A delegation of the UNAIDS Programme Coordinating Board (PCB) conducted a field visit to Indonesia from 22 to 24 October to see how the country has implemented an integrated and decentralized response to AIDS that has accelerated the strategic use of HIV treatment, increased testing and counselling and strengthened HIV prevention services for key populations.

Indonesia demonstrates how a multisectoral approach to HIV, combined with consistent leadership at all levels, is helping the country to stabilize the epidemic, accelerate treatment and provide innovative and comprehensive HIV services. The country’s AIDS response is guided by an investment strategy, developed with support from UNAIDS, which focuses resources and efforts where they are most needed.

“Indonesia’s response shows that cross-sectoral engagement and leadership—including impressive and vibrant civil society involvement—is critical for turning strategies into action,” said UNAIDS Deputy Executive Director Jan Beagle, who was leading the visit. “As we look towards ending the AIDS epidemic by 2030, continued commitment at all levels will be key to effective impact—for AIDS and the broader health and development agenda.” 

According to national estimates, 638 000 people are living with HIV across Indonesia, and latest national data show that new infections are stabilizing, although there are increases among men who have sex with men. Indonesia’s epidemic is largely concentrated among key populations, including sex workers and their clients, men who have sex with men, people who inject drugs and transgender people. While national HIV prevalence is low, a higher burden of HIV is found among key populations and in certain geographic areas, such as urban settings and in the Papua provinces.

The delegation, which included members from Australia, Brazil, El Salvador, Iran (Islamic Republic of), Luxembourg, Ukraine and Zimbabwe, as well as the PCB NGO delegation and UNAIDS Cosponsors, met with a range of national partners, including senior government representatives at the national, provincial and city levels, the National AIDS Commission, development partners, civil society organizations and the United Nations Country Team. The delegation also visited several sites to see examples of scaling up access to HIV testing and treatment and ways of addressing stigma and discrimination.

During a meeting with the PCB delegation, the Acting Governor of Jakarta, Basuki Tjahaja Purnama, highlighted the city government’s response to HIV in the capital. The Acting Governor underscored the significant investments that the local government has made to HIV programmes, including increasing access to HIV treatment, and expressed his commitment to prioritize health, education, employment and housing for people living with HIV, ensuring that no one is left behind.

Over the past years, Indonesia has increased its domestic financing to 42% of its total spending on AIDS. Throughout the visit, political commitment to further increase domestic funding was emphasized at all levels. However, government officials also stressed that international financing remains critical to scaling up the response, in particular for accelerating access to HIV treatment.

Community-friendly services key to a sustainable response

At a gathering of civil society groups, including networks of people living with and most affected by HIV, the delegation was presented with an overview of how youth organizations are mobilizing young Indonesians, as part of the ACT 2015 initiative, to ensure that HIV and sexual and reproductive health and rights remain a priority for the country’s new government and in the next development era.

Site visits to a number of public and private HIV service-providing institutions in Jakarta and Denpasar showcased how community-friendly and community-led services are improving uptake of services and reducing stigma and discrimination. Examples included the country’s main HIV treatment referral hospital in Jakarta, which runs programmes to sensitize staff on the specific needs of key populations at higher risk, and the Yayasan Kertipraja Foundation and the Bali Medika Clinic in Denpasar, where a number of programmes are led by key populations and provide easy-to-access services after work hours and on Saturdays. As well as increasing demand among key populations, such programmes have also led to early uptake of HIV treatment. The National AIDS Commission, with support from UNAIDS, is looking at how to further replicate and scale up such models across the country.

Civil society, public and private organizations and UNAIDS are leveraging advances in mobile technology to empower communities. Together they have produced a new mobile application called iMonitor+, which enables users to access HIV prevention and treatment services and provide feedback on the quality of such services.

The Deputy Governor of Bangkok, Pusadee Tamthai, the UNAIDS Executive Director, Michel Sidibé, the Public Campaign Officer of the Indonesian AIDS Coalition, Ayu Oktariani, and the Director of Service Workers in Group Foundation (SWING), Surang Janyam, launched iMonitor+ on 27 October in Bangkok, Thailand.

