[Kabar-indonesia] HIV-resistant condom for women tested in Papua

[Joyo at aol.com]

also: NYT: In One Country, AIDS on the Rampage... 
And in Another, AIDS in Retreat

The Jakarta Post
Saturday, August 12, 2006

HIV-resistant condom for her is here

Hera Diani, The Jakarta Post, Jakarta

The National AIDS Commission is running a trial on the
use of female condoms in Papua to reduce the rate of
new HIV infections.

The commission's secretary-general, Nafsiah Mboi, said
900 female condoms had been distributed in selected
areas in the province to gauge acceptance of the
contraceptive device. Papua province has the highest
prevalence of HIV/AIDS in the country.

"It's a pilot study to see how people like it, and we
also train people to promote it," said the longtime
HIV/AIDS activist Tuesday.

Nafsiah said she was eager to provide women with
female condoms since they had proven effective in
containing the epidemic in such countries as Thailand
and Zimbabwe.

"The HIV infection rate is increasing much faster
among women than among men in Indonesia. The
percentage of new infections among women is very high.
We have to provide female condoms so that women can
protect themselves. Not just for injected-drug users
or sex workers, but also housewives who know that
their husbands are unfaithful," she said.

Women account for nearly half of HIV infections
worldwide and almost two-thirds of those among young
people. Yet, gender norms and inequality make it
difficult for women and girls to control some aspects
of their lives, particularly sexual matters.

It is often impossible for local women to negotiate
with their partners over abstinence, faithfulness or
condom use.

Zimbabwean activist Caroline Maposhere said the female
condom was a good negotiating tool for women.

The condom is a thin, loose-fitting polyurethane
plastic pouch that covers the vagina, cervix and
external genitalia, and is inserted before
intercourse. It can be put in up to 8 hours before
sex.

"It is large because the vagina is large; it can
accommodate a baby coming out. But the condom sticks
to the wall of the vagina, and fits into any size
vagina," Maposhere told The Jakarta Post.

She said the female condom has many advantages
including preventing pregnancy and sexually
transmitted diseases as well as HIV/AIDS, and
increasing pleasure in men and women.

"In terms of alcohol and drugs, people are often too
drunk and too high to put on a condom. With the female
condom, women who are injected-drug users are already
protected," Maposhere said.

She added that the female condom had increased condom
use by 30 percent.

Nafsiah said the government should increase the
availability of female condoms without waiting for the
study to be completed in November.

"Especially in Papua, we really can't wait a minute
longer," she said.

As of Sept. 30, 2005, Indonesia has 4,065 people who
are HIV positive and 4,186 people living with AIDS,
according to official statistics. Local and
international organizations, however, estimate that
between 90,000 and 250,000 people are living with
HIV/AIDS in Indonesia.

Papua, the easternmost province, has a population of
only 2.5 million (out of the total Indonesian
population of more than 210 million). It has 932
reported cases of AIDS, which is a rate of 40 per
100,000 individuals, or 20 times higher than the
national average of two per 100,000.

The female condom costs around US$1, but Maposhere
said the price will go down if demand increases.

"You cannot put a price on women's lives. It's much
cheaper than the cost of treatment." 

-------------------------------------------------------------------------

The New York Times
August 12, 2006

In One Country, AIDS on the Rampage . . .

By ALAN BRODY

Florence, Italy

AT the International AIDS Conference, which begins
tomorrow in Toronto, there are bound to be various
commemorations of the discovery of AIDS 25 years ago —
if one can ever commemorate something so horrific.

When I arrived in Swaziland in 1999, no one even
wanted to call AIDS by its name. “Silwane,” people
whispered, using a siSwati word for a fearsome animal,
“Silwane got him.” Others said it was witchcraft.

In some measure, it was the failure of Swaziland to
recognize the disease that gave it the world’s highest
prevalence of H.I.V. More than 17,000 people in this
tiny kingdom nestled in the hills of southern Africa
have been dying each year of AIDS, in a population of
about one million. At last count in 2004, 56 percent
of pregnant women ages 25 to 29 had H.I.V.

The ascent was swift. H.I.V. prevalence among pregnant
women was less than 4 percent in 1992, when the
takeoff began, 16 percent in 1994, 26 percent two
years after that, and upward ever since. H.I.V. bides
its time, leaving young women looking beautiful and
men feeling lusty for years before it wears down their
immune systems and the debilitating infections of AIDS
appear.

That has meant plenty of opportunity for those with
H.I.V. to spread the virus unknowingly, and sometimes
knowingly. Policies imported from the West haven’t
helped to encourage widespread testing.

An “AIDS-unique” approach insists on counseling
patients on their right not to be tested (thoroughly
frightening them in the process); the focus on
confidentiality is such that if patients are positive,
not even their spouses are told. Not surprisingly, the
ignorance and stigma that grew up around AIDS in the
West made its leap to Africa.

Deaths on a large scale began here only in 2000.
Suddenly the obituary pages of the national newspapers
began to rival the sports pages in length, and the
young as well as the old found their friends there.
Funeral homes and coffin makers began their macabre
ascendancy as this developing nation’s foremost growth
industry. A wave followed not just of orphans, but
also of children impoverished because AIDS killed the
breadwinners of extended families. Today more than
150,000 of these orphans and vulnerable children exist
on the margins of survival there.

