said, or those experiencing peer pressure. They also explained that partying and heavy drinking contribute to the problem, as children who have ‘free sex’ when they are drunk are more likely not to use protection and consequently more vulnerable to infection. However, not all of the children participating in the FGDs and interviews agreed about the practice of ‘free sex’. Some saw it as meaning that children are not taking care of themselves, while others said it was acceptable when someone gained employment or as long as they were responsible and paid the customary ine, and others said ‘free sex’ was prohibited by religion. Nonetheless, not all Papuan children understand the relationship between sexual practice and the risk of HIV infection. For example, Novendi 253 , one of the Papuan boys interviewed during the research, didn’t know anything about HIV and AIDS. Another child, Ona, who is living with HIV, didn’t know about the disease or its treatment. Ona said, “I know there is no medicine for HIV and AIDS. I get some medicines or vitamins that I have to take every day after eating. If I run out I go to the local foundation that gives me this.” Essentially among the government, development workers, service providers and practitioners, CSO staff, and children themselves, there is an understanding of the long list of contributing factors to both vulnerabilities for children in general such as poverty, poor living conditions, poor education, parent-child relations in the domestic environment, attitudes amongst children towards unprotected ‘free sex’ and in relation to HIV transmission in particular such as knowledge, behaviour, resistance to current modes of education and public information campaigns, attitudes towards illness, and the provision of support and treatment services. However, knowledge about the disease among children themselves is varied. A number of other studies and interviews conirm some of the FGD indings on what is driving the HIV and AIDS epidemic in Papua, which are discussed further below to show why current interventions might not be having an optimal impact in the region. 4.3.4.2 Perceptions of illness, knowledge and language of communication: The challenges for preventing transmission It was repeatedly evident during the ieldwork that preventing HIV transmission in Papua is not simply a matter of basic education about the disease and its effects, although education levels are a problem as has been outlined by various studies mentioned above and in the FGDs. It is a far more complicated problem of communication between people who are knowledgeable of the disease and local communities. In particular, there is resistance to understanding the manifestations of the disease and its relationship with sexual practice and behaviour, and resistance to changing behaviour when it is painted as immoral or as leading to the spread of the disease. Even when people are informed about the disease and its effects, often because it is communicated in ways that are not culturally sensitive, they resist changing their behaviours. Furthermore, some people in the province are suspicious about the origins of the disease. The discussion below highlights that combating HIV and AIDS in the province through knowledge is not just a matter of mass education drives, but rather information dissemination in a culturally sensitive and appropriate way. A number of health practitioners and CSO staff highlighted that one of the problems with HIV prevention is that in the initial stages of infection, people don’t feel sick, so they don’t change their sexual practices to prevent transmission. For example: “HIV and AIDS transmission is strongly related to behaviour. It is dificult to get people who are already infected with HIV or AIDS to change their behaviour. This is what makes the virus so effective. When people get infected, they don’t feel sick. What’s more, they don’t believe they are sick even when they are told they have HIV because they don’t feel sick. So they don’t change their behaviour to prevent transmission.” Participant in FGD with staff from the Jayapura Church and Muhammadiyah organisation, 11 August 2010 253 All names have been changed to protect the interviewees. THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 240 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 241 Another FGD participant further highlighted that: “The problem with changing behaviour is that it is strongly related with levels of knowledge. For those who don’t know about HIV and AIDS it is dificult to get them to change their behaviour, even when they have been infected. This is partly a problem of communication. Often we are lied to [by patients] when we conduct the voluntary counselling and testing. We ask the patients, have you had sex? They say, never. But if we ask [using different terms and language] have you ever ’had it off‘ baku cuki or ’got on top of a woman‘ they say they have. Indeed, these are slang terms that could be considered crude. But we have to use their language so we can communicate and they understand what we mean.” Director of Waena Hospice, 12 August 2010 What’s more, there is the perception in Papua that HIV and AIDS is some kind of trick. Given the struggles between Papuans and the central government for greater autonomy and ultimately independence over the last four decades, different CSO staff and religious leaders argued that there is a fairly strong perception that HIV has been deliberately brought in from outside to get rid of the Papuan race. The view expressed in the following quote was also articulated in a number of other interviews with practitioners struggling to educate about prevention of HIV transmission: “Changing behaviour for people infected with HIV [such as monogamy or condom use], often doesn’t happen because many in the community still believe that HIV and AIDS are a trick. Many still believe that HIV is part of an effort to commit genocide by the central government by bringing in commercial sex workers who are already infected with the virus in order to get rid of the Papuan race.” Confidential interview, 12 August 2010 It was evident in the information gathered during the fieldwork, FGDs and in-depth interviews, that one of the greatest challenges to preventing transmission is getting people to understand how the virus works and that it is a problem throughout the world and not just in Papua. The Head of the AIDS Commission in Papua said: “I try to impress on the community here that HIV and AIDS are not just in Papua, but it is a problem across the world. HIV prevention will be effective when the Papuan people are active in its prevention.” 