Breaking the AIDS curse

AIDS was slow to arrive in the remote central highlands of the Indonesian province of Papua. It was not until 1996 that eight people tested positive in Wamena, the region's capital. By that time, the world had been dealing with this deadly disease for a decade. And yet, in Papua, precisely nothing happened.

AIDS was slow to arrive in the remote central highlands of the Indonesian province of Papua. It was not until 1996 that eight people tested positive in Wamena, the region's capital. By that time, the world had been dealing with this deadly disease for a decade. And yet, in Papua, precisely nothing happened.

"There was no real action," concedes Daulat, the secretary of Wamena's AIDS Commission. "They only started handling these cases intensively in 2006." In the decade of silence, AIDS took a grip. And now it's ravaging the place.

In the West, decades of public awareness campaigns, diagnosis and treatment mean we could almost be considered post-AIDS. Those infected with HIV can live for years with what's now considered a chronic disease not a death sentence.

Papua's epidemic is not in the same league as southern Africa's, but authorities in both places are still playing catch-up to a runaway infection rate, and contracting HIV is still too often fatal.

Papua is a rugged half-island at the extreme east of Indonesia. Its stunning landscapes house a poor and poorly educated population of 2.5 million. Almost 3 per cent are infected with HIV or AIDS - what the United Nations describes as a "general population epidemic" - at a rate 18 times higher than in the rest of Indonesia.

The vast bulk of infections come, as they do in Africa, from heterosexual sex. As many women suffer from it as men, more housewives than prostitutes, and more have full-blown AIDS than its precursor virus, HIV.

Doctors, donors and officials here are at last mounting a serious effort to curb AIDS, but they confront a culture where free sex is considered part of traditional practice, where witchcraft and black magic, not a virus, are often blamed, and where tribal remedies are the first treatments sought.

Recently, Fairfax Media was allowed by the Indonesian government, which keeps a tight rein on Western journalists entering the restive province, a rare opportunity to report on the epidemic. We found its sufferers everywhere. In Papua's thriving capital, Jayapura, we see Victoria, a dull-eyed two-year-old girl coughing her lungs out with tuberculosis, fighting for her life before the AIDS she was born with can be treated. Her father died without telling her mother, Yolanda, he was sick. Since our visit, Victoria has died.

In Timika we meet Julie Arip, who walks the garbage-strewn streets earning a pittance selling sex to the miners, the chancers and the hangers-on near Freeport's Grasberg, the world's richest goldmine.

And in Wamena, a regional capital where supplies must be flown in over high mountains, we meet the Tabuni family, whose AIDS-infected son, Penias, has buried two wives killed by the disease, and whose daughter, Yeni, is perhaps 19 and already a widow.

In Papua, almost everyone is in a high-risk group. Police chiefs and teachers, housewives and school students are infected. For too many, even the marriage bed is not safe.

Jackson, 30, is tall and wafer thin with haunted eyes. He's from a village near Wamena, but is staying in the "Suryah Kasih" (Light of Love) Catholic clinic in the big smoke, Jayapura, receiving the anti-retroviral treatment he needs to survive. He was infected by his late wife.

"In my village a lot of people are infected but they didn't know about it," Jackson says. "They thought it was a curse."

Then he talks about a village culture of free sex. "There are youngsters' parties, for ages 15 to 20. And when night comes we blow out the candles and then we just have sex with each other . . . At weddings, after it gets late, then the guests have sex, not necessarily between husband and wife, it can be between any partner."

During the bow-and-arrow wars that still break out between tribes here, at night in the traditional honai (village house), people have sex as part of "tukar gelang," or fund-raising ceremonies. Jackson's friend Umbo Wonda, from Mulia, also in Papua's highlands, confirms that these practices continue, though they are becoming rarer.

Commercial sex also plays a prominent role in spreading the disease and Timika, a mining town, is at the centre of Papua's paid sex industry. The demands of a male-dominated population create a three-level service to cater to any budget.

The cheap option is on Timika's rubbish-strewn streets and highways, where some indigenous women sell sex for whatever price the market will bear. Julie Arip confesses that she goes out "meeting friends at night", for "drinks and sex".

"They pay?" I ask.

"Yes," she whispers.

Julie says she is 20, but she looks 40. As she talks she holds her left arm, which is covered in a forest of parallel scars. "I cut myself when I'm drunk."

Julie insists she has tested clean, but says, "Many, many of my friends have got AIDS". They continue to have unprotected sex but, asked why, Julie shrugs: "I can't speak for them, that is their own decision."

Arti and Nuriati are a step up-market. Both are 37, Javanese (the most desirable ethnicity here), and have worked at Timika's dusty brothel for five years. Brothel work is legal and regulated, and they are tested regularly and supplied with condoms, which are compulsory.

