Looking back is important
On Friday, January 27, 2017, the Indonesian Ministry of Health and the World Health Organization jointly held an event at the Ritz Carlton Hotel in Mega Kuningan, South Jakarta, to present the preliminary results of the Country Review on HIV Response 2017. The 2017 Country Review is the third such review in Indonesia and a continuation of the Health Sector Review on HIV/AIDS conducted in 2007 and 2011. The 2017 Review had been conducted from January 15-27, engaging a team of 20 national and international experts. Along with Angsamerah a wide range of stakeholders involved in the fight against HIV and AIDS from the government, civil society and private sectors were invited.
The event started with some welcoming words and short presentation by Dr. Fabio Mesquita, the technical officer in charge of HIV and viral hepatitis for the WHO in Jakarta, outlining the three main goals of the review: 1) To gain a better understanding of the current status of the HIV and STI epidemics in Indonesia; 2) To make an analysis of the combined efforts of all sectors, which constitutes the national response; and 3) To put forward recommendations on how to improve program and technical aspects related to the prevention, care and treatment of HIV and AIDS.
Dr. Fabio confirmed that Indonesia is still facing a so called concentrated HIV epidemic, with most HIV and AIDS cases found in key affected populations (KAPs), such as men who have sex with men, sex workers, transgender people and injecting drug users. In a concentrated epidemic prevalence rates among KAPs are 5% or higher, while prevalence rates among the general population are less than 1%. In recent years, prevalence rates among most KAPs have levelled off, but new cases among men who have sex with men have seen a rapid increase.
The second goal of the review was only briefly addressed by Dr. Fabio, emphasizing that the national response must be heavily focused on the above mentioned key populations in order to reach the ambitious 90-90-90 goals of the Joint United Nations Program on HIV/AIDS (UNAIDS) by 2020. Moreover, the audience was reminded that there is a pressing need to step up efforts to mobilize more resources from the national budget to cover the 50% of the HIV budget currently still funded by international donors. Dr. Fabio then passed on the word to Dr. Endang Budi Hastuti, Head of the Sub-directorate of HIV and AIDS and STIs of the Ministry of Health of Indonesia, to present the draft recommendations of the review.
A total of twelve (draft) recommendations were put forward by the team of reviewers, each with a subset of more specific sub-recommendations. Step by step Dr. Endang went through all twelve recommendations and sub-recommendations, which cover a wide range of key issues related to the prevention, care and treatment of HIV and AIDS on a national level (Link to the report will follow). At the end of her presentation Dr. Endang also read out a statement by the Ministry of Health of Indonesia in response to the recommendations of the country review. This was followed by a question and answer session with the audience and selected members of the team of reviewers, Dr. Fabio, Dr. Endang and Dr. Dini from the Health Ministry. The discussion, which made up the last part of the event, was very lively with feedback and questions asked by various members of the audience. However, the limited time did not allow for all statements to be heard and questions to be answered.
Business as usual?
Some in the audience were concerned with the rather normative nature of the recommendations and the careful language chosen, criticizing that it lacked resolution. Indeed, the recommendations are not much different from the recommendations formulated five years earlier, nothing overtly new, nothing groundbreaking. As a representative from the private sector I would have hoped to hear more on the private sector’s role within the national response and on how to improve collaboration between the public and private sectors to improve access and quality of health services and contribute towards the national public health agenda. Furthermore, the issue of PrEP was only briefly mentioned in one of the sub-recommendations, stating that “PrEP might be considered as an additional option of prevention” in the future. Maybe it is the lack or disregard of issues like these that will determine whether Indonesia will be one of the countries at the forefront in the global fight against HIV, or merely follow behind.