10 August 2010 It is important to bear in mind that talking about HIV prevention in Papua is fraught with tension and contradictions, especially when the practices defined and celebrated by cultural values are implied to be immoral, or the imperative of changing accepted behaviour is pressed on local peoples, or sexuality is framed in terms of ‘risk’ and ‘promiscuity’. Customary practices are often viewed as exotic or immoral and are devalued and discouraged in the discourse of HIV interventions, which thus meets ith resistance in communities. 254 As one medical doctor working in the sector put it: “When we talk about Papuan culture, particularly as relates to conjugal relations, non- Papuans tend to focus the discussion on stereotypes of Papuan sexual practices. They are often highlighted as deviant and dangerous. You know, wife swapping, sequential sex and the like. The cultural practices are taken out of context. They are construed as bad. People who work in the field of health point a finger at culture as the underlying cause of the HIV and AIDS epidemic. Then people wonder why Papuans are reluctant to talk about the relationship between culture and HIV and AIDS. Some people even portray Papuans as defensive when they talk about the relations between AIDS and their culture.” in-depth interview, medical doctor, Jayapura, 14 September 2009 254 Butt, L., Numbery, G. and Morin, J. 2002 Preventing AIDS in Papua, Universitas Cenderawasih: Jayapura; Seidel, G. and Vidal, L. 1997 ‘The medical, gender and development, and culturalist discourses on HIVAIDS in Africa, and their implications’, in: Shore, C. and Wright, S. Eds, The anthropology of policy, Routledge: London, pp59-87 Cultural understanding of sexual practices in Papua is incredibly important for creating culturally sensitive forms of communication about HIV transmission, particularly since condom use is low in Papua. 255 While condoms are an effective way of reducing the transmission of HIV and they are relatively cheap and accessible, still promoting behavioural change and condoms use is difficult in a context where there are value systems relating to when and where bodily fluid should be discharged. 256 While research has shown that Papuans have a low level of understanding about HIV and AIDS, there have been few studies that situate knowledge of HIV risk and prevention in a broader context of cultural practice and experience. Studying sexuality in Papua is a complex undertaking. There are over 250 linguistically distinct cultural groups in Indonesia’s easternmost province. It is just as difficult to generalize responsibly about Papuan sexuality overall as it is to fully describe the unique practices and beliefs of particular tribal groups. Being mindful of the diversity within Papua, a Papuan anthropologist gives the following snap shot of Papuan sexual practices. His observations and analysis support some of the indings from the FGDs and other studies discussed above. Furthermore, he also explains how there may be a mismatch between information drives and locally accepted practice: “There are several things, some of them may have roots in culture, some may be the result of newer trends or changes, that we have to take into account when we talk about HIV and AIDS in Papua. “The first thing is age at first sexual encounter. The age seems to be getting younger and younger. Then there is ‘secret sex’ that happens in social events like parties. It is, well, a secret, so it is clandestine. Somebody will ‘hook up’ the couple. It involves gifts, either money or goods. This also takes place across cultural boundaries, such as when people travel outside of their local areas. So it related to a high degree of mobility. “There are some deviations from norms in other places, such as extramarital affairs and multiple sexual partners. A small number of people may have very active sexual lives. In some places some older men have sex with younger girls. There are some cultural roots for this trend. “There is seks antri sequential sex, in which a group of men has sex with a single woman, one after the other. It’s not gang rape, since this is agreed upon and negotiated. Usually it involves a group of men who don’t have enough resources to give gifts to a potential girlfriend. They seek other men in a similar position to pool resources. This places the girl at risk of contracting HIV and AIDS and at risk of facing violence. “Don’t forget social changes that encourage the use of pornography to incite sexual activity. Increasingly, girls and boys may be having sexual intercourse at a very young age. “Oh, I almost forgot to mention that gift-giving that relates to sexual intercourse is rooted in some local cultures. Bride price is one example. When a woman is exchanged for bride price, people understand that a part of the exchange includes sexual access for the groom. 