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FINAL GARP Report 2012- 27 APRIL

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FINAL GARP Report 2012- 27 APRIL
1
Executive Summary
Indonesia, a country with a population of 237.5 million in 2010 has an
estimated HIV prevalence of 0.27% among the 15-49 years age group (MoH,
Mathematic Model of HIV Epidemic in Indonesia 2008-2014). Indonesia’s
HIV and AIDS epidemic is concentrated amongst key affected population
resulting from a mix of two modes of transmissions, sexual transmission and
drug injecting.
While most provinces face a concentrated epidemic amongst key affected
populations, by 2006 evidence showed that across the two provinces of Papua
and West Papua (Tanah Papua) a low-level general population epidemic was
underway, with HIV prevalence of 2.4% among the general population. It is
fueled almost completely by unsafe sexual intercourse (MoH, IBBS Tanah
Papua, 2006).
The cumulative number of reported HIV infections in Indonesia has risen
sharply from 7,195 in 2006 to 76,879 by 2011 (MoH, Year end Report on
Situation of HIV and AIDS in Indonesia, 2006 and 2011). According to the
2009 national estimates of HIV infection, about 186,257 people were infected
with HIV and 6.4 million people were at risk (MoH, Estimation of at-risk
Adult Population, 2009). By 2014, two main targets of the Indonesian response
to HIV and AIDS are to achieve coverage of 80% of key affected populations1
and the general population in Tanah Papua and PLHIV with at least 60% of
those reached practicing safe behavior (NAC, National AIDS Strategy and
Action Plans, 2010-2014).
In the past 2 years, the commitment of the Government of Indonesia to
respond effectively to the epidemic and to reach national and international
1
PWID, sex workers (male, female and transgender), men who have sex with men, high risk men, and
prisoners
Page 1
targets has also been reflected at regional level. The occasion of the 19th
ASEAN Summit in November 2011 was used to mobilize Heads of
State/Government of the Association of Southeast Asian Nations to declare
their commitment towards “an ASEAN with Zero New HIV Infections, Zero
Discrimination and Zero HIV Related Deaths” by 2015.
Prior to this, the Presidential Instruction 3/2010 on Just Development
(Indonesia) had raised the national commitment to accelerate the national
response on goals of MDGs including HIV. As a prerequisite to the
implementation of the Presidential Instruction, an MDG acceleration Action
Plan 2011-2015 had been developed and helped to keep AIDS high on the
national agenda, calling also for a stronger response from sub-national level.
The nation also highly concerned about evolution of the epidemic in the two
eastern most provinces of Indonesia which are experiencing a generalized
HIV epidemic. Responding to a range of challenges, two new policy actions
have been taken: 1) Presidential Regulation No. 65/2011 on Acceleration of
Development in Papua and West Papua and 2) Presidential Regulation
66/2011 on Acceleration of Development Unit in Papua and West Papua.
The total spending on AIDS was US$ 56,576,587 (2006) and has gradually
been increasing, reaching US$ 69,146,880 (2010). Indonesia’s total investment
in AIDS also increased every year, from 27% in 2006 to 40% in 2010 of the
total spending.
During the same period, provincial and district budgets
increased around 2.5 times from US $ 4,329,167 to US $ 10,935,417 (NAC,
National AIDS Spending Assessment, 2009-2010).
In the past two years, AIDS Commissions in Indonesia have grown in skill
and importance from national to province and district/city level. The NAC
was initially established in 1994. In 2006 it was restructured and strengthened
with the Presidential Regulation no. 75/2006. The NAC has become a multisectoral body directly responsible to the President of Indonesia, and tasked
Page
2
with providing leadership, management and coordination far more
“intensive, comprehensive, integrated and coordinated response”. In 2011
there have been functioning AIDS commissions in all 33 provinces and in 2002
priority districts and cities, an increase from 100 districts in 2007.
Sexual transmission
In the beginning, prevention of sexual transmitted of HIV focused on an
individual approach. Evidence indicated this was not enough to bring about
the change needed in the existing socio-cultural environment. The new
structural approach promoting empowerment of sex workers (male, female,
and transgender; direct and indirect), involvement and responsibility of a
wide range of local stakeholders, and partnership with health services across
Indonesia, was developed. It was launched in 159 districts/cities in all 33
provinces of Indonesia during the reporting period, (NAC Program
Monitoring, 2011).
Coverage of some categories of key affected populations is now approaching
the national target. In 2011, the NAC recorded that over two thirds of direct
Female Sex Workers (FSW) and transgender people had been contacted as
well as between one to two thirds of indirect FSW. One indicator also relates
to behavior e.g. the percentage of people reporting condom use at last sex.
FSW, transgender and MSM have all met at least one of the national targets
(MoH, IBBS, 2011). The rising numbers of condoms distributed to key affected
population suggest improvements in condom availability, acceptability, and
use. On the other hand, less than one third of men who have sex with men
(MSM) and high risk men had been reached (NAC, Program Monitoring,
2011).
2
163 districts are supported by Global Fund, and 37 districts are self-funded (the NAC 2011)
Page 3
HIV transmission related to Injecting Drug Use
Harm reduction programs have benefitted from supportive regulations and
program scale-up. At least eight national regulations have been enacted since
2010 to strengthen supportive environment for harm reduction (see Table 1.
Creation of supportive environment for Harm Reduction ). Locations of
Needle and Syringe Program (NSP) and Methadone Maintenance Therapy
(MMT) services have both increased from 120 and 11 in 2006 to 194 and 74 in
2011 (MoH, 2006 and 2011). MMT units are also being selectively embedded
in Community Health Centers (CHC) and prisons. By the end of 2011, two
third of PWID and almost 80% of the estimated prisoners based on the 2009
estimate, had been reached by harm reduction activity (NAC, Program
Monitoring, 2011). The reported rate of needles and syringes sharing was low:
87% PWIDs reported not sharing needles and syringes in the last injection and
already 63% of PWIDs did not share needles and syringes in the last week
injection (MoH, IBBS, 2011).
Increased availability of VCT and ART
Strong evidence has accumulated around the globe in recent years of the
benefits of early diagnosis and early treatment of HIV infection. In Indonesia
serious attention has been given to scaling up HIV testing and counseling
sites. Their number and distribution have increased dramatically from only 25
in 2004 to 500 in 2011 (MoH, Year end Report on the Situation of HIV and
AIDS in Indonesia, 2004 and 2011). The combination of the rapidly rising
establishment of HIV test sites and improving outreach has led to the
increasing proportion of people of key affected populations, IBBS 2011
reported at least 70% of each key affected population (except client of sex
workers) who have been tested (MoH, IBBS, 2011).
ARV treatment for AIDS patients was launched as part of public health
service scaled up in 2005, initially with support from Global Fund. Data of
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4
MoH indicates that by the end of that first year 2,381 patients were receiving
ART. By December 2011, 24,410 people were receiving ART regularly from
303 sites across the country (MoH, Year end Report on Situation of HIV and
AIDS in Indonesia, 2005 and 2011).
Women and Children
While the priority of the national response remains focused on efforts to work
for and with people of key affected populations, the steadily increasing
numbers of reported HIV positive women has made scaling up of PMTCT
services a priority concern. By 2011, it was estimated 8,170 pregnant women
are HIV positive in Indonesia (MoH, Mathematic Model of HIV Epidemic in
Indonesia , 2008-2014).
Looking ahead
This 2012 UNGASS report provides data showing encouraging progress in
some aspects of the response such as harm reduction, for example, in some
locations there has been important strengthening of local leadership and
commitment to increase condom use among sex workers and their partners.
An increase is also important in the number of distribution sites for HIV and
TB testing and for ARV. The AIDS Commission system and effectiveness of
the national M&E and growing success in resource mobilization. Nonetheless,
challenges still remain in Indonesia. In order to achieve UNGASS targets and
reach Universal Access for prevention, care, support, and treatment, building
on its experience, and under the leadership of the NAC and AIDS
Commissions at provincial, district and city levels, Indonesia must continue to
select, prioritize, and scale-up effective interventions while promoting and
strengthening local, national, and international networking and partnerships.
Indonesia’s contribution to “the Global AIDS Response Progress Reporting
2012” has been written with participation of relevant government
Page 5
departments,
civil
society,
PLHIV,
international development partners.