"Honestly, though, not all customers want to use condoms," Arti admits. "We try to persuade them. Most of the time it works. But if it doesn't, well, it's our fate. We just pray that it [AIDS] won't happen to us."

Faced with a client demanding no condom, the brothel workers have little bargaining power. The secretary of the Timika AIDS Commission, Reynold Ubra, says Papua is a "place of prostitution garbage" where older women come after they "don't sell well any more in Java or Jakarta".

Keen to seal the deal, they are seven times more likely to agree to a no-condom service than are their younger, more marketable sisters working on the highest rung of the sex industry ladder, in the bars and karaoke joints.

But Timika is also an example of how the effort to combat AIDS in Papua is starting to get it right. All legal sex workers are tested and their pimps fined if they are positive. New prostitutes are checked on arrival and the ones with the virus sent home at their pimp's expense. The employees of mining giant Freeport and members of the army receive regular tests, and the AIDS commission is trying to negotiate the same deal with police.

Governments and donors such as the Australian government's AusAID are now working throughout Papua to reduce the human cost of this disease. AusAID has recently announced a huge funding boost, and will spend $25 million over four years to increase diagnosis, treatment and care.

In Wamena, armed with new funding, Yoram Yogobi, the head of local NGO Yukemdi, is doubling his staff. They work to encourage people to seek treatment and, in a strong oral tradition, they spend most of their time talking.

"It's very difficult, though. We started in 2006 telling them about the virus - that it was inside you and transmitted when you had sex - and it's only in the past three years we've seen a result."

The barriers are immense. The biggest is remoteness. Some villages in the misty highlands are five days' walk away, along perilous paths.

Another is a strong belief here that "you are only sick if you cannot do anything any more - if you can't get out of bed", Yogobi says. This explains why more people in Papua have full-blown AIDS than HIV.

"Sometimes they come and, in three days they just die," says Dr Anty at Wamena's overworked health agency.

There is also a sometimes violent stigma against AIDS sufferers. As recently as 2000, several people in the highlands were burnt alive in their houses. Menius Wenda, a public servant, feels the threatened rejection keenly in a culture where men are physically close to their friends, often holding hands as they walk.

"I'm afraid my friends will stay away from me and say bad things about me . . . because the disease is fatal and they won't want to be around me."

He admits he himself felt that way before being diagnosed. Between them, these factors suggest that the already high rate of HIV/AIDS in Papua well understates the real size of the problem.

Getting good treatment to where it's needed can also be tough. In Papua, Christianity dominates Islam in the competition for souls, but, either way, many are still deeply attached to their "adat", or traditional practices.

Wenius Alua, 25, is from Kurulu village, 17 kilometres from Wamena. He was a university student and swears he only ever had sex with one woman - Mary, the girl he wanted to marry. She was 15 at the time. At 19, she died of AIDS.

This is an educated young man being treated with anti-retroviral drugs in a Catholic clinic, but still he believes he was infected "because we had sex outside the house and . . . all of what we did came out of our bodies and into nature".

So, before seeking medical help, he tried "wangko", one of an array of traditional remedies, which involves sitting on the grass roof of a house while inside his family lit a wood fire.

"The smoke comes out to the sick person on the roof . . . and the person must say his name, then the girlfriend's name, and the tribe of both as the smoke goes into his body."

He sought medical help when "wangko" didn't work, but for others traditional treatments can cause fatal delays.

Anti-retroviral drugs are provided free by the Indonesian government. For those with access to them, they are a life-saver. In 2008, Kiptea Rahayan and husband Johanes lost their three-month-old baby without even knowing all three of them had AIDS. After two years of treatment, they are now almost well enough to try for another.

But expecting a remote tribal villager without clothes, much less a watch, to take two pills a day, at 8am and 8pm, and to come to town regularly for new supplies, remains a huge task.

Huge, too, is the infrastructure required to deal with this disease.

The success of organisations such as Yukemdi in bringing people forward to be tested has highlighted an emerging shortage of doctors and hospitals.

"The hospitals tell me they can only handle 15 people maximum, but then 23 to 28 people come," Anty says. "So patients have no choice - they just have to go back to their kampungs [villages]."

Unfortunately in Papua, none of this happens in a political vacuum. Amid a continuing military crackdown on separatist sentiment, some indigenous Papuans believe AIDS is just another of the weapons arrayed against them by the powers in Java.

"We always feel abandoned," says Yukemdi's leader, Yoram Yogobi. "The slowness of the reaction, the slow recruitment of health workers when they know we have a serious problem - it's not surprising that some think being independent [from Indonesia] is an option."

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