Feature Story

Accelerating the HIV response in Indonesia

12 May 2014

Home to the world’s fourth largest population and with a vast geographical spread, Indonesia is a country of critical focus for the AIDS response.

Given the increasing numbers of new HIV infections in recent years, the government and partners are accelerating action across the country to help increase programming and action to reduce the number of new HIV infections and deaths and to increase access to HIV treatment.

In 2013, a national strategy was adopted to rapidly increase access to antiretroviral therapy, in order to maximize its prevention impact. Through the programme, early initiation of antiretroviral therapy, regardless of CD4 count, can now be offered to pregnant women, serodiscordent couples, all members of key populations living with HIV, and people living with HIV, tuberculosis and/or hepatitis B and C coinfection. The programme is currently being rolled out in partnership with the authorities, civil society, and development and international partners in 13 districts across the country and will be expanded to 75 districts by the end of 2014.

In parallel, Indonesia continues to scale up HIV prevention efforts, focusing on key affected populations. Recent data from 16 cities across Indonesia show that efforts to increase access to condoms—especially for sex workers—and their effective use has lowered the number of sexually transmitted infections, for example syphilis, and therefore reduced the risk of HIV transmission.

“From increasing treatment and prevention programmes, to focusing responses geographically and among key populations, there are examples of progress that now need to be replicated, rapidly, to make further progress,” said UNAIDS Deputy Executive Director Jan Beagle, who made an official visit to Indonesia in April.

A time for action

Partners in the Indonesian AIDS response agree that further scale up must be continued. There were an estimated 76 000 new HIV infections in 2012. The number of people with access to antiretroviral therapy rose to just under 40 000 in 2013 (a 27% increase from 2012). While there may be signs that epidemics among sex workers and people who use drugs are stabilizing in some areas, HIV prevalence among men who have sex with men has significantly increased nationally, from 5.3% in 2007 to 8.5% in 2011, and in Jakarta from 8.1% in 2007 to 17.2% in 2011, according to national Integrated Biological and Behavioural Surveillance 2007 and 2011 data.

“In a decentralized country like Indonesia, we have to translate strategies into progress and action at the provincial and district levels, and to do this we need to make sure we have excellent partnerships,” said Deputy Minister of Health Ali Ghufron Mukti, when meeting with the UNAIDS Deputy Executive Director in Jakarta. “We are working hard with our local authorities in the districts and with civil society and communities,” he added.

Bali is a province heralded as having a growing number of strategies and initiatives that are showing positive results. For example, Bali’s programme to prevent sexual transmission of HIV has been strengthened through updating of regulations on sex work that enable sex workers to have easier and confidential access to HIV and sexual health services. Bali has also been in the forefront of implementing the national programme on the strategic use of antiretroviral therapy, providing treatment to all key populations without reference to CD4 levels.

Community-centred action driving results

Community-centred and community-led services are showing significant results in terms of increasing interest in and uptake of services. For example, despite the complex and sensitive cultural context on the issue of sex between men, the Bali Medika Clinic in Kuta (Bali) is viewed by community groups as friendly to such people. Over the past few years, it has seen an increasing number of clients taking up its anonymous testing and counselling service and referral to early initiation of HIV treatment.

“The Bali Medika Clinic is a community-led initiative. Our services are built around the needs and requests of men who have sex with men. Our clients can enjoy a patient-centred approach and our one-stop service, which is affordable and also confidential,” said Yogi Prasetia, from the Clinic.

United efforts of UNAIDS

Strong partnership among the United Nations on HIV is also helping to support the accelerated efforts in Indonesia. UNAIDS led the development of a Joint Support Programme on AIDS, which represents the combined United Nations efforts to support the Government of Indonesia and its partners in the national AIDS response.

The Programme responds to Indonesia’s identified priorities within the national strategic plan, with particular focus on ensuring increased access to antiretroviral therapy. It particularly aims to maximize the impact of the United Nations’ collective response, harmonize and better coordinate Cosponsor programming, financing and reporting, and reduce duplication and transaction costs.