Page
6
the
academic
community,
and
List of Abbreviations
AIDS:
Acquired Immune-Deficiency Syndrome
ART:
Anti Retroviral Therapy
ARV:
Anti Retroviral Drugs
ASEAN:
The Association of Southeast Asian Nations
AusAID:
The Australian government’s overseas aid program
AID
Agency for International Development
IBBS:
Integrated Biological and Behavioral Surveillance
CBS:
Central Bureau of Statistics
CDC:
Directorate General of / Centre for Communicable Disease Control
CHC:
Community Health Center
DFID:
United Kingdom Department for International Development
IDHS:
Indonesian Demographic and Health Survey
FHI:
Family Health International
FSW:
Female Sex Worker
GFATM:
The Global Fund to fight AIDS, TB and Malaria
HCPI
HIV Cooperation Program for Indonesia (Australian supported program
in Indonesia)
HIV:
Human Immunodeficiency Virus
PMTS
Comprehensive approach to prevention of sexual transmission (in
Indonesian: Pencegahan Infeksi HIV Melalui Transmisi Seksual/PMTS)
IBBS:
Integrated Bio-Behavioral Surveillance
ILO:
International Labor Organization
MDG:
Millennium Development Goals
M&E:
Monitoring and Evaluation
MMT:
Methadone Maintenance Treatment
MoH:
Ministry of Health
MSM:
Men who have Sex with Men
NAC:
National AIDS Commission
NASA:
National AIDS Spending Assessment
NCPI:
National Composite Policy Index
NGO:
Non-Governmental Organization
Page 7
NSP:
Needle and Syringe Program
PLHIV:
People Living With HIV
PITC:
Provider’s Initiative (HIV) Testing and Counseling
PMTCT:
Prevention of Mother to Child Transmission
PWID:
People who Inject Drugs
OVC:
Orphans and Vulnerable Children
STI:
Sexual Transmitted Infection
TB:
Tuberculosis
UA:
Universal Access
UNAIDS:
Joint United Nations Program on HIV and AIDS
UNDP:
United Nations Development Program
UNESCO:
UN Educational, Scientific and Cultural Organization
UNFPA:
UN Fund for Population Activities
UNICEF:
United Nations Children’s Fund
UNGASS:
United Nations General Assembly Special Session
USAID:
United States Agency for International Development
VCT:
Voluntary Counseling and Testing
WHO:
World Health Organization
Terminology: Consider addition of note to the reader, Community Health Center. In this
report the “community health center” refers to all registered facilities providing
primary health care services both those in the government public health system and
others, for example, which might be run or financed by faith-based groups, NGOs, or
private sector.
Page
8
Table of Contents
Executive Summary ........................................................................................................................ 1
List of Abbreviations...................................................................................................................... 7
List of Tables and Map ................................................................................................................ 10
List of Figures ................................................................................................................................ 11
Acknowledgement........................................................................................................................ 12
I. Status at a Glance ...................................................................................................................... 14
1.1. Participation of stakeholders in the report writing process ........................................................ 14
1.2. The Status of the Epidemic ......................................................................................................... 15
1.3. Partnerships, Policy and Programmatic Response 2010-2011 ................................................... 17
II. Overview of AIDS Epidemic .................................................................................................. 31
III. National Indicators................................................................................................................. 34
Target 1. Reduce sexual transmission of HIV by 50 percent by 2015 .............................................. 34
General Population .................................................................................................................... 34
Sex Workers ................................................................................................................................ 39
MSM 48
Target 2. Reduce transmission of HIV among people who inject drugs by 50 percent by 2015 ........ 52
Target 3. Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDSrelated maternal deaths ...................................................................................................................... 58
Target 4. Have 15 million people living with HIV on antiretroviral treatment by 2015 ................. 60
Target 5. Percentage of estimated HIV-positive incident TB cases that received treatment for both
TB and HIV ....................................................................................................................................... 63
Target 6. Reach a significant level of annual global expenditure (US$ 22-24 billion) in low and
middle-income countries .................................................................................................................... 65
Target 7. Critical Enablers and Synergies with Development Sectors .............................................. 67
IV. Best Practices ......................................................................................................................... 83
4.1.
4.2.
Building a comprehensive approach to prevention of sexual transmission of
HIV in Indonesia ......................................................................................................... 83
HIV Intervention in Prisons and Detention Centers in Indonesia .................... 90
V.
Major Challenges and Remedial Actions .......................................................................... 94
VI.
Support from the Country’s Development Partners ...................................................... 101
VII.
Monitoring and Evaluation Environment ..................................................................... 106
Annexes ....................................................................................................................................... 112
Page 9
Annex A: Completed Questionnaires of NCPI Part A and B ......................................................... 112
Annex B: National AIDS Spending Assessment (NASA) Matrix ................................................ 166
Annex C. List of Documents consulted ........................................................................................... 175
Annex D. Member of Extended Monitoring and Evaluation Working Group ............................... 177
Annex E. Member of the NAC Executing Team ............................................................................. 178
List of Tables and Map
Table 1. Creation of supportive environment for Harm Reduction ............................................. 22
Table 2. Overview of The 2012 Report on UNGASS Indicators .................................................... 25
Table 3. Reported New and Cumulative HIV and AIDS, 2010-2011 ............................................ 33
Table 4. HIV and Syphilis Prevalence and Condom Use at Last Commercial Sex for FSW and
Transgender People by Age Group................................................................................................... 38
Table 5. MSM prevalence of HIV and STIs, proportion with more than 1 partner, and average
number of sex partner in the last year .............................................................................................. 39
Table 6. HIV and Syphilis Prevalence and Condom Use at Last Commercial Sex for FSW and
Transgender People by Age Group................................................................................................... 39
Table 7. Consumptions of condoms in Indonesia 2006-2011 ......................................................... 40
Table 8. Annual AIDS expenditures 2006-2010 and source domestic or international .............. 65
Table 9. Results of NCPI Part A (Government Officials) year 2011 .............................................. 69
Table 10. Results of NCPI Part B (Representatives of NGOs, bilateral organizations and UN
agencies) year 2011 .............................................................................................................................. 71
Table 11. Social Protection Framework ............................................................................................ 82
Table 12. 2011 coverage against 2009 estimate and 2014 target of key affected populations .... 88
Table 13. Condom PMTS operations, July 2009 – June 2011 .......................................................... 88
Table 15. Global Fund support to phased development of Indonesian national response ..... 104
Map 1. Distribution of HIV and AIDS prevalence, and people living with HIV across
Indonesia based on 2009 estimate ..................................................................................................... 32
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10
List of Figures
Figure 1. Percentage of sex workers reached with HIV prevention program, by Sex ............... 41
Figure 2. Percentage of sex workers reached with HIV prevention program, by Age .............. 42
Figure 3. Percentage of sex workers reporting the use of a condom with their most recent
client, by Sex ......................................................................................................................................... 43
Figure 4. Percentage of sex workers reporting the use of a condom with their most recent
client, by Age ........................................................................................................................................ 44
Figure 5. Percentage of sex workers who have received an HIV test in the past 12 months and
know their results, by Sex................................................................................................................... 45
Figure 6. Percentage of sex workers who have received an HIV test in the past 12 months and
know their results, by Age ................................................................................................................. 45
Figure 7. Percentage of sex workers who are living with HIV, by Sex ........................................ 47
Figure 8. Percentage of sex workers who are living with HIV, by Age ....................................... 47
Figure 9. Percentage of female sex workers who are living with HIV, by length of
participation in sex work .................................................................................................................... 48
Figure 10. Percentage of men who have sex with men reached with HIV prevention program,
by Age ................................................................................................................................................... 49
Figure 11. Percentage of men reporting the use of a condom the last time they had anal sex
with male partner, by Age .................................................................................................................. 50
Figure 12. Percentage of men who have sex with men that have received an HIV test in the
past 12 months and know their results, by Age .............................................................................. 51
Figure 13. Percentage of men who have sex with men who are living with HIV, by Age ........ 52
Figure 14. Percentage of people who inject drugs who report the use of a condom at last
sexual intercourse, by Sex (IBBS 2007, IBBS 2011)........................................................................... 53
Figure 15. Percentage of people who inject drugs who reported using sterile injecting
equipment the last time they injected, by Age ................................................................................ 55
Figure 16. Percentage of people who inject drugs that have received an HIV test in the past 12
months and know their results, by Age ........................................................................................... 56
Figure 17. Percentage of people who inject drugs who are living with HIV, by Age ................ 57
Figure 18. Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce
the risk of mother-to child transmission .......................................................................................... 58
Figure 19. Percentage of adults and children with advanced HIV infection receiving
antiretroviral therapy .......................................................................................................................... 60
Figure 20. Percentage of adults and children with HIV known to be on treatment 12 months
after initiation of antiretroviral therapy ........................................................................................... 62
Figure 21. Percentage of estimated HIV positive incident TB cases that recieved treatment for
both TB and HIV, by Sex .................................................................................................................... 64
Figure 22. Percentage of estimated HIV positive incident TB cases that received treatment for
both TB and HIV, by Age ................................................................................................................... 64
Figure 23. Percentage of AIDS Expenditure 2008 and 2010 by Category .................................... 67
Figure 24. Current school attendance rate of orphans aged 10-14 , by Sex ................................. 79
Figure 25. Current school attendance rate of orphans aged 10-14 both of whose parents are
alive and who live with at least one parent, by Sex ........................................................................ 79
Figure 26. Schematic representation of partnership in structural intervention .......................... 86
Page 11
Acknowledgement
The drafting committee offers great thanks to all – individuals and
institutions – who have supported the preparation of this report. Valuable
guidance and inputs were provided by Nafsiah Mboi (NAC Secretary) and
Nancy Fee (UNAIDS Country Coordinator). Many other people who have
also made valuable contributions include members of the Extended
Monitoring and Evaluation Working Group, Naning Nugrahaeni, Kemal
Siregar, Yanti Susanti, Lely Wahyuniar, Suzanne Blogg, Sri Pandam, and
Nurcholis Madjid, as well as Ari Wulansari, Victoria Indrawati, Fetty
Wijayanti, Karen Smith, Wenita Indrasari, Djadjat Sudradjat, Vidia Darmawi,
and Kharisma Nugroho. Most of the data in this report are taken from data
collected by surveillance systems in Indonesia and program monitoring, and
we thank the MoH and the NAC who have worked so hard to generate,
gather and make these data available. We are grateful for the commitment
and support from the Extended Monitoring and Evaluation Working Group
and the NAC executing team meeting in the course of reporting process (see
annex for the list of Extended Monitoring and Evaluation Working Group
member, and the list of institutions in the NAC executing team).