“This is a data revolution: real-time, mobile health information systems. iMonitor+ is not just a gadget, but a tool for social transformation. It will empower people to demand services and foster public accountability,” said Mr Sidibé.

iMonitor+ uses global positioning satellite technology to locate a user, who can then receive information on where to access condoms, HIV testing, counselling and treatment and other key services. If there are stock-outs of antiretroviral medicine and other HIV commodities, the user can send alerts to a central dashboard and be directed in real time to other services nearby.  Users can also report any experience of stigma or violation of their rights in HIV service and other delivery settings to the dashboard. Public health authorities and community partners are working together to resolve as quickly as possible issues raised by the alerts.

“iMonitor+ has great potential as an important early warning tool, which can notify public health authorities of gaps in key services,” said the Deputy Governor of Bangkok. “By working with civil society to develop iMonitor+ we have opened up an important channel for dialogue and strengthened key partnerships for social transformation.” 

Since early June more than 100 volunteers from five community networks in Thailand, Indonesia, India and the Philippines have been pilot testing iMonitor+ to provide feedback and adapt the application to each network’s specific needs. In Thailand, the Bangkok Metropolitan Administration has partnered with SWING to test and fine-tune the application.

“iMonitor+ is an effective platform with which to work with public health authorities,” said the Director of SWING. “It is providing us with an opportunity to directly influence the way the services are delivered to communities.”

The Indonesian AIDS Coalition has been running a trial with iMonitor+ in four cities, including Jakarta. Ayu Oktariani said, “We are finding that health authorities are taking the real-time alerts we register with iMonitor+ seriously and that they move much more rapidly than before to close service delivery gaps.”

The feedback from communities and service providers will ensure continuous innovation and adaptability of the app. This participatory monitoring tool is not only an important community tool for quality assurance and responsiveness of HIV services, but can give people the power to monitor services in many areas aside from public health and serve as an instrument for improved public accountability.

Two of the major networks of people living with HIV in the Indian Ocean region have merged. The decision, which is aimed at strengthening civil society participation in the AIDS response in the Indian Ocean islands, was announced during the 13th Indian Ocean Colloquium on HIV and Hepatitis, which concluded on 10 October in Saint-Gilles-les-Bains, Réunion.

Ravane+, which means uniting people living with HIV, and Femmes Positives Océan Indien will work together under a single network—Ravane Océan Indien—in advocating for the rights of people living with HIV and those most vulnerable to HIV infection. The network will focus on advocating for equitable health care and public services for people living with HIV and creating an enabling policy and legal environment for populations at higher risk of HIV infection, including men who have sex with men, sex workers and people who inject drugs.

The newly appointed President of Ravane Océan Indien, Ronny Arnephy, stressed that although each island has specific challenges in the HIV epidemic, having a common goal will bring greater opportunities for stronger advocacy and representation from civil society.

For the past 12 months, the two networks—with technical and financial support from UNAIDS and other partners—have been working together in refining the details of the merger, including defining the vision, operational modalities and workplan for 2015. 

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A high-level delegation of parliamentary and private sector leaders from the Republic of Korea visited India from 10 to 15 September to learn about the impact that HIV has on communities and how the country is responding to the AIDS epidemic.

The delegation was led by the recently formed Korean Women against AIDS (KOWA) organization, which works through women parliamentarians and senior business leaders to advocate for greater engagement in the Republic of Korea for ending the AIDS epidemic in Asia, Africa and across the globe.

While in New Delhi, the group met with Indian parliamentarians and visited the HIV Vaccine Translational Research Laboratory. As part of the fact-finding mission, the group also visited nongovernmental organizations providing counselling, care and support services to women and children living with HIV, as well as the K. B. Bhabha Hospital in Mumbai, which has a prevention of mother-to-child HIV transmission centre. The leaders spoke with women living with HIV, learning how antiretroviral treatment can prevent babies from being born with HIV and keep their mothers alive.

While India has the largest HIV epidemic in Asia, with an estimated 2.1 million people living with HIV in 2013, the country has made significant progress. New HIV infections have dropped by 19% since 2005, about a third (36%) of people living with HIV are receiving life-saving treatment and AIDS-related deaths have dropped by 38% since 2005.