255 BPS - Statistics Indonesia and Ministry of Health 2006 Situasi perilaku berisiko dan prevalensi HIV di Tanah Papua 256 Butt, L., Numbery, G. and Morin, J. 2002 Preventing AIDS in Papua THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 242 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 243 This exchange of goods for sex is already part of the cultural make-up in many Papuan groups. This is important to understand because nowadays some people give cash as a gift. That can be misconstrued as commercial sex by somebody who is not familiar with the Papuan culture. Well, in a lot of cases it is not commercial sex, even when the women have sex with multiple partners. “Now, having sex with ‘friends’ and ‘acquaintances’ in Papua offers a similar level of risk to having sex with sex workers, but the difference between the two is not necessarily clear to the many youth who have sex with members of both groups. Promoting safe sex with friends needs to be a prominent feature of youth-focused campaigns. “This pattern is also shaped by economic changes, for younger girls may have sex with older men because they imagine older men to be rich and able to easily look after them.” In-depth interview, Papuan anthropologist, Jayapura, 9 September 2009 It is evident that understanding Papuan sexual practices is important for those working in health service delivery and HIV prevention, especially concepts of monogamy and multiple sex partners. As one CSO activist in the field put it: “Now, when we talk about the relations between culture and HIV and AIDS we have to be aware that there are two cultures at play, the Papuan and the non-Papuan cultures. Health providers and health users often belong to different cultures. If the health provider belongs to a culture that adheres to monogamy, don’t you think that he or she will look at monogamous relationships from his or her cultural angle? I think there is a possibility that health providers will look down upon the culture that is not their own. As a consequence, the local culture is labeled as being a risk factor for HIV and AIDS infection. While that may be so, a judgmental tone won’t sit well with the Papuans.” NGO activist, Jayapura, 13 September 2009 Understanding of Papuan value systems is crucial for shaping policy regarding HIV and AIDS. In Papua, government and non-government agency employees work together to educate the general population about AIDS, using a simple prevention message based on the ABC approach: A for abstinence abstinen, B for be monogamous baku setia, and C for use a condom kondom. Given the lower age of sexual debut discussed further below, and what are considered to be locally acceptable sexual practices, there may be a mismatch between the information conveyed in HIV prevention campaigns and local value systems, particularly with regard to abstinence and monogamy. This is especially the case given that a 2009 University of Indonesia survey of adolescents found that males, particularly in the 16-18 years age group, were more likely to have had multiple sexual partners, particularly in eastern Indonesia - in NTT and Papua. Realistically, safe sex may be a more appropriate way to address the risks of HIV and AIDS, albeit with less political viability. 257 4.3.4.3 Early age of sexual debut The average age of sexual debut is 19.5 years for males and 18.8 for females, according to 2006 data. 258 However, among youth in Papua 15-24 years the number with sexual debut before 15 years of age is significantly higher than amongst people in older age groups 25-39 and 40-49 257 Ibid. 258 BPS - Statistics Indonesia and Ministry of Health 2006 Situasi perilaku berisiko dan prevalensi HIV di Tanah Papua years. 259 In 2009, the University of Indonesia conducted a survey on the situation of adolescents in Indonesia, as discussed previously in Section 3.3. Amongst survey respondents aged 10-18 years old, the earliest age of sexual debut reported was 9 for boys and 11 for girls in the rural Jayawijiya district, and the average age for girls was 14.8 while the average age for boys was 13.7 in this district. However, in the more urban Jayapura municipality, the average ages of sexual debut were higher 15.5 for boys, 15 for girls with the earliest reported ages among respondents also being higher, at 13 for boys and 15 for girls. These results confirm the findings of 2006 data and also illustrate that the age of first sexual debut may be younger in more rural areas in the province. Like many teenagers around the world, teenagers have sex for a variety of reasons, but knowledge of safe sex can prevent transmission of HIV. Two children describe their experience in Box 4.3.3 below, where lack of condom use in one case led to HIV infection. Box 4.3.3: What youths say What Nita, 16 years old, says... “Here’s how it went. That night he asked me, ‘Do you care for me?’ I told him I did, and he asked me to prove it. Well, I asked, ‘Prove what?’ He then told me to close my eyes and it happened blah…blah…blah... and on that night I was introduced to the world of sex. It happened on a Saturday, at midnight on 8 August 2008. At the time I was so afraid of losing him and I didn’t want to be apart from him, and I hoped one day to always be with him.” After the incident, Nita suffered a pain in her vagina and had difficulty walking for a week. She also described her feelings after the incident. “I told my boyfriend that I was hurting, and he took pity on me, apologized and felt guilty. I also felt guilty, towards God, because I know it was against religious teachings, because we weren’t married. I also felt guilty towards my mother, because she gave birth to me, but now I no longer listen to her words. I’m no longer a trustworthy daughter. Even though my mother doesn’t know it, I still feel guilty.” To prevent infection, Nita says, “We always have an umbrella [condom] ready before anything happens.” Nita has not told anyone else that she is sexually active. She considers it a secret not to be shared with anyone, because she fears the potential scolding, the guilt, the shame, the mocking, and being cast out. She has not told her relatives, best friends or her dance-group friends, even though her friends often come to her with their secrets. Although, she says, “They often confide in me, telling me that they’ve had sex with their boyfriends or with someone else. Often they tell me these things clearly while feeling guilty or sad, and ask that I keep their secrets. I feel for them, I give them advice. Still, even though many of my friends tell me these things, I don’t want to tell them my secret, I’m too ashamed and embarrassed. It’s my secret. Only I, my boyfriend, and God, knows.” Nita acknowledges that being in her teens makes her very vulnerable and impressionable. Nita confesses to often yielding to peer pressure to smoke, drink alcohol and other reckless activities. Many of her friends like these activities, and Nita often finds herself joining in. She feels that her happiest moments in life are moments spent with her friends. Nita is less comfortable and content at home because of her father’s strict parenting and her awareness of the family’s less than prosperous economic situation. 