Society struggles to hold together in the face of all
that. Evangelists, local and international, interpret
hell-fire, promise salvation and pass the hat. Youths
convinced that they are already infected act out with
a violence and bravado that speaks of no tomorrow.
Spouses accuse each other of bringing AIDS into the
relationship, arguments punctuated all too often by
violence or suicide.

This does not mean that gloom prevails everywhere. A
radio soap opera and call-in show, “There Is Still
Hope,” tells amusing, lurid and tragic tales of
H.I.V.’s inexorable march through a fictional village,
creating a new understanding of how unprotected sex,
multiple partners, rape, incest and intact foreskins
have played their part in the nation’s encounter with
the virus. “If we had known all this 15 years ago,” a
caller says, “we would have acted differently.”

Many communities have started to create refuges for
the orphans and at-risk children they now call
bantfwana bemamungo, “children of the community.” At
these places, situated close to their often troubled
and sometimes empty homesteads, children can get
guidance, health care and a daily meal.

Just before I left Swaziland, I visited a district
called Mahlangatsha, which in the last year
established 41 such sites. At ceremonies organized by
the district chief, I sat for more than three hours
among 300 of these children reciting poems, dancing
and singing hymns.

As I looked at these young people drawing strength
from one another, I was reminded that Africa cries for
its dead and dying, but it will survive. This
continent’s energy and creativity and spirit of
ubuntu, or humanity, are still alive, embers just
waiting to burst into flame again.

Alan Brody was Unicef’s representative in Swaziland
from 1999 until May.

----------------------------------------------------------------------

The New York Times
August 12, 2006

Op-Ed Contributors

. . . And in Another, AIDS in Retreat

By CHRIS BEYRER and VORAVIT SUWANVANICHKIJ

Twenty-five years into the H.I.V. pandemic, there
remain few developing countries that have had success
in controlling the virus. Thailand is one of them.

In the late 1980’s, Thailand experienced the first
H.I.V. epidemic in Asia, and one of the most severe.
By 1991, 10.4 percent of military conscripts from
northern Thailand were infected by the virus, the
highest level ever reported among a general population
of young men outside Africa.

It became clear early on that the commercial sex
industry — illegal but popular among Thai men — was at
the core of the virus’s explosive spread. The Thai
response was the 100 Percent Condom Campaign.

As part of the campaign, public health officials
aggressively focused on bars, brothels, nightclubs and
massage parlors for condom education, promotion and
distribution. Sex workers were likewise offered
counseling, testing and treatment. The openness of sex
venues there and health officials’ access to the women
in them made this a relatively simple intervention.

Venues that did not agree to require condom use were
shut down. Signs appeared over bar doors saying, “No
condom, no sex, no refund!” And the government put
resources behind the effort, distributing some 60
million free condoms a year.

A wider national effort was also under way. Condoms
appeared in village shops and urban supermarkets, and
frank H.I.V. education was introduced in schools,
hospitals, workplaces, the military and the mass
media. Thais worked hard to reduce fear and stigma and
to support those living with H.I.V.

This national mobilization was classically Thai —
funny, nonthreatening and sex-positive. When we
briefed the Thai surgeon general on an H.I.V.
prevention program for soldiers, he said, “Please be
sure the program maintains sexual pleasure, otherwise
the men won’t like it and won’t use it.”

It worked. By 2001, fewer than 1 percent of army
recruits were H.I.V. positive, infection rates had
fallen among pregnant women, and several million
infections had been averted.

The 100 Percent Condom Campaign proves that H.I.V.
prevention efforts can succeed by focusing on at-risk
populations, providing tangible services and making
healthy behavior, like condom use, social norms.
Cambodia, the Dominican Republic and other countries
have successfully adopted the Thai model.

It’s troubling then that the United States now
requires all foreign and domestic recipients of H.I.V.
and AIDS funding to pledge to oppose prostitution.
After all, the “100 Percent Condom Campaign” and
similar efforts have been shown to decrease the spread
of the epidemic through sexual intercourse; the pledge
policy can make no such claim.

Quite the opposite: the policy may even limit outreach
and access to sex workers, and make condom
distribution more difficult. This is why Brazil
rejected some $40 million in AIDS funding from the
United States last year rather than take the pledge.

This is not the time for us to turn away from any
approach that’s proven to slow the spread of H.I.V.,
and yet the Bush administration lets its moral
concerns trump the evidence. Even in Thailand, the
government has refused to expand successful prevention
services to include gay men and injecting drug users,
leading to rising infection rates among these groups.

Still, we cannot ignore the lessons learned during the
100 Percent Condom Campaign. H.I.V. policy should be
driven by only what’s been shown to work, and
prevention services have to reach those most at risk,
whether or not we condone their behavior.

Chris Beyrer, a medical epidemiologist, directs the
Center for Public Health and Human Rights at Johns
Hopkins. Voravit Suwanvanichkij, a physician in
Thailand, is on the faculty at Johns Hopkins.

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Joyo Indonesia News Service
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