With only 1% of Indonesia total population, in June 2001, Papua accounted for 21% of HIV positive cases and 36% of AIDS cases. Merauke alone accounts for 150 AIDS and 330 HIV-positive case so far, and around 70-80 new AIDS cases are identified on average every year in the local hospital.
MSF has launched a programme for the medical care and psychological support of AIDS patients in Merauke city, Indonesia. The project, with three MSF international staff plus local staff, is the first of its kind in Indonesia and assists HIV-positive and AIDS patients in Merauke city and the surrounding areas. The project aims at ensuring an appropriate medical care and follow-up of patients through the formal health sector, and having patients benefit from drugs,such as antibiotics, that could improve their quality of life. AIDS patients will also benefit from medical, social and psychological services once they are back again in the community.
Merauke, with 38,000 inhabitants, is the capital of Merauke district, at the south east of the West Papua province of Indonesia. It borders Papua New Guinea and it is mainly a swampy area with thousands of rivers and small streams, crossing lush tropical forests. The geography makes transport and communication very difficult and time consuming. It can take between two hours by road to two days by boat to reach certain areas of the district.
A high number of HIV-positive people are found in Papua and specifically in Merauke. With only 1% of Indonesia total population, Papua accounted by June 2001 for 21% of HIV positive cases (338 out of 1,572) and 36% of AIDS cases (210 out of 578).
By December 2001, the figures had risen to 525 HIV and 293 AIDS cases. Merauke alone accounts for 150 AIDS cases and 330 HIV so far, and around 70-80 new AIDS cases are identified on average every year in the hospital of the city. "We cannot speak of an AIDS epidemic yet. However, it is acknowledged that due to the enormous trafficking of sex workers from port to port - where they stay from 3 to 6 months - there might be pockets of epidemics in many big cities", said FranÃ?§ois Fille, MSF context coordinator for Indonesia.
The area is inhabited mainly by Papuan tribes living a traditional life in the forest. West Papua is very rich in natural resources - gold and copper mines, oil and forestry. Under a new policy of decentralisation, West Papua is allowed to keep 70% of its revenue, while previously it kept only 20%. With more money available in Merauke town, the number of brothels is increasing. There are 26 brothels with about 30 freelance sex workers each.
There are no other places of entertainment except a disco, frequented by freelance sex workers. "Many Papuans are in acute danger and there is a need for immediate intervention", said FranÃ?§ois. "Their culture has no time to adapt to a disease like AIDS, with such a pattern of propagation. They have minimal access to health services.
With many Papuans getting richer, sex has become a commodity and prevention is difficult due to the cultural environment and the geographical inaccessibility." The AIDS-care project will have an initial duration of three years and hopes to influence future AIDS-care and treatment in other parts of Indonesia.