HIV AND AIDS PREVALENCE IN PAPUA

THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 236 THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 237 • HIV and AIDS is attributed to various problems from witchcraft to tuberculosis. Despite the prevalence of HIV and AIDS in the highlands, few highlanders compared to lowlanders report knowing people affected by HIV or AIDS. • Lowlanders tend to seek medical help for illness, while highlanders tend to self-treat; which indicates different availability of and access to medical services in the two regions. • Papuans’ perceptions of sickness compound the problems related to HIV and AIDS. Many people do not get prompt treatment because they do not think they are sick. One FGD participant explained that Papuans don’t regard fever as a sign of illness. They will acknowledge that they are sick only when they can no longer get out of bed. • There are growing numbers of sex workers in the province, accompanying increasing development and industrial expansion. • Women who are unable to make a living from subsistence production ind sex work a way to supplement their meagre incomes. • There are around 4,000 regulated sex workers. There are another 4,000 ‘street workers’, or sex workers who do not operate from a fixed location. There are almost certainly at least another 4,000 women who are involved in an ‘underground’ sex industry in rural locations across the province. • Some are willing to be paid a minimal amount of money for sex; enough to buy credit for their mobile phones. This type of sexual transaction is known as seks pulsa sex for phone credit. • Having multiple sex partners in a group context is labelled sequential sex seks antri. Sequential sex is a negotiated sexual service where a woman allows several men to have sex with her one after the other. This may increase exposure to HIV. • There are inconsistent and contradictory regional regulations some yet to passed relating to HIV and AIDS. Where regional regulations have been passed, none have accompanying technical guidelines and thus have not been implemented. According to one regulation, if a pimp is aware of a sex worker having contracted an STI, they must bar the sex worker from working, and a failure to do so would result in a hefty ine. Yet this regulation has not been implemented. • Currently NGOs implement the majority of programmes targeting adolescents. The government has no programmes specifically targeting youth. • Several government programmes were clearly designed without a prior needs assessment. As a result, these programmes do not correspond to the realities in the field. • One clear planning issue is insuficient funding at the district level. This means that health agency staff are not able to make field visits when forming policies, programmes or action plans - they engage in ‘desk planning’ that is not based on actual data. This is also a human resource problem - agency staff lack comprehension of the programme planning process. Impressions about changes beginning to occur and efforts being made to combat the problem: • The Jayapura AIDS Commission has a programme speciically targeting adolescents aged 12-14 years. The programme aims to educate adolescents on sexual and reproductive health and HIV and AIDS, given the growing risks facing young people. • The provincial government is leading the mainstreaming of HIV and AIDS and life skills education into the education sector to reach all students. • Information and education campaigns are beginning to make use of local culture and idioms to increase effectiveness. For example, ‘Dare to say No, and nothing ill will come about’, ‘Healthy dating - remember, dating is for releasing the heart, not for sexual release’, ‘Protect yourself, use protection’, and ‘Recklessness can lead to HIV’. • There is increasing awareness on prevention of mother-to-child transmission of HIV. Expectant mothers are provided with information, advised to have early blood tests, and, if HIV-positive, given drugs to suppress the virus. The mothers are advised to give birth via caesarean section and not to breastfeed. • Nowadays numerous sex workers do not fear rejecting customers who refuse to wear condoms. Those most reluctant to use condoms tend to be the boyfriends and the regulars. Source: FGDs conducted at the provincial level with education officials and practitioners 7 September 2009, Jayapura municipality with education officials and practitioners 10 September 2009, and in Jayawijaya municipality with health officials, CSO representatives, and health practitioners 17 September 2009. Follow-up FGDs were also conducted between 11-14 August 2010 with CSO staff and health practitioners in Jayapura. FGDs were also conducted with children to ascertain how they perceive both the situation of children in Papua in general and the problem of HIV and AIDS in particular. Box 4.3.2 outlines how children themselves perceive their situation and main vulnerabilities. Box 4.3.2: Voices of children in Papua on the vulnerabilities they face - FGD results The situation for many is difficult for the following reasons: • Many children have to work, particularly if their parents are no longer alive, and many quit school. • One of the largest inluences on children is whether their parents are alive, and if they are, whether they are able to live with them or not. There is little assistance from the government or community for children who have lost one or both parents. • Some parents, particularly poor parents, are very busy with work and struggling for money and material happiness, but children don’t just need that. With busy working parents, children feel like they have lost their parents and are therefore unhappy. So they prefer to stay at their friend’s houses or on the street since they can’t stand to be alone in their houses anymore. • Home and family should be the main source of support for children’s growth and development both physically and mentally. Families should also be the main source for love, attention and protection. In reality, home and family become the main source of verbal, physical and psychological violence. To escape from this situation, children prefer to be away from the home, and one alternative is the church. In such cases, the church is not seen as a place to seek God’s love, but to look for love and attention from friends, carers and counsellors. • There are gaps between the children in immigrant and local ethnic groups. The phenomenon is like an iceberg that could melt and fall apart, endangering social relationships between communities. Violence in the street through ‘thuggery’ is common among Papuan children; they are allowed to do it against people who have different coloured skin. • The allocation of Special Autonomy funding has not been fully felt by students in Papua, not when compared to the effects of the Special Autonomy funding for the health sector. The high school fees are still burdensome for poor students, despite the promise of free 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.