...positive endeavors...

Some of you may have read Michael Buehler's article "No positive news: People living with HIV face corruption and incompetence in the health system" in the last issue of Inside Indonesia. I am very aware of the case he reports, and sadly it is only too typical. We have been fighting these problems since antiretrovirals (ARVs) first became available in Indonesia over five years ago.

At that time, we had to make a decision: wait for a trustworthy system to be put into place, or try to force things. We took the latter approach. although not without trepidation. One doctor with an international agency warned that we were taking a big risk, but the idea of telling people who were dying, "Just hang on, we'll get you treatment Real Soon Now" just didn't seem to be an acceptable solution. We formed an ARV fund to buy ARVs for activists, as I recounted in the story of Mama Dora. We purposely chose recipients from outside Jakarta - indeed one of the first, in late 2003, was from Merauke, Mama Dora's home in Papua.

He had come to Jakarta for a meeting of people with HIV, fallen sick with a very low CD4 count. So we started him on ART at one of the hospitals here in Jakarta. Luckily MSF had just set up what turned out to be a highly successful HIV treatment program in Merauke, so I rang the MSF doctor to tell her that he was returning to Merauke to continue his therapy. She was quite upset, saying they were not yet ready. But, as they say here, 'apa boleh buat' (what could she do?). They had to become ready fast.

But I must say, I did assume that a workable and working program could be set up in a few years. The fact is that the Indonesian ART program is unable to support only around 10,000 people, while several smaller countries in Africa have in the same time scaled up to provide ARVs to over scores of thousands each - why? I know, there are a different set of challenges, but...

Should we have waited? I think we would still be waiting - and most of those who are (reasonably) complaining now would not be alive...

I'll return to some of the other points in Michael's essay tomorrow.

Babé