259 Ibid. THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 244 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 245 What Natalia, 15 years old, says... Natalia ran away from home when she was 15 and still has limited contact with her family. She is HIV-positive. She says, “[My ex-boyfriend] said that if we love each other we don’t need to use condoms, he said, ‘If you get pregnant, I’ll take responsibility.’ That’s what he said the first time we had sex. Initially I was afraid, but he said if I loved him then I have to prove it, and that I’ll have to let him take my virginity. My ex-boyfriend infected me with HIV. I’m certain it was him because I went out with him for a long time, and I was still with him when I found out I had been infected.” “After I broke up with my ex-boyfriend, I became a street sex worker. Initially because a friend brought me along. Before that I didn’t want to do it. The friend forced me into it, and eventually I wanted to do it, mainly because I need money to live, of course. My friend had nice clothes, could buy nice face powder, and I wanted to have those things too. I always ask [the clients] to wear a condom. If they refuse, then I refuse to service them.” Source: Source: Child interview conducted by PSKK, UGM in Jayapura, 2009; Nita and Natalia are not the real name 4.3.4.4 Knowledge of reproductive health, safe sex and HIV testing The relatively early age of sexual debut is not accompanied by sufficient knowledge of reproductive health in Papua, such as about STIs, including HIV and AIDS. This lack of information increases sexually active children’s vulnerability to infection. A 2006 study found that 48 per cent of the population had never heard of HIV or AIDS. 260 Population groups with low rates of formal education i.e., many who never attended school or did not complete primary education had much lower levels of knowledge, with 74 per cent never having heard about HIV or AIDS, compared to 20 per cent of those who have graduated from senior high school or university. 261 However, the 2009 University of Indonesia survey did ind that across the age cohorts, as age increased so too did knowledge of reproductive health. Further discussion regarding knowledge of STIs and safe sex practices among adolescents in Indonesia, including Papua, can be found in Section 3.3, which highlighted the infrequent use of condoms and safe sex practices, and the poor knowledge about Voluntary Counselling and Testing VCT clinics. Even when people are aware of the routes of HIV and AIDS transmission and have the intention to protect themselves, gender inequality often undermines these efforts. Women’s low status makes it harder for them to demand fidelity from their partner, to insist on condom use or to refuse sex, even if they know their partner is infected. 262 They may face violence, abuse or abandonment. Often local women are expected to be ‘unaware’ and submissive in sex, which makes negotiating for safer sex more difficult. 263 It is therefore not surprising that the categories of women most affected include sex workers and the wives of IDUs and of clients of sex workers. 260 Ibid. 261 BPS - Statistics Indonesia and Ministry of Health 2006 Situasi perilaku berisiko dan prevalensi HIV di Tanah Papua 262 Ledang, V. and Mayabubun, K. 2010 Situasi perempuan dan anak Papua di era Otonomi Khusus: Catatan untuk satu tahun terakhir, INFID: Jakarta 263 Butt, L. 2005 ‘“Lipstick Girls” and “Fallen Women”: AIDS and conspiratorial thinking in Papua, Indonesia’, Cultural Anthropology Vol.203: 412-442 4.3.4.5 Rapid development and the growing sex industry: Risks for children and women The traditional way of life, values and practices in Papua have been transformed by a variety of factors including the introduction of the cash economy and increasing access to resources since implementation of Special Autonomy, the introduction of Christianity, the process of internal migration, and also the influx of transmigrants from other parts of Indonesia, bringing new cultural value systems. 264 Rapid development and the cash economy together have increased the frequency with which people in Papua seek money or goods in exchange for sex, according to Butt et al. 2002a and b. 265 Follow-up interviews in Papua also revealed that with the creation of new regions following the implementation of decentralisation, job opportunities are opening up in other parts of the province, which has led to an increase in internal migration rates. The sex industry, interviewees argued, tends to follow the migration routes. 266 This is important, given that sex workers, their clients, and their clients’ partners are among the most vulnerable groups with regard to HIV infection, as discussed above. Interviewees also explained that with the speed of migration and the consequent frequent relocation of the sex industry, particularly to remote areas, information dissemination and health facility provision is failing to keep up, despite efforts to place VCT centres in community health clinics in at least some of these areas. 267 They also argued that with migration for employment and the use of different sex workers, infected men are spreading the virus to sex workers and to their partners. 268 Many argued that rapid development under Special Autonomy in places like Jayapura has created a growing culture of consumerism, which is attractive to children as they witness the development of new hotels and restaurants, and the increased use of mobile phones, etc. 269 Several different interviewees and participants in different FGDs in various regions also elucidated the problem popularly portrayed as the ‘3 Ms’ men, mobile phones, money. The 3Ms have led to greater risks for children and women, whose fathers and husbandspartners men travel for work money, and use sex workers who may be HIV-positive, are then infected with HIV and on return later infect their partners. Different interviewees added that increased incomes, the growing cash economy, and growing consumerism with Special Autonomy have led youth with repeated mention of street children to exchange sex for money to buy mobile phones. 