The Indonesian military recently announced that at least 144 of its 15,000 servicemen stationed at the Trikora Regional Military Command in Papua have tested positive to HIV. Papua Regional Military Command chief Maj. Gen. Hotma Marbun stated that they were mostly between the ages of 18 and 20 and most likely contracted HIV through unsafe sexual behavior.

Amid wide media coverage, there is actually nothing surprising about this news. Anyone who engages in HIV-risk behavior, including unsafe sexual practices, is susceptible to HIV transmission.

What is surprising is the reactive response of one of our lawmakers, Tubagus Hasanuddin (a legislator of the Indonesian Democratic Party of Struggle), who strongly suggested the Indonesian military dismiss these HIV-positive soldiers.

Hasanuddin maintained that their HIV-positive status will automatically make them incapable of performing their jobs as soldiers. We do not need to be an expert of HIV to see that this reactive response reveals Hasanuddin’s ignorance to the nature of HIV, including the fact that anti-retroviral treatment, which is available in Indonesia, can assist these soldiers to stay fit and capable in doing their job.

Hasanuddin’s statement also reveals that the ignorance of our elites, including our lawmakers, may exacerbate stigma and discrimination toward people living with HIV and AIDS. This is not the first case in which our high-ranking officials delivered a misleading view on HIV that may aggravate stigma and discrimination toward HIV/AIDS.

It is noteworthy that stigma and discrimination associated with HIV/AIDS are significant constraints in our efforts to prevent the spread of HIV.

Stigma and discrimination toward people living with HIV and AIDS exacerbate HIV epidemics worldwide, including HIV epidemics in Indonesia. President Susilo Bambang Yudhoyono in his speech at the Asia Pacific Conference on AIDS in Bali last year maintained that “we cannot win the battle against HIV/AIDS if we fail to alleviate stigma and discrimination toward [it] and toward vulnerable groups [for example, sex workers and their clients, injecting drug users and homosexuals]”.

During the conference, many HIV researchers and activists advocate the necessity to respect the rights of HIV/AIDS and vulnerable groups to access prevention and treatment services to improve their health status and well-being.

They also advocated that combating stigma and discrimination toward HIV/AIDS and vulnerable groups should be considered more seriously as crucial elements in overall programs to prevent the spread of HIV.

To better understand why we need to minimize stigma and discrimination toward HIV/AIDS and vulnerable groups, a brief explanation on the term stigma and discrimination is needed.

Asia Pacific Network of People living with HIV (ANP+) summarized that stigma is a process of producing and reproducing inequitable power relations, where negative attitudes toward a group of people, on the basis of particular attributes such as their HIV status, sexuality orientation and behaviors, gender, race, ethnicity, socio-economic status etc, are created and sustained to legitimize dominant groups in society.

It is noteworthy that stigma associated with HIV is often based upon the association of HIV with already marginalized and stigmatized behaviors such as sex work, drug use and same-sex and transgendered sexual practices.

In addition, stigma associating to HIV affects not only HIV/AIDS sufferers but also their partners, children, households and other people in their communities.

It is also worth mentioning that internal or self-stigma frequently occurring, refers to the way a person living with HIV feels about themselves and particularly if they feel a sense of shame about being HIV positive.

Internal or self-stigma may decrease self-esteem and lead to depression or can result in HIV/AIDS sufferers withdraw from intimate and social contact. These potentially lead them to social exclusion.

Stigma is slightly different from discrimination. Discrimination is a manifestation of stigma and may consist of action or lack of action directed toward individuals who are stigmatized.

Moreover, discrimination may occur on many different levels such as within a family or a community setting or within a workplace or educational setting or even within national policies or laws. As stated above, stigma and discrimination toward HIV/AIDS and vulnerable groups are big barriers in combating HIV and AIDS.

Stigma and discrimination trigger fears and misleading myths on HIV/AIDS and lead to attitudes of denial. Furthermore, stigma and discrimination may hinder the access of HIV/AIDS and vulnerable groups toward information, prevention and treatment services. Stigma and discrimination therefore may disrupt basic principles in public health services, for example early diagnosis and prompt as well as adequate treatment.

In addition, stigma and discrimination will hinder the greater involvement of people living with HIV and AIDS (GIPA), a principle that is widely recognized as an important part in designing and implementing culturally appropriate programs for HIV prevention.

The GIPA principle is crucial to enable HIV/AIDS sufferers and vulnerable groups to be engaged in the overall stages of design, implementation and evaluation of HIV programs.

“Nothing about us without us” is a common motto among contemporary AIDS activism.

Abundant research suggested that countries such as Australia, New Zealand, Canada; countries in Western Europe or even developing countries such as Thailand and Uganda, which are successful in reducing or slowing HIV epidemics characterized by their significant success in reducing stigma and discrimination toward HIV/AIDS and vulnerable groups.

Reducing stigma and discrimination toward these people will allow them to fulfill their rights to the highest attainable standard of health as one of the fundamental rights of every human without distinction of race, religion, political belief, economic and social conditions as recognized in 1946 with the adoption of the constitution of the World Health Organization.

This was supported two years later in article 25 (1) of the Universal Declaration of Human Rights (UDHR) and again echoed in article 12 of the International Covenant of Economic, Social and Cultural Rights (ICESCR) in 1996.

Many countries, including Indonesia, have ratified the ICESCR and are now challenged to translate their ratification into action in many related fields, including in the field of HIV prevention and treatment.

Studies on HIV/AIDS strongly suggested that respecting and fulfilling the rights of HIV/AIDS and vulnerable groups are a basic requirement to reduce the spread of the epidemics.

In contrast, repressive policies and attitudes toward HIV/AIDS and vulnerable groups will only lead to the exacerbation of the epidemics.

Our lawmakers should play a key role in combating stigma and discrimination toward HIV/AIDS and vulnerable groups as essential parts of our effort to fight the epidemics.

Source: The Jakarta Post, 25 August 2010