Yayasan Kasih Suwitno at Ruang Carlo Community Centre: Non-discriminatory, friendly and free services for people with HIV and AIDS in Jakarta, Indonesia.
World Aids Day took place on 1 December 2014 and according to UNAIDS, HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) in Indonesia is one of the fastest growing epidemics in Asia, due to the lack of awareness, lack of education and health services, not to mention the social stigmas attached to having HIV or AIDS. Indonesia’s first case of the HIV virus was reported in 1987 and in 2011, 310,000 were reported to have the virus, with 8,700 annual reported deaths.
Today, the highest concentration areas are Papua, where 2.7% of the population have contracted the virus, followed by Jakarta, East Java, West Java, Bali and Riau. In Wamina, West Papua, 30% of the population have HIV, and nearly 100% have either Chlamydia or Gonorrhea, as these particular STDs are closely linked with the HIV virus.
Steve Wignall, Founder of Yayasan Kasih Suwitno (YKS) in Jakarta and Yayasan Bali Peduli (YBP) in Bali, has been working in Indonesia for 30 years and is an expert in HIV and AIDS. Due to an increase in cases in young people, in 2011 Steve and Dr. Emon Winardi (Director of the clinic) and their friend Johan set up YKS at Ruang Carlo Community Centre to provide services to patients that were friendly, efficient, easy to access and most importantly, free.
The clinic is located in the Saint Carolus Hospital and is a comfortable and discreet area, closed off from the rest of the hospital. Walls are painted a calming cream, service is friendly and knowledgeable, and there are different areas where patients can wait in peace.
“For young people with a chronic sickness, it’s very hard. They don’t have a lot of disposable income; the system often doesn’t respect their time and the cost of transport back and forth,” Steve tells me on my visit to the clinic in the centre of Jakarta.
Today the clinic has six full-time staff and is a wonderful example of a public-private partnership, working with the government who provide the reagents and drugs, and the NGO providing the environment and resources to make it accessible to people.
A common misconception is that HIV is a death sentence, when this is no longer true. If a person is tested early, before their immune system is damaged, medication is free and they will be able to live happy, healthy lives, have families and not infect other people. People are afraid to come for testing because of the stigmas associated with the virus.
Dr. Janice Tandraeliene works at Ruang Carlo Community Centre and believes stigmas are the main reason why people don’t take the test. “Some people are afraid to come, not just here but to all health facilities that test for HIV. There are many reasons, including the stigma, because they’re alone and don’t know what to do. When people come here alone, we try to consult and explain about HIV and make them comfortable so that they want to take the test.” If the result is positive, patients will be guided by therapy and given medication, which they are expected to take for the remainder of their lives.
The medication given to HIV patients is called anti-retroviral therapy and works by suppressing the virus and stopping the progression of the disease. Killing the virus is not possible, but these drugs stop it from developing. HIV is different from other viruses and infections because it becomes one with the DNA, integrating and hiding within it. Patients do not die from HIV; they die from infections, viruses and funguses, which are able to attack the weakened immune system.
“Unfortunately, HIV goes for the dalang (mastermind) of our immune system, the CD4 positive T cells, a type of white blood cell that is vital to fighting off infection. We’re all exposed every day to viruses and funguses but our immune system takes care of that,” Steve explains.
HIV is transmitted in key infected populations: injecting drug users – a problem that is decreasing in Indonesia as people are switching to amphetamine-like substances –, female commercial sex workers – 10-15% of whom are HIV positive -, and men who have sex with men – a rapidly expanding population of over 1 million individuals. In Jakarta in 2003, studies showed that 2% of gay men were found to be HIV positive; in 2007, 8%; and in 2011, 17%. At YKS today, an average of 27% of young men tested, are HIV positive.
What is the reason for this growing statistic? Social medias are providing a new platform for young people to meet and sex is happening at a younger age. Unfortunately, this is not coupled with adequate sexual education in local schools, and not at an early enough age, by teachers who are able and willing to talk openly about sex.
One of the fastest growing groups in Indonesia are housewives infected by their husbands who are visiting sex workers or are having sex with other men. In Bali, one in 200 pregnant women have contracted the virus from their husbands.
Steve believes the focus should shift towards men. “The focus often goes to the women, but it’s really the man that’s the problem. There’s only a sex industry if there’s a market to sell sex; if men didn’t buy it, there would not be women selling it. Getting men who buy sex to use condoms is a challenge and we need to continue to work on that; the best we see is 40-50% condom use.”
Antonio is Case Manager at Ruang Carlo Community Centre and is HIV positive. He’s passionate about helping others who are going through what he has. “My life has become more positive, living healthily, and getting support from family and friends. Of course, I want to be a role model for other friends so they do not feel despair and can continue to enjoy their lives by giving and sharing information about the ups and downs of life with HIV, and supporting each other.”
The only way to break the process of infection is for people with high risk behaviours to get tested. “We’re only going to be able to break this chain of infection if people know their status,” reminds Steve. Recently, the team at YKS have been bringing free HIV testing to certain high-risk establishments in Jakarta, resulting in a much higher number of people agreeing to be tested.
How to help
YKS would like to provide more mobile testing, and welcome your donations to help them continue to run their operations.
Donations can be made to:
Yayasan Kasih Suwitno
148 5 017678
Harco Mangga Dua Blok I no. 5 A-B
Swift Code PINBIDJA
First published in Indonesia Expat December 2014