270 As one child explained: “Nowadays there are many kids who have things. They have everything from head to foot. Their clothes are really good quality. I know my parents are only small-scale farmers. They can’t buy me things like my friends have. But I get jealous when I see my friends with their good things. My parents know I want good things and they feel sad that they can’t buy me a mobile phone… I wanted to see a different world, which was fun So, I went to Jayapura [city]. When I was on the boat, I did cry because I was a bit scared, then I found Mama Fin [who runs a halfway house for homeless children]. Sometimes, I remember my parents and I miss them, but I have contacted them. They said to me, ‘Look out’, if I go home they will hit me. But I am not scared anymore… Jayapura is great.” Ester, 10 August 2010 264 Butt, L., Numbery, G. and Morin, J. 2002 Preventing AIDS in Papua; Butt, L., Numbery, G. and Morin, J. 2002 ‘The smokescreen of culture: AIDS and the indigenous in Papua, Indonesia’, Pacific Health Dialog , Vol.92: 283-289. 265 Ibid. 266 A variety of interviewees, Jayapura 11 August 2010 267 A variety of health practitioners, Jayapura 11-14 August 2010 268 Ibid. 269 Ibid. 270 Ibid. THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 246 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 247 Mama Fin, who runs the halfway house, described the situation as follows: “Many girls who run away from home take the boat from Serui or Sentani to Jayapura. They are pretty smart kids. When they get on the boat they pretend to be food peddlers [allowed on the boat to sell food to passengers]. But we have investigated this pattern somewhat and found that many kids don’t sleep on the deck, but instead they pay for their ticket with their bodies through sex making it easy to go back and forth between Serui and Jayapura without buying a ticket. Kids like Ester were lucky because she found her way directly here. But many kids don’t know Jayapura at all and they are at great risk of exploitation because they have to survive somehow and meet their daily needs…There are many children who are selling sex on the streets to buy things that they want, mainly mobile phones. But they face so many risks. When they get drunk from the local alcohol or sniff glue, they don’t really know what they are doing…often they only understand the risks after they have been infected with HIV.” 13 August 2010 A number of different NGO and health workers in Papua explained that many parents don’t know how to parent their children, and some of them use violence to solve problems. Children, especially those from poor families whose parents spend most of their time working in the fields or plantations, don’t have time for their children. 271 These problems lead to children feeling abused or neglected and they may either run away or find other forms of entertainment, such as having sex as was also evident from the discussions with children, as previously described. One World Vision staff member explained that in Wamena, for children in junior or senior secondary school, it was not uncommon that they changed sex partners up to 10 times at teenage sex parties or other festivals Interview, 14 August 2010. Rates of domestic violence, forced sex and sex work have increased with the large inflows of money in once remote regions. 272 Women are at increased risk of abuse. Competition between men for money, resources and prestige can lead to increasingly risky sexual behaviour. 273 One teacher made the following argument: “We need to understand that many of our young people are caught in two worlds. Many children in the highlands have to travel a long way to go to school. Sometimes the teachers are not there. So the transfer of knowledge is often minimal. At the same time, their understanding about the values of their people has weakened. Well, tradition in general has weakened. Originally sex was strictly regulated in tribal traditions. Now things have changed. Sex is loosely ruled. Punishments that made youth delay having sex are no longer carried out. Life has changed. Youths need more activities to ill in their time, but they don’t have a lot of choice. What’s left as a source of enjoyment is their bodies. At the same time, they have no knowledge about diseases and infections and how they can get them. This puts them at a high risk for contracting HIV. Clearly, the HIV and AIDS epidemic will not be solved by focusing only on changing the sexual behaviour of youth, but should emphasise their lives in a more complete way.” Jayawijaya, 17 September 2009 Understanding teenage sexual practices within the larger socio-economic and cultural environment in Papua is important for designing more effective communications programmes to prevent HIV transmission. The above discussion goes some way towards explaining what may be preventing the national campaign and education policies and their local level equivalents 271 Ibid. 272 Butt, L., Numbery, G. and Morin, J. 2002 Preventing AIDS in Papua; Butt, L., Numbery, G. and Morin, J. 2002 ‘The smokescreen of culture: AIDS and the indigenous in Papua, Indonesia’ 273 Ibid. from improving levels of knowledge and safer sex practices in the region. Given the diversity in terms of terrain and culture in Papua, and the larger constraints of poverty, poor health and low education levels in the province, it is clear that even the programmes themselves will need to be flexible enough to adjust to the wide variety of local environments. 4.3.4.6 Stigma of HIV and AIDS The attitudes of people in Papua who personally know someone living with HIV are highly diverse. According to 2006 data, the highest percentage of survey respondents 34.3 per cent kept their distance from people living with HIV PLHIV. 274 PLHIV were shunned by a slightly higher percentage of males than females 36.7 per cent compared to 31.4 per cent, and by those with lower levels of education 57.3 per cent of residents who had not attended school completed primary school, compared to 43.2 per cent of those educated to primary and junior high school, and 21.8 per cent who those graduated from senior high school and above. 275 Just over one quarter 28.3 per cent treated PLHIV just like any other people. 276 Females are less likely to stigmatize PLHIV compared to males, as are people with higher education levels compared to those with lower education levels.