Notwithstanding our efforts and the support received, there are surely
shortcomings. We welcome suggestions and corrections. In closing, the
drafting committee hopes that this record of the progress made and the
challenges ahead will contribute to the great national endeavor to bring the
epidemic under control and assure to PLHIV the support and freedom to lead
dignified, independent and fulfilling lives.
March 2012
Page
12
Foreword
This country report presents information specifically focused on
achievements of the Government and civil society in Indonesia related to the
Declaration of Commitment on HIV and AIDS of UNGASS in the past two
years, 2010-2011. This report is a collaborative effort reflecting the
perspectives of both the Government and a wide range of civil society
participants in this field.
For the period covered by this report, UNAIDS has stipulated 30 indicators to
measure progress in the response to HIV and AIDS. Indonesia can report
what has been accomplished related to indicators relevant to concentrated
epidemics. However, information related to some indicators is not available,
as they refer to aspects of generalized epidemics that are not widely found in
Indonesia except the provinces of Papua and West Papua.
The Government of Indonesia has shown strong commitment to mounting
and sustaining an effective response and it endorses a broad range of
activities run by many stakeholders. During the period under review,
management of Indonesia’s response has improved. Presidential Instruction
no. 3/2010 on Just Development put in place a roadmap for GOI to accelerate
the achievement of the MDGs including all those relevant to HIV and AIDS.
This regulation ensures synergy amongst ministries and between central and
local governments and communities as well as identifying possible financial
mechanism for the allocation of funds and incentives for HIV and AIDS
control.
Although much remains to be done, there has been great progress in the past
two years. Indonesia notes with appreciation the contribution of the
government, the private sector, and nongovernmental organizations, both
domestic and international, who have helped the country address the
challenges presented by the twin epidemics of HIV and injecting drug use
across Indonesia. Activities responding to the needs and aspirations of those
infected and affected have become more diverse and accessible.
Preparing this report has been a useful exercise for all of us. We are pleased to
be part of this global process. We hope its publication and circulation will not
only fulfill an obligation as a UN member but will lead to improvements in
our national monitoring and evaluation system as well as providing good
evidence and data to support our continuing efforts to mount an ethical,
humane and effective response to HIV and AIDS.
Coordinating Minister for People’s Welfare/
Chairman, Indonesian National AIDS Commission
Agung Laksono
Page 13
I. Status at a Glance
1.1. Participation of stakeholders in the report writing process
A range of partners have been actively engaged in producing and analyzing
the data used in this report. Data collection and analysis was done in
coordination with the Monitoring and Evaluation Working Group of the NAC
that was composed of representatives of government departments, donors
and civil society. The principle governmental departments’ responsible for
data collection and analysis were the Ministry of Health and the NAC.
The National AIDS Spending Assessments is carried out by the NAC and a
team from the University of Indonesia. An analysis of program and data were
reported, discussed and agreed to in a series of consultation meetings with
the Monitoring and Evaluation Working Group beginning in January 2012.
Civil society was actively involved in preparation of this report as was the
case in the previous rounds of UNGASS reporting including participation in
discussion forums related to the National Commitment and Policy
Instruments. The comprehensive report on the National Commitment and
Policy Instruments is reported in chapter 3.
While there is some variation from place to place, it can be said that thanks to
the generally conducive environment for civil society participation, today
people living with and affected by HIV and key affected population are well
represented in many discussions, monitoring and evaluation of the national
progress on UNGASS indicators.
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14
1.2. The Status of the Epidemic
Change in mode of transmission requires an adjustment in the strategy of Indonesia’s
response:
The dominant mode of transmission of HIV infection at this time in Indonesia
is through 1) unprotected sex particularly among people with a high numbers
of partner and 2) unsafe injecting behavior.
In a mathematic model of the HIV epidemic in Indonesia, the MoH projected
that without an acceleration of prevention, 541,700 people will be HIV
positive by 2014. It also projected a shift in the main mode of transmission
from injecting drug use to sexual transmission. New infection among PWID
was projected to decrease from 40% in 2008 to 28% in 2014, while infection
through sexual transmission will rise from 43% to 58% (MoH, Mathematic
Model of HIV Epidemic in Indonesia, 2008-2014). In facts cumulative reported
AIDS cases shows the majority was due to heterosexual transmission, rising
from 37% (2001-2005) to 71% (2011), while infection from drug injecting use
dropped from 53% to 34% during the same period.
Relatively high HIV prevalence has been reported in the 2011 IBBS especially
among transgender sex workers (43%), male sex workers (34%), and direct
FSW (10%). Prevalence of HIV infection among PWID has declined from 52%
(IBBS 2007) to 36% (IBBS 2011).
The prevalence of unsafe injecting behavior is much lower than unsafe sexual
behavior, but is not yet reflected in the prevalence among PWID over time
given that the prevalence of HIV in PWID population remains high.
The level of condom use reported by people of key affected populations when
having last commercial sex is high (MoH, IBBS, 2011). A detail discussion on
needles and syringe sharing and condom use of people of key affected
populations will be found in chapter 3.
Page 15
Further analysis shows that the proportion of FSW and PWID who are
infected in their first year of engagement is high overtime (2007 and 2011) at
6% and 4% (FSW), and 27% and 13% (PWID). Although programs are having
an impact, improvement is still needed in prevention programs.
In the two provinces of Tanah Papua, Papua and West Papua, in the extreme
east of Indonesia, this situation is different. Comprising only 1% of
Indonesia’s population, reports show the AIDS level 15 times higher3 than the
national average. The mode of transmission in Tanah Papua remains
predominantly by heterosexual transmission. The prevalence rate amongst
males in the general population age 15 – 49 is 2.9% in males, and 1.9% in
females, resulting in Tanah Papua being classified as a low level generalize
population epidemic region (MoH, IBBS Tanah Papua, 2006).
The national surveillance shows MSM often reported having non-commercial
partners (84%), while most of the FSW clients are married or have regular
sexual partner (70.5%) or have irregular partners (14%) (MoH, IBBS, 2011).
Multiple partners, more frequent sexual intercourse, low level of demand for
condoms, low condom use and access have all increased the risk of
transmission not only among key affected population, but for women who are
sexual partners of clients of sex workers or PWID. New efforts are now being
made to attract more men high risk and general population to have an HIV
test hoping to reduce transmission to women. In 2011, 3% of women who
visited ANC and were tested for HIV in 2011 were HIV-infected (MoH,
Program Monitoring in Universal Access Report, 2011). There was a HIV
modeling by MOH projecting a rise in number of HIV positive women from
4,560 in 2008 to 8,170 in 2014. Subsequently, the projection of HIV-infected
children is also showed an increase from 1,070 in 2008 to 1,590 in 2014 (MoH,
Mathematic Model of HIV Epidemic in Indonesia , 2008-2014).
3
December 2011 the MoH CDC. Comparing the reported AIDS case rates (number of confirmed AIDS
cases per 100,000 population) found that the case rate for the province of Papua at 133.07 was just over
15 times that of the national rate of 8.66
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16
National spending on treatment will be required to meet the needs of the
population. In 2011, the number of ART participants has increased to 24,410
people (MoH, Year end Report on Situation of HIV and AIDS in Indonesia,
2011). This equals 40% of the total estimate of people eligible for ART (MoH,
Mathematic Model of HIV Epidemic in Indonesia, 2008-2014). In the absence
of reduction in new infection, the need for ARV therapy among the 15-49 age
groups is projected to increase three fold from 30,100 in 2008 to 86,800 in 2014
(MoH, Mathematic Model of HIV Epidemic in Indonesia , 2008-2014).
