Good women standing shoulder to shoulder

Unusually, the Jakarta Post on Wednesday published an opinion article on its front page. Headlined "Taking charge in a transition", it was by Sri Mulyani Indrawati, Managing Director of the World Bank Group and a former finance minister of Indonesia. For some reason (probably copywrong), this article is not accessible on the Post's web site, but I managed to find it at its original location, under the headline "Winning the Transition."

Although having no direct connection with HIV, I commend this article to you for its clarity and simple language - and because I'm sure that Ibu Sri does have an indirect impact on HIV here, an impact which hopefully will increase.

Indonesia is lucky in having many women like Ibu Sri. Another closer to home is our Minister of Health, Ibu Endang R Sedyaningsih. An ex-AIDS activist, she's now attempting the Herculean task of sorting out the culture of her ministry, sullied as it is by alleged corruption by several of her predecessors (not all female leaders can be trusted!).

There's another women making an impact, Ibu Sri Pandam Pulungsih. This Ibu Sri was previously a very caring Medial Services Director at the Infectious Diseases Hospital in Jakarta, and is now a hugely respected WHO manager, working on their response to HIV in Jakarta.

We are lucky to have so many talented and dedicated women in Indonesia. Standing shoulder to shoulder, they give us hope for the future.

Babé

Woman, hard beset

Recent research among inmates in Indonesian prisons has raised a worrying red flag. While HIV prevalence among male inmates was a little over 1%, the figure was 6% among female inmates. The report does not attempt to explain this difference, although it should be noted that random selection of study prisons turned out not to include any of the narcotics prisons, where the rate among men would be expected to be much higher. A further study of these prisons is planned. But at least in theory. these results should reflect the situation in Indonesian prisons in general. Clearly we've got to strive to reduce this high rate of infection among women in prison. Ideas?

Once again, this study does not provide a picture of the incidence of HIV infection in prisons. The conventional wisdom is that HIV is spreading uncontrolled in Indonesian prisons. Redefining AIDS in Asia, the 2008 report by the Commission on AIDS in Asia, notes that "men who had recently arrived in jail were only a quarter as likely to be HIV-infected compared with other prisoners," citing a Health Ministry surveillance report as the source of this data. Perhaps this was the case then, but my gut tells me that it's not true today. Yes, there is still some drug injecting in prisons, and yes there's certainly some unprotected sex occurring.  But the study reports only 0.7% of male respondents and no female respondents had injected while in prison. And given that almost half of both sets of respondents had served less than one year of their current sentence, it does seem unlikely that a significant number had been infected after incarceration. What it does tell us is that we really do need a follow-up study to give us a better picture of the real risks for HIV infection in Indonesian prisons.

There is a good summary of the results available for download, together with the full report.

Babé

Marriage: A Risk Factor for HIV?

This morning while browsing an article with that title caught my eye. It was about South Africa, but in my experience reflects reality in Indonesia. It seems that almost all of the women with HIV I meet were infected by their husband or partner. Often they only find out that they are infected after their partner dies and the cause of death is found to be HIV. Usually this is a result of earlier injecting drug use that the female partner may not even have known about. The women is then tested: positive. Often a baby is also tested: positive. By coincidence, Prof Samsu answered a question from such a women in his weekly QA column in the Kompas daily today.

Of course, the result is not always quite as bad. Again, by coincidence, a posting appeared this morning in the sharing forum on our web site. This women lost her husband two years ago; the cause was again only identified after death. She and her child were subsequently tested and found negative. Sadly, as is often the case, it appears she was not properly informed, and is still not convinced that she and her child are uninfected, even though she has been retested since with the same (negative) result.

Her shame has prevented her from seeking support, together with information she can trust. I hope my reply to her cry for help will assist her to overcome her fear - and her shame.

Since Spiritia was set up by Suzana, we have always felt that those affected by HIV have an equal - or greater - need for peer support as those infected. Sadly many of the international activists pressing for greater involvement of people living with HIV (GIPA) ignore the needs of such people. One such recently told me that he 'never came across an organisation for people affected by HIV' (in fact there are several in Indonesia), and quite clearly could see no need for such. Seems to me that ignoring or sidelining the negative partners of positive people is not only inhumane, but also overlooks an incredible resource.

GIPA originally included both infected and affected. It will be a pity if we allow it to become exclusive.

Babé