4.3.5 STRATEGIES AND CHALLENGES OF COMBATING HIV AND AIDS UNDER SPECIAL AUTONOMY

4.3.5.1 The national policy environment The following discussion extends the discussion in Section 3.3 and focuses briefly on national level HIV and AIDS prevention efforts, with a greater focus on local HIV and AIDS prevention efforts by local level governments and CSOs, as well as the on some additional challenges in policy implementation, further to those previously discussed. National HIV and AIDS prevention policy, as discussed in Section 3.3, aims at creating an enabling environment for successful programme implementation. Important policies and documents formulated by the government that support implementation of HIV programmes are: • Presidential Decree No. 361994 regarding the Establishment of the National AIDS Commission KPA and Regional AIDS Commissions KPAD as the government institutions that will coordinate the fight against AIDS. • The irst National AIDS Strategy 1995-1999 Strategic Plan, the 2003-2007 Strategic Plan, and most recently the 2007-2010 Strategic Plan. • The adoption of the commitment at the United Nation General Assembly Special Session on HIV and AIDS UNGASS in 2001, as a working framework for an expanded response to AIDS. • The signing of the Sentani Commitment in 2004 by the six provinces with the most serious HIV epidemics Bali, Jakarta, West Java, East Java, Papua and Riau, as a joint movement to combat AIDS. • The Memorandum of Understanding MoU between the National Narcotics Agency and the National AIDS Commission, which was followed by the Coordinating Minister for Peoples Welfare Decree No. 22007 regarding the Reduction of Harm Caused by Drug Use National Action Plan 2007-2010. 274 BPS - Statistics Indonesia and Ministry of Health 2006 Situasi perilaku berisiko dan prevalensi HIV di Tanah Papua 275 Ibid. 276 Ibid. THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 248 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 249 In addition to these important documents, several efforts have been initiated to strengthen leadership and commitment at the national level. Special cabinet sessions on AIDS were held in 2002 and 2003 and were followed by the announcement of the National AIDS Movement. Also, to strengthen the capacity of the National AIDS Commission at the central level and in the regions, Presidential Regulation No. 752006 was issued to restructure the National AIDS Commission in order to promote a more intensive, comprehensive, integrated and coordinated response. The National AIDS Commission currently has 12 working groups that help formulate technical policies, with each working group responsible for a speciic aspect of the HIV response. These working groups are focused respectively on: Papua; Women; Children and Youth; Harm Reduction; Communications and Promotion; Care, Support and Treatment; Monitoring and Evaluation; Estimation and Surveillance; World of Work; Migrant Populations; Law and Human Rights; and Research and Operational Studies. In addition to strengthening of the National AIDS Commission as a leading entity to respond to the epidemic, there has been some progress made in national HIV programmes such as an increased number of services provided to PLHIV, as discussed in Section 3.3. The national 2010-2014 Operational Plan Rencana Operasional for HIV and AIDS Reduction highlights four programme areas: prevention; care, support and treatment; impact mitigation; and conducive environment. The focus of prevention includes different high-risk groups, one of which is youth aged 15-24 years. Since the Special Autonomy Law was passed in Papua, the provincial government has far more regulatory and policymaking power in the region. Therefore, the provincial policymaking environment is as important as national strategies for HIV prevention initiatives. However, time is needed for capacities to build and the institutional environment to strengthen in the province, as discussed further below. 4.3.5.2 The Special Autonomy regulatory environment: A brief overview Law No. 991999 divided Tanah Papua the indigenous name which Papuans use to describe the region into three provinces, but this was then rescinded by Law No. 212001 on Special Autonomy for Papua Province in 2001 and the province was returned to a single entity. Two years later, Presidential Decree No. 12003 split the province into three parts again, this time dropping the name Papua, and calling the regions Irian Jaya Tengah Central Irian Jaya, Irian Jaya Timur East Irian Jaya and Irian Jaya Barat West Irian Jaya instead. 277 The formality of installing the local government in West Irian Jaya took place in February 2003 and a governor was appointed in November. Installing the government for Central Irian Jaya was delayed from August 2003 due to violent local protests. The creation of this separate central province was blocked by Indonesian courts, that declared it to be unconstitutional and in contravention of Papua’s Special Autonomy agreement. The other two provinces were allowed to stand as the provincial governments had already been formed. 278 East Irian Jaya is now called Papua and West Irian Jaya is now known as West Papua. 