1.3. Partnerships, Policy and Programmatic Response 2010-2011
Indonesia has embraced a broad and comprehensive approach to the AIDS
epidemic including prevention, care, support, treatment, and mitigation of
social and economic impact. Implementation of this approach requires
partnerships among all actors in the response, development of relevant
policies, and prevention and treatment programs for the broad range of key
affected populations. This is the key to breaking the cycle of infection and
changing the direction of the epidemic.
Even in the setting dominated by a concentrated epidemic, programs
addressing the general population are also important to introduce
basic
information about HIV and AIDS, non discrimination and principles of
human rights; practical messages of mutual fidelity between husband and
wife; and reinforcement of religious values.
In work with PLHIV, as with people of key affected populations, emphasis
has been given to promoting knowledge, skills, and activities to support self
reliance, personal responsibility to avoid transmission of infection to others,
and adherence to medication while living a full and fulfilling life. Each set of
concerns those related to the key affected populations, the general population,
and the community of PLHIV has a place in Indonesia’s national response
Page 17
(NAC, The Response to HIV and AIDS In Indonesia 2006 – 2011: Report on 5
Years Implementation of Presidential Regulation No. 75/2006 on the NAC,
2011)
Partnerships
The enactment of Presidential Regulation 75/2006 intensified diversified the
national programmatic response to AIDS in the country. As an interministerial body responsible to the President of Indonesia, the NAC was
restructured to be more inclusive in membership and strengthened to
promote a more intensive, comprehensive, integrated and coordinated
response. The role of the AIDS Commissions system was, at the same time
strengthened from national to local level. Since 2008, AIDS Commissions have
been functioning in 33 provinces and in 200 priority districts and cities, an
increase from 100 districts in 2007, as well as the National level.
The
management support at district level has been followed by the gradual
launching of comprehensive programs4 from 68 districts in 12 provinces
(2008) growing to 137 districts in 33 provinces in mid 2011 (NAC, The
Response to HIV and AIDS In Indonesia 2006 – 2011: Report on 5 Years
Implementation of Presidential Regulation No. 75/2006 on the NAC, 2011).
Because of stigma and discrimination, some people of key affected
populations do not yet make extensive use of available HIV services in CHCs.
Self treatment among key affected population is still high. Outreach services
are not only provided to educate but also to assist the sex workers to increase
utilization
of
health
services.
The
involvement
of
non-government
organizations (NGOs) providing outreach services have been improving
especially since the infusion of Global Fund resources, with the most
The “comprehensive response to HIV and AIDS”in Indonesia includes provision of the necessary
information, supplies, and services for comprehensive counselling and testing for HIV, along with well
distributed systems to provide care, support, and treatment including reliable ARV treatment for those
needing it. It implies, as well, the ongoing capacity development and system building necessary to
sustain, modify, and continue the response in the future.
4
Page
18
influential Muslim religious group, Nahdatul Ulama, and the National Family
Planning Association (PKBI) serving as a principle recipient (PR).
Between 2006 and 2009, five national networks of the key affected
populations5 were established at the national level. Development has been
uneven but all have started the process of organizing local branches, some of
which are thriving and active in many provinces.
Several international development partners have been longstanding,
supportive actors in the response to HIV and AIDS contributing both funds
and technical support. The development of the NAC since Presidential
Regulation no. 75/2006 has formalized organization in working with
international development partners.
The private sector, through the Indonesia Business Coalition for AIDS, has
mounted a response to HIV and AIDS in the form of public-private
partnerships for the prevention of sexually transmitted diseases, including
HIV amongst Indonesia’s large, mobile, male work force.
As of May 2011, 32 (15%) of 218 hospitals with private CST services were
reported, providing ARV treatment for 4,440 patients amounting to 21% of
those receiving ARV
(MoH, Report on Situation of HIV and AIDS in
Indonesia, May 2011).
Policy
Since Presidential Regulation no. 75/2006, numerous policies have been issued
by government ministries to strengthen and sustain the response to HIV.
Home Affairs Regulation no. 20/2007 (art 13) states that the cost required for
carrying out the work of AIDS Commission at National, Provincial and
District/City shall be borne by respective government levels. However,
adequate funding is not yet guaranteed, even though 16 provinces and 34
5National network of key affected people: 1. Sex Workers, 2. Gay-Transgender-Lesbian, 3. PLHIV, 4.
Women who are HIV positive, 5. Victims of narcotics, psychotropic drugs and other addictive
substances
Page 19
districts/cities already have local regulations on HIV and AIDS. Experience
thus far has been that in local AIDS budgets depend mostly on the personal
commitment of the governor, district head, mayor and members of the
legislature (DPRD). The 2010-2014 planning and budgeting of the national
response has been integrated in the National Mid-Term Development Plan
(RPJMN-Rencana Pembangungan Jangka Menengah Nasional 2010-2014).
This will assure some measure of support from the National Budget at least
until 2014.
Presidential Instruction 3/2010 on Just Development has focused national
attention on acceleration of efforts to achieve the Millennium Development
Goals, including Goal 6 (MDG 6), which specifically refers to halting and
reversing the spread of HIV and AIDS.
The Action Plan (2011-2015) for
implementation of this instruction has been developed and keeps AIDS high
on the national agenda and calls for a stronger response from sub-national
level, as well.
The commitment of the government to respond effectively to the epidemic
and to reach national and international targets has been strengthened across
the Southeast Asia region.
The occasion of the 19th ASEAN Summit in
November 2011 was used to mobilize Heads of State/Government of the
Association of Southeast Asian Nations to declare their commitment towards
an ASEAN with Zero New HIV Infections, Zero Discrimination and Zero HIV
Related Deaths. This commitment should contribute to strengthening of the
legal environment and financial commitment to full and equitable response to
the epidemic.
Implementation and effectiveness of these supportive policies and budget
commitments
still
need
impact-oriented
monitoring
and
evaluation
mechanisms which will provide information on the quality of program
implementation and its effectiveness in addressing the epidemic. Current
available epidemiological data on the status of the epidemic is still uneven.
Page
20
For example, surveillance data for general population in Tanah Papua is still
based on IBBS 2006/2007, and national AIDS related estimates data are from
2009. A new national estimate and the IBBS among the general population in
Tanah Papua are both planned for 2012. Another health survey related to HIV
and reproductive health among married men and women, as well as
unmarried youth (IDHS and IYARHS) is planned for 2012.
Programming
Sexual Transmission Prevention Program
Evidence of the rise in the sexual transmission of HIV led the secretariat of the
NAC to diversify approaches both to improve effectiveness and to reach more
people involved in high risk sex through a comprehensive approach to
prevent sexual transmission.
Financial support in 2011 was provided by the Global Fund and the National
Budget. The National Population and Family Planning Board and Family
Health International in turn also provided support in the form of condoms.
As of December 2011, the MoH reported 643 STI services units available
through CHCs, private clinics and company clinics. Condom promotion
programs have been provided in numerous sites and reached about 70% of
FSW, 18% of their clients, 75% of transgender male sex workers, 9% of MSM
and 58% of PWID (NAC, Program Monitoring, 2011).
Harm Reduction Program
Indonesia has responded to the PWID HIV epidemic by developing policies,
regulations and programming to address the problem. Hospitals and
Community Health Centre services provide needle syringe programs (NSP)
and methadone maintenance therapy (MMT) with an increase in the number
Page 21
of facilities and the geographical distribution over several years. The
evolvement of policy that has been contributing to the growing movement of
harm reduction programming is presented in Table 1 below.
