A national report estimated that there were 227,700 people living with HIV/AIDS in Indonesia in 2007.
According to the Health Ministry, the number increased by at least 21,770 in 2010, despite the United Nations-sanctioned Millennium Development Goals (MDG) that calls for efforts to substantially curb the spread of the virus by 2015.
Studies have highlighted actions to significantly reduce the spread of HIV, such as sufficient political and financial support from the government; better coordination and cooperation between government agencies, strength alliances with community-based organizations and participation of people living with HIV and AIDS in designing, implementing and evaluating the programs.
Yet in addition to the problem of how to halt the virus, there is also the problem of addressing the stigma toward people with HIV/AIDS.
Secrecy and denial pose a great problem for HIV/AIDS control in Indonesia. People are worried they will be banned from social activities because they are living with HIV/AIDS. Husbands are afraid to let their wives know about their HIV status because they are afraid they will be abandoned. Wives are worried they cannot get pregnant if they are HIV positive.
These are some examples of stigma facing people with the virus in Indonesia. Stigma and hopelessness always seem to accompany people with HIV/AIDS.
HIV/AIDS stigma is considered a major barrier to effective responses to the HIV epidemic. Link and Phelan’s theory states that stigma is the convergence of labeling, stereotyping, separation, and discrimination by the perpetrators of stigmas who have access to social, political and economic power.
Stigma absolutely limits the coverage of critical services, such as voluntary counseling, testing and antiretroviral therapy.
In a study of 112 patients receiving antiretroviral therapy in Botswana, 69 percent of patients did not reveal their HIV status to their family, and a majority of those who reported delaying testing for HIV did so due for fear of the HIV/AIDS stigma. Without questioning that an HIV/AIDS stigma exists and needs redress, some argue that the profound lack of access to antiretroviral therapy in resource-limited countries, rather than stigma, is the real driver of poor uptake of testing and treatment services.
Individuals with advanced HIV/AIDS, who exhibit visible signs of disease and are no longer able to work, experience severe stigma.
According to Mahajan, the majority of HIV/AIDS specific interventions are designed to reduce stigma at the community level by increasing the tolerance of people living with HIV/AIDS (PLHA) among the general population. Strategies underlying these interventions are education of factual information about HIV/AIDS, increasing the willingness of healthcare providers to treat PLHAs and developing coping skills among PLHA.
One of the strategies is via mass-media campaigns. These campaigns can disseminate facts about HIV/AIDS and could potentially reduce the HIV/AIDS stigma.
One of the key means of reducing the stigma is providing factual information to health workers about HIV/AIDS. Butt stated in June 2010 that some healthcare workers in Papua who have received training for voluntary counseling and testing agree with statements that PLHA are dirty, should be shunned and should receive punishment.
Most health workers agreed with more subtly stigmatizing statements, such as PLHA having to accept limits on their behavior, or assume that PLHA feel ashamed of their status.
Violations of confidentiality affect the willingness of Papuans to go for HIV testing. Many respondents said they were afraid healthcare workers (both indigenous and migrant) would not respect their privacy. Secrecy is the PLHA’s primary concern, but confidentiality is routinely violated at health service centers in Papua.
We also know that there are many doctors in Indonesia who still recommend misleading suggestions to PLHA, including sterilization programs for women who are infected with HIV. The government or NGOs can provide training for doctors or nurses on how to handle HIV and AIDS cases properly.
Religious leaders also need to take part in reducing the stigma. We are glad to hear the Vatican statement that using a condom is a lesser evil than transmitting HIV to a sexual partner.
The government should support good access for PLHA to antiretroviral therapy. Both the government and NGOs can build clinics that can provide holistic therapy. PLHA can arrange appointments with health workers trained on methods for coping with HIV/AIDS status. They can also seek voluntary testing to understand their HIV status.
Proper antiretroviral therapy will enable PLHA to return to productive lives and motivate others to take tests and seek treatment.
Theoretically, a widespread increase of testing and treatment access may turn HIV into a treatable, rather than a deadly disease, and thereby ultimately reduce the HIV/AIDS stigma.
The government must also promote policies that could reduce the stigma and discrimination of people who live with HIV/AIDS. Current laws and policies in many countries directly contribute to stigma and discrimination associated with at-risk groups. Governments should stop policies that criminalize PLHA or require proof of residency status to access antiretroviral therapy.
Finally, approaches to reducing stigma must be viewed as a long path that requires cooperation between the government and society. The society should give empathy to people living with HIV/AIDS and help them cope with the stigma and discrimination.
Society should also build community-based interventions that are designed to mobilize PLHA, help leaders to address maladaptive self-stigmatizing behaviors and advocate against discrimination in the wider community.