279 277 King, P. 2004 West Papua since Suharto: Independence, autonomy, or chaos? University of New South Wales Press: Sydney 278 Ibid. 279 Kivimaki, T. 2006 Initiating a peace process in Papua: Actors, issues, process, and the role of the international community, East-West Center: Washington, D.C. The Special Autonomy Law No. 212001 comprises twenty-seven chapters and seventy-nine articles. It includes greater authority granted to the province to manage its own government and natural resources Chapter IV, Article 4; Chapter XIX, Articles 63 and 64. It also recognizes and respects the basic rights of indigenous Papuans and emphasises their need for empowerment Chapter V, Articles 20 and 21. Furthermore, it is in line with the principle of good governance, which promotes participation, transparency and accountability Chapter V, Articles 10, 14, 18. In addition, the Special Autonomy Law also acknowledges and respects the existence of traditional rights and customary laws Chapter XI, Articles 43 and 44. Despite the contested nature of Special Autonomy there are still demands for independence in some quarters, the law has given extended powers, wide-ranging autonomy and fiscal resources to the Papuan government. It has also allowed for the creation of unique institutions to represent various Papuan groups which are not present in other provinces, such as the Papuan People’s Assembly Majelis Rakyat Papua, MRP, which is intended to represent indigenous Papuan groups and include local customary groups, in addition to religious and women’s groups. The MRP was given the mandate of promoting and protecting the rights and customs of Papuan people. 280 It was also given powers of consultation and assent over candidates for the position of governor and over decisions and regulations relating to the basic rights of Papuans. 281 On one hand, decentralisation, the Special Autonomy Law, and the greater powers these bring the province has both regulation-making power and can directly implement programmespolicies which differ from other provinces without Special Autonomy have enabled local governments to customize responses to local issues. One example is addressing issues related to children who migrate alone from mountainous areas to cities such as Jayapura, for higher education or due to the attractions of the city. Some find their way to church-based institutions and halfway houses such as the examples described above in the discussion on HIV and AIDS but others end up on the street, in some cases as commercial sex workers children forced into sex work. The Jayapura municipal government has established dormitories asrama for these child migrants, but some argue this is insufficient: “It is very good that local government tries to help those kids. However, dormitories alone are not enough. Those kids need mentoring, life skills development...The government needs to build a comprehensive support system for those children. Not one single agency can meet those children’s need. The Office of Social Affairs has to work together with the Office of Education, the Bureau of Women’s Empowerment and Child Protection, and local NGOs. The government also needs to do something to prevent those children from migrating alone. They need to ask questions. Why do they leave the mountains to come to Jayapura, leaving them vulnerable to all kinds of mistreatment by bad people? Because they want to go to school. Are schools available in the mountains? Do they have sufficient teachers? If not, why? Is teachers’ absenteeism high? If so, why? Some teachers have to go to the districts to take care of administrative things. Why doesn’t the government establish offices at the sub-district level to help these teachers, who are often poor, to manage their lives more easily? When teachers are often absent, ultimately children suffer.” Teacher, Jayapura, 11 September 2009 On the other hand, Special Autonomy presents a number of challenges during the institution building and transition process of Papua’s development. According to the multiple stakeholders who participated in the FGDs at the provincial level, implementation of Special Autonomy has 280 Blair, D. C. and David, L. P. 2003 Indonesia commission: Peace and progress in Papua 281 Ibid. THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 250 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 251 not always been smooth, especially given that in many cases there is an absence of relevant regulations or accompanying technical guidelines needed by civil servants or districtmunicipal governments to implement regulations and policies. As one participant put it: “The Special Autonomy Law is excellent in spirit and letter. It opens the room for Papuans to govern Papuans in accordance with the perspectives and the needs of Papuans. However, implementation of the law is a whole different matter. Papuan leaders do need to provide explicit and specific instructions on the implementation of the law on the ground. Those instructions should be contained in special provincial regulations. It took the provincial government a long time to draft and enact the regulations necessary to even implement the law.” Government staff, Jayapura, 13 September 2009 There are a number of other challenges of implementing Special Autonomy, not all of which are discussed here. Many relate to a political environment where, in response to a Papuan sense of marginalisation and government sponsored transmigration programmes, some Papuans have felt they have lost control of their own homeland to the Indonesians and have become marginal to Papua’s political and economic life, leading to expressions of Papuan nationalism with a strong ethnic tone. 282 These dynamics - migration and tribal arrangements, local conflicts and the demands for indigenous Papuans to occupy civil servant positions under the ‘sons of the region’ putra daerah phenomenon - are discussed in a number of other studies. 283 Suffice to say that such politics and dynamics do impact the implementation of Special Autonomy and complicate the process of achieving consensus in policymaking among the various levels of government, parties, the parliament at the provincial and district levels, and with the Papuan People’s Congress. As one respondent put it: “Special Autonomy is like a double-edged sword. On one hand, it has afforded many opportunities Papuans never had before, such as access to funds and educational opportunities. On the other hand, its implementation has roused primordial sentiments and regional affiliations within the regional government bureaucracy and the community. The primordial sentiment is partly a consequence of social inequality in Papua in terms of distribution of government positions.” 