Table 1. Creation of supportive environment for Harm Reduction
Year
Policy
2003
MoU between the NAC and National Narcotic Bureau on integrated HIV and AIDS
prevention and prevention of injecting drug abuse
2006
Decree of Minister of Health 567/Menkes/SK/VIII/2006 on guidelines for
implementation of harm reduction for narcotics, and other addictive substances
2007
Regulation of the Coordinating Minister on People’s Welfare number 02 on Harm
Reduction
2008
Regulation of the Minister of Health 350/ MENKES /SK/IV/2008 designating
hospitals and satellites for Methadone Maintenance Therapy and Guidelines
2009
National Law no 35 on narcotic drugs. (User recognized as victim entitled to
treatment)
2010
Regulation of the Minister of Health 422/ MENKES /SK/III/2010
Medical Treatment of Drug Abusers
2010
Circular letter of the Supreme Court no 4/ 2010 (Drug users/addicts to be referred to
treatment)
2010
Regulation of Minister of Justice and Human Rights no. HH 01.PH.02.05/2010 on the
National Action Plan for control of HIV and AIDS and Drug Abuse in Correctional
Institutions 2010-2014
2011
Presidential Instruction 12/2011 on registration of, and medical and social
rehabilitation for Drug Users
2011
Regulation of the Minister of Health 1305/MENKES/SK/VI/2011 (Designating
appointed 131 health centers for far registration of accept drug users and to
provision drug rehabilitation and services
2011
Regulation of the Minister of Health 2171/MENKES/SK/X/2011 on Drug Registration
Procedure
2011
Circular letter of the Supreme Court no 3/ 2011 on referral of Drug Users to Medical
and Social Rehabilitation
2012
Regulation of the Minister of Social Affairs 3/2012 on standardization of social
rehabilitation centers for drug users
Guidance on
Source: The Response to HIV and AIDS in Indonesia 2006-2011: Report on 5 years implementation of
Presidential Regulation no. 75/2006 on the National AIDS Commission
Harm reduction services are now available in Community Health Centres
(CHC), correctional institutions, and NGOs where staff carry out some or all
of the nine basic components of comprehensive harm reduction. The number
Page
22
of sites which provide NSP has increased, from 120 sites in 2006 to 194 by the
end of 2011. During this same period, MMT has been made available in 74
sites across the country a significant increase from 11 sites in 2006 (MoH, Year
end Report on Situation of HIV and AIDS in Indonesia, 2006 and 2011).
HIV Testing and Care, Treatment and Support
HIV infection is asymptomatic, and a blood test is the only way to know if a
person is infected with HIV. Early diagnosis will improve the possibility of
PLHIV receiving timely treatment, as well as encouraging them to avoid
infecting others. A local study (Riyarto S, 2010) found the underlying factor
for delayed diagnosis of HIV is the lack of knowledge about the improved
prognosis of early ARV treatment, and a fear of being stigmatized by the
community. Increased availability of HIV testing at CHC, combined with
improved knowledge of the prognosis of HIV treatment among key affected
population, and the community at large and may improve earlier testing.
In December of 2011 the Ministry of Health reported 500 active VCT sites
located in 142 districts/ cities across Indonesia including 45 in correctional
facilities (prisons and detention centers) of the Ministry of Law and Human
Rights across the country (MoH, Year end Report on Situation of HIV and
AIDS in Indonesia, 2011). There has also been progress in scaling up
collaborative TB/HIV activities. Some studies on the quality of services makes
clear that, with adequate training, supervision, and motivation, facilities can
provide consistently acceptable services. It is hoped that Provider Initiated
Counseling and Testing (PICT), which is already underway in some areas and
scheduled for expansion will help increase utilization of HIV testing.
The network of hospitals providing ART had increased from 148 in 2007to 235
hospitals with 68 associated satellite CHC in 2011 (MoH, Year end Report on
Situation of HIV and AIDS in Indonesia, 2011). Future programming will
Page 23
need to identify and develop strategies to address both the delivery side and
demand side of ARV-related services to improve the level of its intake and
continuation.
Page
24
Overview Table: Data and Indicators
Table 2. Overview of The 2012 Report on UNGASS Indicators
Indicators
Numbers
Data Sources
TARGET 1. REDUCE SEXUAL TRANSMISSION OF HIV BY 50 PER CENT BY 2015
1.1. Percentage of young women
Age
and men aged 15-24 who correctly
Males
Females
%
%
All
identify ways of preventing sexual
15-19
11.7
12.9
-
transmission of HIV and who reject
20-24
16.7
20.1
-
major misconceptions about HIV
All
13.7
15.1
14.3
Age
Males
Females
All
%
%
IDHS 2007
transmission
1.2. Percentage of young women
and men aged 15-24 who have had
sexual intercourse before the age of
15-19
0.4
0.3
15
20-24
0.3
0.04
All
0.33
0.21
1.3. Percentage of women and men
Males
Females
aged 15-49 who have had sexual
%
%
intercourse with more than 1
All
0.3
-
partner in the last 12 months
15-19
-
-
20-24
0.2
-
25-49
0.3
-
1.4. Percentage of women and men
IDHS 2007
0.28
IDHS 2007
Indicator is not relevant to Indonesia
aged 15-49 who have had more
than one partner in the last 12
months reporting the use of a
condom during their last sexualintercourse
1.5. Percentage of women and men
Indicator is not relevant to Indonesia
aged 15-49 who received an HIV
test in the 12 months and who
know their results
1.6. Percentage of young people
Indicator is relevant, but national data
aged 15-24 who are HIV infected
are not available
1.7. Percentage of sex workers
Sex
Integrated Bio
reached with HIV prevention
Workers
Behavior Survey
Page 25
%
programs
All
18.48
Males
11.85
Females
19.91
<25
14.1
25+
24.3
IBBS 2011
1.8. Percentage of sex workers
Sex
Integrated Bio
reporting the use of a condom with
Workers
Behavior Survey
their most recent client
%
(IBBS) 2011, CDC
All
58.0
MoH
Males
49.4
Females
59.9
<25
49.5
25+
61.7
1.9. Percentage of sex workers
Sex
Integrated Bio
who have received an HIV test in
Workers
Behavior Survey
the last 12 months and who know
%
(IBBS) 2011, CDC
All
79.4
MoH
Males
89.2
Females
77.0
<25
78.0
25+
79.81
their results
1.10. Percentage of sex workers
Sex
Integrated Bio
who are living with HIV
Workers
Behavior Survey
%
(IBBS) 2011, CDC
All
9.0
MoH
Males
18.3
Females
7.0
<25
8.0
25+
9.4
Female
SW
1.11. Percentage of men who have
Page
26
< 1yr
4.1
1+ yr
7.6
MSM
Integrated Bio
%
Behavior Survey
All
23.4
(IBBS) 2011, CDC
<25
20.4
MoH
25+
25.2
sex with men reached with HIV
prevention programs
1.12. Percentage of men who have
MSM
Integrated Bio
sex with men reporting the use of a
%
Behavior Survey
condom the last time they had anal
All
59.8
(IBBS) 2011, CDC
sex with a male partner
<25
63.8
MoH
25+
58.1
1.13. Percentage of men who have
MSM
sex with men that have received an
Behavior Survey
%
HIV test in the last 12 months and
who know their results
Integrated Bio
All
92.0
<25
92.3
25+
91.8
1.14. Percentage of men who have
MSM
sex with men who are living with
(IBBS) 2011, CDC
MoH
Integrated Bio
Behavior Survey
%
HIV
All
8.5
<25
6.1
25+
9.8
(IBBS) 2011, CDC
MoH
TARGET 2. REDUCE TRASMISSION OF HIV AMONG PEOPLE WHO INJECT DRUGS BY 50
PER CENT BY 2015
2.1. Number of syringes
7 syringe per person who inject drugs
NAC Program
distributed per person who injects
per year
Monitoring,
drugs per year by needle and
= 689,662 syringes/105,784 people who
Estimation 2009
syringe program
inject drugs
the MoH
2.2. Percentage of people who
PWID
Integrated Bio
inject drugs who report the use of a
%
Behavior Survey
All
51.6
(IBBS) 2011, CDC
Males
N/A
MoH
Females
N/A
<25
56.0
25+
50.2
condom the last sexual intercourse
2.3. Percentage of people who
PWID
Integrated Bio
Page 27
inject drugs who reported using
%
Behavior Survey
sterile injecting equipment the last
All
87.0
(IBBS) 2011, CDC
time they injected
Males
N/A
MoH
Females
N/A
<25
82.2
25+
88.6
2.4. Percentage of people who
PWID
inject drugs that have received an
Behavior Survey
%
HIV test in the last 12 months and
who know their results
Integrated Bio
All
90.6
Males
N/A
Females
N/A
<25
83.7
25+
92.1
2.5. Percentage of people who
PWID
injecting drugs who are living with
(IBBS) 2011, CDC
MoH
Integrated Bio
Behavior Survey
%
HIV
All
36.4
Males
N/A
Females
N/A
<25
11.6
25+
43.9
(IBBS) 2011, CDC
MoH
TARGET 3. ELIMINATE MOTHER TO CHILD TRANSMISSION OF HIV BY 2015 AND
SUBSTANTIALLY REDUCE AIDS RELATED MATERNAL DEATHS
3.1. Percentage of HIV-positive
2010: 9.78% (=468/4,784 X 100%)
CDC MoH
pregnant women who received
2011:15.7% (= 813 /5,171 x 100%)
program
antiretroviral to reduce the risk of
monitoring 2010,
MTCT
2011,
3.2. Percentage of infants born to
National data is not available
HIV-infected women receiving a
virological test for HIV within 2
months of birth
3.3. Mother to child transmission of
HIV (modelled)
Page
28
National data is not available
TARGET 4. HAVE 15 MILLION PEOPLE LIVING WITH HIV ON ANTIRETROVIRAL
TREATMENT BY 2015
4.1. Percentage of eligible adults
2010:38.8% (=19,572/50,400 x 100%)
CDC MoH, 2010,
and children currently receiving
2011: 84 % (= 24,410/29,012 x 100%)
2011
antiretroviral therapy
4.2. Percentage of adults and
children with HIV known to be on
Adults & children
2010
2011
CDC MoH, 2010,
70%
67.7%
2011
treatment 12 months after initiation
of antiretroviral therapy
TARGET 5. REDUCT TUBERCULOSIS DEATHS IN PEOPLE LIVING WITH HIV BY 50 PER
CENT BY 2015
5.1. Percentage of estimated HIV-
2009
2010
2011
positive incident TB cases who
All
3.9%
received treatment for TB and HIV
Males
2.5%
Females
1.4%
<15
0.1%
15+
3.8%
CDC MoH, 2011
TARGET 6. REACH A SIGNIFICANT LEVEL OF ANNUAL GLOBAL EXPENDITURE (us$22-24
BILLION) IN LOW-AND MIDDLE INCOME COUNTRIES
6.1. Domestic and International
AIDS spending by categories and
financing sources
2009
$
2010
$
Total
60,285,420
69,146,880
Domestic
21,318,844
27,779,280
International
38,966,576
41,367,600
Spending
National AIDS
Spending
Assessment
2011, Indonesia
National AIDS
Commission
TARGET 7. CRITICAL ENABLERS AND SYNERGIES WITH DEVELOPMENT SECTORS
7.1 National Commitments and
Please see chapter 3
Policy Instruments (NCPI)
Indonesia NAC,
2011
7.2. Proportion of ever-married or
Indicator is relevant but national data is not
partnered women aged 15-49 who
available
experienced physical or sexual
violence from a male intimate
partner in the past 12 months
Page 29
Non-
Indonesia
orphans
Demographic
%
%
Health Survey
All
87.2
92.6
(IDHS) 2007,
Males
83.8
91.8
Statistic Indonesia
Females
91.2
93.5
7.3. Proportion of the poorest
Rice for
Conditio
households who received external
Food
nal Cash
7.3. Current school attendance
Orphans
among orphans and among nonorphans aged 10-14
Transfer
economic support in the last 3
months
Page
30
70.0 %
3.2 %
ILO Report 2011
II.
