About
In late 2011, epidemiologist, writer and adventurer Elizabeth Pisani granted herself a sabbatical from the day job and set off to rediscover Indonesia, a country she has wandered, loved and been baffled by for decades. She was on the road and the high seas for a year, covering dozens of islands in 27 provinces. This site records photos and musings from that journey and beyond. See more about the project


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Which is worse: HIV or corruption?

Indonesian poster declaring war on corruption, drugs and HIV

West Papua will lead the fight against corruption, drugs, and HIV/AIDS

After another giant geographic leap (roughly the equivalent of London to Tehran) I find myself in Manokwari, West Papua. Tanah Papua, Indonesia’s eastern extremity, has the country’s highest rates of HIV, and also its highest levels of stigma. Which makes me wonder who came up with this commitment, made on an ageing poster that has pride of place outside the provincial Governor’s office. It declares:

The West Papua government will lead the fight against:

    KKN (Corruption, Collusion and Nepotism)
    Narcotics and illegal drugs
    HIV/AIDS

Though hopeful donors have been pushing voluntary testing and counselling clinics on Papua for years, all the clinics I’ve visited in the last week report that the truly voluntary “I’ll just go along and see whether I’m infected” walk-in client is rare. Most are referred to the clinics by health staff who see signs and symptoms of AIDS — often, in other words, after people have been walking around with HIV for a decade or so. Why don’t more people want to get tested? Perhaps in part because we still tell people AIDS can’t be cured. But also because we are equating HIV with distinctly undesirable things like corruption and illegal drugs. It brings us back to the eternal prevention dilemma. We want people to think HIV is undesirable, because we want them to protect themselves from infection. But we also want to stop treating it like some horrid plague which deserves to be feared (and financed) more than any other inconvenient, chronic, treatable disease.

If you’ve been reading this blog much, you’ll have gathered that the parallel with corruption is not actually so far off for Indonesia, in that corruption is also an undesirable, inconvenient and chronic disease. At least HIV is treatable.


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HIV prevention, Indonesian style: stay away from blondes

AIDS prevention poster in Southeastern Maluku, 2011

AIDS prevention poster in Southeastern Maluku, 2011

I have a collection of daft AIDS posters going back years, but I’m glad to say they are getting harder to find. This one, in Saumlaki, the main town in the remote Tanimbar islands, was thus a great find. The headline reads: AIDS: there’s not yet any cure! On the right is this helpful information:

AIDS!!!
You can’t avoid it by:

  • Choosing your sex partners on the basis of their appearance
  • Drinking/injecting antibiotics, alcohol, or herbal medicine before and after having sex
  • Washing your sex organs after having sex

Some, including the South African president Thabo Mbeki Jacob Zuma* and uber-philanthropist Bill Gates would take issue with the last point. I, of course, would take partial issue with the second — you can avoid AIDS by taking medicine, you just can’t avoid HIV that way. But the most egregious part of this ad is the illustration.The population of Tanimbar is largely Melanesian. Overwhelmingly the highest HIV risk for them is the sex they might have on their frequent money-spinning travels to neighbouring Papua. Indonesian Papau, rich in minerals, forests and much else, is swimming in cash. It is also swimming in HIV; it’s epidemic looks more like East Africa 15 years ago than it does like any other part of Indonesia today. And it is populated not by pointy-nosed tourists with straight blonde hair but with flat-nosed Papuans with crinkly black hair.

Most AIDS posters are pretty useless, in my opinion. But this poster associates HIV with Western tourists slow-dancing under the palm trees — an “other” that most people here will never come across, while saying nothing about commercial sex in high risk areas (Papua, but also with the local transgender (or waria) population). Those are very real risks that many certainly do face, at least if Astuti, one of the latter, is to be believed. She excused herself early from a grilled fish dinner because her phone rang. Not her Blackberry, that’s for friends and family, but her “HP selinkungan” (cheating phone). In Tanimbar from neighbouring Kei for around a year, she hasn’t had a day without clients. And though she has helped distribute condoms and promote testing in other cities around Indonesia (in some of which one transgender sex worker in three is infected with HIV), she’s seen no sign of an HIV prevention programme in Tanimbar. By maintaining the fiction that something is being done about HIV prevention in Tanimbar, this poster is a lot worse than useless. It is actively dangerous.

*(Thanks to Thakhani for correcting my presidential confusion.)


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