14 September 2009 4.3.5.3 Weaknesses in the regulatory environment and service provision under Special Autonomy in general Tackling HIV and AIDS as has been outlined above is challenging in Papua, considering the wide geographic area, underdevelopment, poor education levels, and sexual practices, among others. However, it is further complicated by the weaknesses in the institutional environment as Papua builds governance and new institutions under Special Autonomy. The following discussion alludes to just a few of these challenges, namely passing legislation, budget disbursement, civil servant capacity, and the effectiveness of consultative planning processes. While Papua avoids some of the problems experienced under decentralisation discussed in the case study on the province of NTT where the provincial government has little authority to instruct district governments or to undertake direct programme and policy implementation, it faces similar problems of poor institutional capacity to deliver services across such a large area, due in part to the regulatory environment and the skills of civil servants. 282 Bertrand, J. 2007 Papuan and Indonesian nationalisms: Can they be reconciled?; Chauvel, R. 2007 Refuge, displacement and dispossession: Responses to Indonesian rule and conflict in Papua ; McGibbon, R. 2004 Plural society in peril: Migration, economic change and the Papua conflict ; McGibbon, R. 2004 Secessionist challenges in Aceh and Papua: Is Special Autonomy the solution? 283 Hoey, B. A 2003 ‘Nationalism in Indonesia: Building imagined and intentional communities through transmigration’, Ethnology, Vol.422: 109-126; Brata, A. G. 2008 The creation of new regions in Papua: Social welfare vs. elite interests, Atmajaya University: Yogyakarta; McGibbon, R. 2004 Plural society in peril: Migration, economic change and the Papua conflict; McGibbon, R. 2004 Secessionist challenges in Aceh and Papua: Is Special Autonomy the solution?; Universitas Cendrawasih. 2006 Studi evaluasi kebijakan dan implementasi Otonomi Khusus di Tanah Papua tahun 2002-2006 Division of powers and creating legislation Legislation has been passed in Jakarta for the purpose of reining the original Special Autonomy laws, but it has often exacerbated confusion. The decentralisation laws passed in 1999 devolved power to the districtmunicipal level, but under Special Autonomy in Aceh and Papua power was devolved to the provincial level instead. This has caused some confusion among some authorities at the district level. As one government civil servant in Jayapura observed, “It seems as if we have two masters, the provincial and the national government. Sometimes we don’t know who we should listen to, particularly if they have conflicting demands.” Jayapura, 14 September 2009 Under Special Autonomy, there are several ambiguities in the division of powers between the provincial and district parliaments and the MRP, and the role of the governor includes both representing Papua’s interests as well as being responsible for implementing central government policies in Papua. 284 One important difference between the provincial parliament DPRD and the MRP, for example, is that the former represents all the people living in Papua, including migrants from other regions who constitute a significant portion of the population. The MRP, however, more specifically represents indigenous Papuans. The process by which the MRP can review legislation affecting indigenous rights is not entirely clear. 285 Aside from being able to voice and formally contest legislation or regulations that infringe on Papuan rights or customs, there are no legal mechanisms by which these measures can be halted. 286 The MRP has only restricted rights of consultation and approval on issues related to native rights and only in relation to special regulations for implementation of the Special Autonomy Law. No such approval is required for normal legislation and regulations of the provincial parliament. 287 In 2007 the Indonesian government issued Presidential Instruction Inpres No. 52007 concerning the Acceleration of Development in Papua and West Papua. This Presidential Instruction indicates five priority areas for the provinces’ development. They are: 1 food resources and poverty reduction; 2 education quality improvement; 3 health service improvement; 4 basic infrastructure increase for improved access to remote areas, the interior and border areas; and 5 affirmative action in quality development of indigenous Papuan human resources. This has generated confusion in Papua among Papuan local governments since the content of the Presidential Instruction seemed to overlap with the goals of the Special Autonomy Law which also emphasises the development of health, education, economics and infrastructure, and was perceived to have the potential to undermine Special Autonomy. 288 As one interviewee argued, “The Presidential Instruction was made by the central government alone, without input from Papuans. Yes, the priorities are well thought out. But I have to ask this: who are the intended beneiciaries of development in Papua? Papuans, right? How can the government identify Papuan’s needs and priorities without consulting Papuans?” Medical doctor, Jayapura district, 15 September 2009 284 Halmin, M. Y. 2006 The implementation of special autonomy in West Papua, Indonesia: Problems and recommendations; Sullivan, L. 2003 Challenges to Special Autonomy in the province of Papua, Republic of Indonesia, Research School of Pacific and Asian Studies, the Australian National University: Canberra; USAID. . 2009 Papua assessment. 285 Halmin, M. Y. 2006 The implementation of Special Autonomy in West Papua, Indonesia: Problems and recommendations; McGibbon, R. 2004 Plural society in peril: Migration, economic change and the Papua conflict; McGibbon, R. 2004 Secessionist challenges in Aceh and Papua: Is Special Autonomy the solution? 286 Ibid. 287 Ibid. 288 King, P. 2004 West Papua since Suharto: Independence, autonomy, or chaos?