Overview of AIDS Epidemic
The Indonesian HIV epidemic has not changed from a concentrated epidemic
since the 2010 UNGASS report, with high HIV prevalence in some
populations (key affected population), namely People who Inject Drugs
(PWID) (36%), transgender people (43%), FSW (7%), and MSM (8%).
In the last 4 years, there has been a noticeable shift in the predominant mode
of infection among reported AIDS cases (cumulative) from 2,873 (2007) to
29,879 (2011). Unsafe injecting is no longer the dominant mode of infection.
While in 2007, 49.8% of new reported AIDS were drug related and 41.8% were
the result of heterosexual transmission, by 2011 that situation had changed
with only 18.7% of the total new reported AIDS cases associated with drug
injecting, and 71% were the result of heterosexual infection (MoH, Year end
Report on Situation of HIV and AIDS in Indonesia, 2007 and 2011).
The HIV epidemic in Tanah Papua is generalized, and different from the rest
of the country, and driven largely by commercial sex. As of 2006, HIV
prevalence in Tanah Papua was reported 2.9% in men and 1.9% in women
(age 15-49). It was higher in rural than urban areas.
Reports on HIV infection and related statistics at province and district/city
level allow us to observe the intensity and distribution of the epidemic. The
most recent estimate was done in 2009, which serves as a critical point of
reference for discussions about the status of the epidemic and for planning the
response. In 2009, 6,396,187 people were estimated to be at high risk of HIV
with 186,257 people estimated to be living with HIV (MoH, Estimation of atrisk Adult Population, 2009). The reports which map the epidemic shows HIV
and AIDS are unevenly distributed across the country (see Map 1. Distribution
Page 31
of HIV and AIDS prevalence, and people living with HIV across Indonesia based on
2009 estimate). Infection has been reported in 300 districts in 32 provinces.6
Map 1. Distribution of HIV and AIDS prevalence, and people living with HIV across
Indonesia based on 2009 estimate
Source: MoH estimate 2009, Mapping NAC
Indonesia reported continuing new and cumulative HIV infection and AIDS
cases climb from a combined total of 79,979 in 2010 to a combined total of
106,758 in 2011, indicating 42,622 new PLHIV had been identified during the 2
year period. During the same period the number of facilities for counseling
and testing increased more than four times from 156 in 27 provinces in 2009 to
500 reporting VCT sites in 33 provinces in 2011 (MoH, Year end Report on
Situation of HIV and AIDS in Indonesia, 2011). High numbers in reported
HIV cases reflects, among other things increase in the availability and
utilization of counseling and testing (VCT and PITC), an important step
forward in the national response. Choosing to be tested is an activity of high
importance in efforts to reduce new infection and to improve the quality of
life of PLHIV. The IBBS also indicates a rising number of people of key
At time this map was published in ‘the Response to HIV and AIDS in Indonesia 2006-2011: Report on 5
years implementation of Presidential Regulation no. 75/2006 on the National AIDS Commission’,
Indonesia has 33 provinces, and according to information from Ministry of Home Affairs 524
districts/cities
6
Page
32
affected populations reporting to have an HIV test, which suggests that
stigma and discrimination in relation to HIV and AIDS may be declining
compared with earlier times in the epidemic. These 2011 IBBS findings are
discussed in details in chapter 3.
Table 3. Reported New and Cumulative HIV and AIDS, 2010-2011
HIV
AIDS
New
Cumulative
New
Cumulative
2010
21,591
55,848
4,158
24,131
2011
21,031
76,879
4,162
29,879
Page 33
III.
National Indicators
The IBSS findings presented in this report were collated between 2010 and
2011. To show the trends, this report also uses some the IBBS findings that
were collated between 2006 and 2007, as target groups in both IBBS were
surveyed in the same selected districts/cities.
In the case of FSWs, transgender people, high risk men and MSM, two-stage
cluster sampling design method was employed, while random sampling was
used to select both sample locations (clusters) and respondents. In the IBBS on
PWID, cluster sampling was employed for sample selection and data
collection purposes. Respondent Driven Sampling was employed, with data
being collected during face-to face interviews between NGO officers and the
respondents. In this case, bias might have occurred as the sample through
networks is basically the same as service provision networks.
Indonesian data is available on only a few indicators about risk behavior
among the general population. At the national level where the epidemic is, for
the most part, a concentrated epidemic they have limited relevance. The last
complete data on the general population in Tanah Papua was collected in
2006-2007, while the 2011-2012 data collection was still in progress during the
reporting period. We are therefore not yet able to track trends in risk behavior
and HIV prevalence due to some aspects of the national responses.
Target 1. Reduce sexual transmission of HIV by 50 percent by 2015
General Population
Indicator: Percentage of young women and men aged 15-24 with
1.1.
comprehensive knowledge about HIV-AIDS
It is vital to educate young people about HIV transmission before they are
exposed to situations that put them at risk of HIV infection. Comprehensive
Page
34
knowledge for young people means knowing how HIV is transmitted, how
to prevent it (including abstinence or delay in sexual debut, reduction in the
number of sexual partners, monogamy, and correct and consistent condom
use for those who are sexually active), and knowledge about availability of
services for those who are HIV positive. It also includes knowledge about
misconceptions about HIV transmission or prevention: that HIV cannot be
transmitted by mosquito bites, or by sharing food with a person who has
AIDS, or attributed to witchcraft.
Findings from the 2007 IYARHS report showed that at that time only 3
percent of unmarried women and 1 percent of unmarried men has
comprehensive knowledge about HIV and AIDS. Comprehensive knowledge
about HIV and AIDS was better, among married people at the same age
group although still low. The IDHS survey from 2007 show that 9.5% of ever
married women and 14.7% of currently married men aged 15-24 had
comprehensive knowledge about HIV and AIDS.
A recent rapid study showed that comprehensive knowledge about HIV and
AIDS among the general population aged 15-24 years was increasing from
11.4% in 2010 to 20.6% in 2011, with similar proportion between men (20.2%)
and female (20.3%) respondents.
Almost two third of young people (57% women, 56% men) reported that
AIDS cannot be transmitted by sharing food with a person with AIDS, and
over two thirds of young people (68.1% of women and 67.3% of men)
responded correctly to the question about whether or not a healthy-looking
person can have the AIDS (MoH Rapid Study on HIV comprehensive
knowledge in 5 cities in 5 provinces 2011).