The mission came to India at the suggestion of UNAIDS Executive Director Michel Sidibé, who, during a recent visit to the Republic of Korea, encouraged KOWA members to experience the AIDS response first-hand.

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UNAIDS Executive Director Michel Sidibé recently visited a centre in Moroni that primarily provides antenatal care for pregnant women and prevention of mother-to-child transmission of HIV. It is run by the Association comorienne pour le bien-être familial (ASCOBEF), a nongovernmental organization.

At the centre, women have access to health services early in pregnancy and are offered an HIV test so that, if they need it, they can get treatment for themselves and appropriate postnatal care for their infants. The work ASCOBEF does at the centre highlights the critical role that civil society plays in supporting the Government of the Comoros in its response to HIV.

During his visit, Mr Sidibé had the opportunity to meet with members of civil society whose organizations conduct HIV counselling and testing, awareness-raising and community mobilization. They discussed their activities and the challenges they face in providing comprehensive care for people living with HIV, including the limited support they get from other sectors.

“We must not tolerate the shrinking of a democratic space of nongovernmental actors. The role of civil society is essential,” said Mr Sidibé.

Mr Sidibé reiterated the important role of civil society in advocating a human rights approach, especially in the context of the post-2015 development agenda and the rights and gender action that is needed to ensure that no one is left behind.

The passion, dedication and commitment that young people are bringing to the AIDS response, driving the agenda and taking a leadership role, were celebrated by UNAIDS Executive Director Michel Sidibé in closing remarks at the AIDS 2014 youth preconference event.

Mr Sidibé commended the 200 young people assembled, and others around the world, on how they have come together in the past year to increasingly become involved in key decision-making processes and ensure investment in high-impact programmes that work for young people on the ground. He advised them to redouble their efforts and build even stronger alliances in national movements with clear political goals and promised to share their central message: treat, reform, educate, love.

The two-day event, which took place on 18 and 19 July, addressed a number of key issues relevant to young people and culminated in the development of a Youth Action Plan calling for the inclusion of their voices in all national, regional and international discussions on AIDS advocacy, policy and treatment.  

The event included a number of skills-building and knowledge exchange workshops, such as a session launching a new youth tool on participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria and how to navigate its New Funding Model. The ACT 2015! plenary explored ways in which the youth sector could put the health, well-being and human rights of young people at the heart of the post-2015 agenda through advocacy at the national and global levels. 

In addition, young members of key populations debated increasing their leadership role and how to challenge stigma and discrimination more effectively. World Health Organization guidelines relevant to young people and the need to reform parental consent laws, which can deny young people access to services such as HIV testing and other sexual and reproductive health services, were also examined.  

Organized by the Melbourne YouthForce, the event was guided by the UNAIDS-supported pact for social transformation, a unifying, youth-led, collaborative international framework designed to advance the HIV-related needs of young people.

Making the money work for young people: a participation tool for the Global Fund to Fight AIDS, Tuberculosis and Malaria is available for download from the links below:

Guidelines for young activists and youth organizations

Guidelines for Country Coordinating Mechanism members and other Global Fund actors

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The vital role that a vibrant civil society plays in strengthening and deepening the AIDS response at the national, regional and global levels was recognized and championed by UNAIDS Executive Director Michel Sidibé during an informal consultation at AIDS 2014 called Working Together to End the AIDS Epidemic and Leave No One Behind.

According to Mr Sidibé, the dialogue reinforced the importance of having the voices and perspectives of civil society inform his speeches, conversations and interactions throughout AIDS 2014. 

More than 80 participants representing a range of civil society organizations from around the world and UNAIDS discussed how they could work even more closely together to achieve the end of the epidemic by 2030. It was agreed that this would require redoubling efforts in scaling up quality service delivery, including sustained access to HIV treatment, challenging stigma and discrimination and promoting an equity and human rights agenda. In addition, the post-2015 development agenda and how civil society can be an integral part of it, such as contributing to the setting of country-level targets, was explored.

Mr Sidibé highlighted that without reinforcing communities it will be difficult to sustain the response. He promised that UNAIDS, including its Community Mobilization Division, would be available to offer practical, concrete support to increase civil society engagement and participation in the strategic effort to end the AIDS epidemic and leave no one behind.

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