Indonesia HIV/AIDS, STDs Prevention and Care Project - Indonesia

The project's strategies include:

• National support - strengthening the Indonesian government's capacity to develop and coordinate HIV/AIDS and STD prevention and care activities in accordance with the National AIDS Strategy.
• Provincial support - assisting the Provincial HIV/AIDS Commissions in developing a programme of HIV/AIDS and STD activities in Bali, South Sulawesi, and East Nusa Tenggara provinces.
• Community mobilisation - developing NGOs in the three designated provinces and supporting them in undertaking HIV/AIDS and STD prevention activities.
• Management of STDs - aiding the Indonesian government in developing improved HIV/AIDS and STD management programmes, such as health-service delivery, laboratory support, and training in diagnosis and patient management.
• Social, cultural and behavioural research - improving HIV/AIDS and STD prevention and care by enhancing existing knowledge of the contributing social, cultural, and behavioural factors.

One key strategy involves educating religious leaders so that they might consider compromising strict prohibitions (like those that decry condom use) in the interest of community welfare. In South Sulawesi, Muballig (Islamic preachers) completed a 5-day training course that focussed on AIDS prevention strategies. Islamic scholars reviewed Islamic literature and identified principles supporting HIV/AIDS and STD prevention activities. The scholars prepared a policy document urging the teaching of HIV/AIDS awareness, promoting safe sex, and advocating tolerance and compassion for people living with HIV/AIDS. As a result, Muslim clerics began preaching HIV/AIDS awareness in their sermons and providing education in mosques, schools, and community halls. Although they primarily promote abstinence and fidelity, the clerics also offer advice on condom use in specific circumstances. In East Nusa Tenggara, Catholic and Protestant churches trained preachers to provide outreach to congregations both during church services as well as in other forums such as Bible discussion groups, marriage counseling, and youth groups. The church's basic three-point strategy for sexual health is ABC: Abstinence, Being Faithful, Condom Use. The Catholic church has also produced a special Catechism to encourage AIDS prevention.

District youth leaders are also trained to conduct peer education both within their own religious youth groups as well as in more informal settings such as gatherings of school friends or families and neighbours. For example, the project supported production of AIDS-related publications and training materials on the part of the Perkumpulan Keluarga Berencana Indonesia (PKBI). PKBI has a nationwide peer-educator programme that encourages dialogue between children and their teachers, parents, families, and religious educators.

In short, efforts are made to foster a comprehensive network - down to the neighbourhood level - of educated personnel and volunteers who are familiar with local culture and languages, and who are willing and able to work with fellow citizens to prevent HIV/AIDS.

To support these and other efforts, the project has devoted resources to enhancing existing systems and institutions to promote HIV/AIDS prevention. For example, the project supports outreach programmes, encouraging a greater awareness of the risk of HIV/AIDS infection among female and male sex workers and their clients. The project also works with organisations that include transient and part-time workers in the education process. A key focus here has been encouraging learners to share the results of their training with their communities.

The project has supported a multi-phase National Media Campaign with television and radio ads and supporting print media that have been distributed by NGOs. The campaign has been directed primarily at young people and has moved from a general awareness campaign to one increasingly aimed at high risk behaviours such as unprotected sex and sharing needles among injecting drug users.

The project also engages in research of various kinds. For instance, it conducted a rapid assessment and response study of injecting drug users in collaboration with the USAID HIV/AIDS Prevention Program, the World Health Organisation, the Ford Foundation and PATH in eight Indonesian cities. As part of a strategy of increasing male participation in HIV/AIDS prevention, the project is supporting research on clients of sex workers to develop more effective programmes targeted at these men. Two organisations in Bali and Makassar have designed outreach programming in an effort to increase awareness and promote safer sex among the gay population. Finally, the project is funding and undertaking measurement of the prevalence of a wide range of STDs. Researchers are studying sex workers and their customers, women in the general community, and changing social attitudes towards HIV/AIDS. Laboratories are being provided with refrigerators, sterilisers, and essential clinical supplies (beds, syringes, medicines, and reagents). Organisers also work with community institutions to help provide information to the community about awareness of STDs and the importance of seeking appropriate clinical treatment.

HIV/AIDS, Religion, Women, Health, Youth.

In 1992, the Indonesian government asked the Australian government, through its international aid agency, AusAID, to help implement its medium-term plan for HIV/AIDS control.

Recent surveys supported by the project estimate that fewer than 20% of commercial sex acts take place using a condom. In the wider community, religious institutions traditionally oppose the use of condoms except in family planning.

In South Sulawesi, only two preachers out of the 312 that were trained refused to change their views. One organiser claims that "The condom still remains controversial, however, while the Muballig continue to preach that sex outside marriage is a sin, they also emphasize that sex outside marriage without a condom is a bigger sin." The condom controversy has in effect been neutralised, as have other controversial subjects such as mass blood testing and labeling all HIV/AIDS positive people as sinners, thereby also reducing the stigma and discrimination associated with this still-controversial illness. One 17-year-old participant said, "Before the AusAID program, we thought HIV was a curse from God. We had problems letting go of the idea that it was sinners who caught the disease."