Page 35
1.2.
Indicator: percentage of young women and men aged 15-24 who have
had sexual intercourse before the age of 15
Female virginity has a high value among Indonesian youth with 98-99% of
women and men aged 15-24 saying that it is important for a woman to
maintain her virginity. Values about virginity might help delay age at sexual
debut among young Indonesian with surveillance showing that only 1% of
women and 6% of men in the 15-24 year age group reportedly having had a
sexual experience. Unmarried respondents who reported having sex before
age 15 among male age group 15-19 age group and 20-24 is similar, which is
1% and 0.9%.
In IDHS survey, 26.2% percent of ever married-women currently aged 15-17
years reported having had sex before the age of 15. This may have to do with
the tendency of girls (especially in rural areas) to marry at a relatively young
age.
Indicator: percentage of adults aged 15-49 who have had sexual
1.3.
intercourse with more than one partner in the past 12 months
Individuals who have multiple sexual partners increase their risk of
contracting HIV as each new relationship introduces another pathway for
potential HIV transmission. Thus, multiple partnerships with inconsistent
condom use can contribute to the spread of HIV.
Findings from the IDHS in 2007 show that 3 in 1000 currently married men
had engaged in sexual intercourse with an extramarital, non-cohabitating
partner in the previous 12 months meaning that these men have had sexual
intercourse with more than one partner. The actual number may be larger
considering some respondents may be reluctant to provide information on
their recent sexual behavior particularly if it departs from the socially
acceptable monogamous norm. It should also be noted that only married men
Page
36
were asked this question. No women were asked about multiple sexual
partners within the previous year.
A Tanah Papua surveillance found high risk sexual behavior among adults,
with 25 % of married men and 7% of married women reportedly having
extramarital or non-cohabiting partners in the previous year. Of those who
had extramarital or non-cohabiting sexual relationships, men have been more
likely to have multiple sexual partners (20% men compared to 8% women)
(MoH, IBBS Tanah Papua, 2006).
1.4.
Indicator: percentage of adults aged 15-49 who had more than one
sexual partner in the past 12 months who report use of a condom during
their last intercourse
The indicator is not available at this time in Indonesia
1.5.
Indicator: percentage of women and men aged 15-49 who received an
HIV test in the past 12 months and know their results
The indicator is not available at this time in Indonesia
Page 37
1.6.
Indicator: Percentage of young people aged 15-24 living with HIV
The indicator is relevant to Indonesia but national data are not available.
In 2011, there was sentinel surveillance available from 2 sites - one in the
western Indonesia (Riau province) and one in the eastern Indonesia (Tanah
Papua) of Indonesia- to young women who visited ANC. However the data is
not yet available.
It is interesting to look at HIV prevalence in those aged 15 to 24 years who are
already involved in the sex industry and drug injecting. Transgender HIV and
syphilis increased with the age. Condom use by FSW is lower in younger
FSWs compared to older FSWs although a lower proportion of transgender
people aged 25 years or more reported using condoms during the last
commercial sex. See Table 4. HIV and Syphilis Prevalence and Condom Use at
Last Commercial Sex for FSW and Transgender People by Age Group for
further information.
Table 4. HIV and Syphilis Prevalence and Condom Use at Last Commercial Sex for FSW
and Transgender People by Age Group
(NAC, MoH, UNICEF 2006-2007)
Key affected
Population
FSW
Transgender
Age Group
15-19
20-24
25+
15-19
20-24
25+
HIV
prevalence
(%)
5
8
7
5
14
19
Syphilis
Prevalence
(%)
6
6
9
10
11
24
Used condom
last commercial
(%)
52
63
68
61
65
58
The percentage of young MSM who had sex with more than one partner in
the past 1 year was highest in the 20-24 year age group and they also had the
highest average number of sex partners, although STI ad HIV prevalence was
highest in those aged 25 years or more. Levels of reported condom use at last
sex with commercial partners were high between 55% - 59%, and less condom
use with non-commercial partners (43% - 45%).
Page
38
Table 5. MSM prevalence of HIV and STIs, proportion with more than 1 partner, and
average number of sex partner in the last year
(NAC, MoH, UNICEF 2006-2007)
Age
Group
HIV prev.
(%)
STI prev.
(%)
More than
1 partner
in the last
year (%)
Average
number of
sex
partners
15-19
20-24
25+
2
5
7
2.4
5.7
7.3
43
55
52
2.5
4
3.5
Used
condom
last non
commercial
(%)
43
45
45
Used
condom last
commercial
(%)
55
59
58
PWID who are aged 25 years or older have higher HIV and syphilis
prevalence than younger age groups, although a higher proportion of those
aged 15-19 shared needles and syringes.
Table 6. HIV and Syphilis Prevalence and Condom Use at Last Commercial Sex for FSW
and Transgender People by Age Group
(NAC, MoH, UNICEF 2006-2007)
Age Group
HIV prevalence
(%)
15-19
20-24
25+
6
30
50
Syphilis
Prevalence
(%)
0
0.8
1.3
Used condom last
commercial (%)
52
33
30
Sex Workers
1.7. Percentage of sex workers reached with HIV prevention program
One of the methods to measure reach of HIV prevention programs among sex
workers is by asking respondents if a) they know where to go to receive an
HIV test, and b) if they had received a condom at anytime in the last three
months.
At first glance, program reach seems low with less than one fifth of sex
workers knowing where to find HIV test providers and having received
condoms within the last 3 months.
Page 39
However, by disaggregating variables for different sub-populations, we find
exposure to programs varies. Almost two third (60%) of male sex workers
know where to get an HIV test, yet few (16%) reported having been given a
free condom in the past 3 months. Male sex workers may not have intensive
contact with outreach workers who usually give free condoms. Yet many
male sex workers seem to be aware of HIV test sites from other sources such
as friends or the internet.
Among FSW, a moderate result was obtained with 37% reporting knowing
where to get An HIV test and 38% had received a condom in the last 3 months
respectively (MoH, IBBS 2011).
It is noteworthy however, that condoms are now being heavily promoted.
Consumption of condoms, free and for purchase has more than doubled in
the past 5 years from 94,806,211 in 2006 to 194,213,765 in 2011 (see Table 7.
Consumptions of condoms in Indonesia 2006-2011)
Table 7. Consumptions of condoms in Indonesia 2006-2011
(Source: NAC Program Monitoring 2006-2011)
Respondents of IBBS surveillance reported various sources for condoms;
many (36%) obtained them from pharmacy and stores, 21% from pimps and
establishments, 8% from outreach workers, and 5% from STI clinics indicating
that there has been a growth in the sources of condoms among individual,
community and STI service providers (MoH, IBBS 2011).
Page
40
Surveillance data indicates sex workers had greater exposed to programs as
they get older. It shows that young people remain at the centre of the
epidemic and lack access to information, prevention and services.
Figure 1. Percentage of sex workers reached with HIV prevention
program, by Sex
Percentage of Sex Workers reached with HIV prevention program, by Sex
IBBS 2007, IBBS 2011
100
80
60
e
g
a
t
n
e
cr 40
e
P
55.2
All
Male
29.0
Female
23.9
19.9
18.5
20
11.8
0
2007
2011
Page 41
Figure 2. Percentage of sex workers reached with HIV prevention
program, by Age
(IBBS 2007, IBBS 2011)
Percentage of Sex Workers reached with HIV prevention program, by Age
IBBS 2007, IBBS 2011
100
80
60
e
g
ta
n
e
rc 40
e
P
All
29.0
<25
30.6
25.7
24.2
25+
18.5
20
14.1
0
2007
2011
1.8. Percentage of sex workers reporting the use of a condom with their
most recent client
The percentage of condom use at last sex with client reported by sex workers
was high yet shows a downward trend (see Figure 3. Percentage of sex
workers reporting the use of a condom with their most recent client, by Sex).
Sex workers reports on condom use are very consistent with clients reporting
that their last sexual intercourse with a sex worker took place mostly with a
condom (58%), with less condom use with male sex workers (49%) compared
to FSW (60%).
In some cities, the reported condom use level among direct FSW has risen
such in Batam (from 66% to 79.9%), in Jakarta (from 39% to 49.4%), in
Denpasar (from 79% to 90%), and among indirect FSW in cities such Bandung
(from 64% to 72%), Surabaya (from 54% to 85.2%) as well as in Jayapura
among both direct and indirect FSW (direct FSW: from 80% to 95%, indirect
FSW: from 42% to 57.7%). But, a low percentage of FSW reported that they
Page
42
had used a condom with their most recent client was in Jayawijaya (Direct
FSW: 28.8%) and in Lampung (Indirect FSW: 17.6%). There was also a
decrease in reported condom use in Deli Serdang (from 43% to 36.4%) among
direct FSW, in Semarang (from 80% to 74.2%) among indirect FSW, as well as
in Bekasi and in Malang for both direct and indirect FSW. The combination of
these results related to condom use contributed a major portion of the
decrease in overall results.
It remains a challenge to reach young sex workers. Their condom use is high,
but not as encouraging as sex workers 25 years of age or more (Figure 4.
Percentage of sex workers reporting the use of a condom with their most
recent client, by Age).
Figure 3. Percentage of sex workers reporting the use of a condom
with their most recent client, by Sex
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of sex workers reporting the use of a condom with
their most recent client, by Sex
(IBBS 2007, IBBS 2011)
100
79.1
80
67.8
66.0
59.9
58.0
e 60
g
a
t
n
e
cr
e 40
P
49.4
All
Male
Female
20
0
2007
2011
Page 43
Figure 4. Percentage of sex workers reporting the use of a condom
with their most recent client, by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of sex workers reporting the use of a condom with
their most recent client, by Age
(IBBS 2007, IBBS 2011)
100
80
70.0
67.8
63.6
61.7
58.0
e 60
g
a
t
n
e
cr
e 40
P
49.5
All
<25
25+
20
0
2007
2011
1.9. Percentage of sex workers who have received an HIV test in the past 12
months and know their results
Ten years ago, sex workers in Indonesia reported routinely experiencing
stigmatization and discrimination in health care settings. For the past 4 years,
training of health staff in CHC has been scaled up to understand more about
HIV and promote the adoption of comprehensive HIV prevention. The MoH
has designated at least 643 CHC across Indonesia to provide STI treatment,
and some are able to provide HIV testing and TB/HIV treatments (MoH, Year
end Report on Situation of HIV and AIDS in Indonesia, 2011).
Some establishments refer their FSW for regular screening of STI, as well as
routine HIV testing. The numbers of direct sex workers and male sex workers
tested for HIV has been climbing, indicating progress in expansion of HIV
testing and promotion during the last 2 years.
Page
44
Figure 5. Percentage of sex workers who have received an HIV test
in the past 12 months and know their results, by Sex
(IBBS 2007, IBBS 2011)
Figure xx: Percentage of sex workers who have received an HIV test in the
past 12 months and know their results, by Sex
(IBBS 2007, IBBS 2011)
100
89.2
79.4
77.0
80
e
g
ta 60
n
e
rc
e
P
40
57.2
All
Male
Female
32.6
27.8
20
0
2007
2011
Figure 6. Percentage of sex workers who have received an HIV test in
the past 12 months and know their results, by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of sex workers who have received an HIV test in the
past 12 months and know their results, by Age
(IBBS 2007, IBBS 2011)
100
79.4
80
e 60
g
a
t
n
e
cr
e 40
P
78.0
79.8
All
<25
35.2
32.6
25+
27.3
20
0
2007
2011
Page 45
1.10. Percentage of sex workers who are living with HIV
Among key affected populations, male sex workers have the second highest
HIV prevalence at 18%. The prevalence among direct FSWs has never been
lower than 10% in the last 4 years, while indirect FSWs are 3%.
HIV prevalence among indirect female sex workers has decreases in cities
such Batam, Jakarta, Medan and Semarang. In Batam from 9% in 2007 to 6.9%
in 2011, Jakarta from 6% (2007) to 5.2% (2011), Medan from 4% (2007) to 3.2%
(2011) and Semarang from 2% (2007) to 0.8% (2011) respectively. In Surabaya
prevalence has been stable remaining low at 2%. The highest HIV prevalence
was among direct female sex workers in Jayawijaya (25%) and Batang (20%)
and there was an increase in Denpasar and Jayapura (from 14% to 16%).
These increases and decreases explain the comparatively unchanged in
overall prevalence among direct FSW.
Surveillance data also indicated FSW were becoming exposed to HIV at early
initiation of their sex work with 4.1% of newer sex workers were infected (see
Figure 9. Percentage of female sex workers who are living with HIV, by
length of participation in sex work). Among direct female sex workers who
work in brothels and on the streets, and who have worked less than a year
there was no significant increase or decrease in prevalence from 2007 to 2011
in all the sites studied. Aggregate prevalence in this group is about 8%.Two
thirds of new FSWs started their career in karaoke, massage parlor, bar,
restaurant, or street sex workers. HIV prevalence among indirect female sex
workers who have been involved in sex work for less than a year in the
hospitality industry, has decreased by two thirds from almost 10% to 3% from
2007 to 2011 (MoH, IBBS 2011).
Page
46
Figure 7. Percentage of sex workers who are living with HIV, by Sex
(IBBS 2007, IBBS 2011)
40
Figure xx. Percentage of sex workers who are living with HIV, by Sex
(IBBS 2007, IBBS 2011)
35
30
24.4
25
e
g
20
a
t
n
e
rc
e
15
P
18.3
All
Male
Female
10.2
10
7.8
9.0
7.0
5
0
2007
2011
Figure 8. Percentage of sex workers who are living with HIV, by
Age
(IBBS 2007, IBBS 2011)
30
Figure xx. Percentage of sex workers who are living with HIV, by Age
(IBBS 2007, IBBS 2011)
25
20
e
g
15a
t
n
e
cr
e
10P
All
10.2
10.4
10.1
<25
9.0
9.4
8.0
25+
5
0
2007
2011
Page 47
Figure 9. Percentage of female sex workers who are living with HIV, by length of
participation in sex work
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of sex workers who are living with HIV, by lenght
of participation in sex work
(IBBS 2007, IBBS 2011)
30
25
20
e
g
t
15 a
n
e
rc
e
P
10
All
<1
10.2
8.4
1+
9.0
7.6
6.8
4.1
5
0
2007
2011
MSM
1.11. Indicator: Percentage of men who have sex with men reached with
HIV prevention programs
Findings from the 2011 IBBS report show that the percentage of MSM who
know where to go to get an HIV test 47% and been given condoms in the last
3 months (30%) has decreased compared to the results of the IBBS from 2007.
There was a high number of MSM in Malang and Jakarta who reportedly
knew where to get HIV test (72% and 52%) and had been given condoms in
the last 3 months (62% and 40%), while only 11% of MSM in Bandung and 7%
in Semarang who had been given condoms in the last 3 months.
Monitoring found that the program coverage for MSM almost halved in 2011
(12,960 people) compared to 2010 (26,232 people). Surveillance confirmed the
program records that there was a slight decrease of MSM who had ever been
reached by outreach workers within the last 3 months, from 37% (2007) to
Page
48
26% (2011). However, the number of MSM who search for information about
HIV on the internet is promising (41,650 total visits7 per year), suggesting this
could be a good way to reach MSM.
Figure 10. Percentage of men who have sex with men reached with
HIV prevention program, by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of men who have sex with men reached with HIV
prevention program, by Age
(IBBS 2007, IBBS 2011)
100
80
e 60
g
a
t
n
e
rc
e
P 40
All
47.9
44.0
<25
37.6
25+
23.4
25.2
20.4
20
0
2007
2011
1.12. Indicator: percentage of men reporting the use of a condom the last
time they had anal sex with a male partner
Most MSM (84%) reported having had non-commercial and casual partners.
However, only 20% of MSM bought sex. Condom use among MSM reporting
use at last anal sex with a partner has shown increases in some areas of
decreases in other. No of 57% in 2007 to 60% in 2011 (60%) pattern is
apparent, yet. In Surabaya and in Malang from 65% to 75% and from 66% to
7
Indonesian Gay, Transgender and Lesbian Network website record Mar 2010- Feb 2012
Page 49
77%. Use increased in Bandung (from 83% to 49%), in Jakarta (from 77% to
65%) and in Semarang (from 55% to 34%) it decreased.
Rates of consistent condom use among MSM remained at 30%. The
consequence of risky behavior is reflected in the rising rate of STIs overtime,
from 4% to 13% for Syphilis and 1% to 33% for Gonorrhea and/or Chlamydia
(MoH, IBBS 2007 and 2011).
Figure 11. Percentage of men reporting the use of a condom the last
time they had anal sex with male partner, by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of men reporting the use of a condom the last time
they had anal sex with male partner, by Age
(IBBS 2007, IBBS 2011)
100
80
e 60
g
ta
n
e
cr
e 40
P
57.3
55.7
58.2
60.0
63.8
58.1
All
<25
25+
20
0
2007
2011
1.13. Indicator: percentage of men who have sex with men that have
received an HIV test in the past 12 months and know their results
The numbers of MSM in Indonesia who have had a HIV test has risen
dramatically from 34% to 92%, as a result of increasing availability of
information among MSM (see indicator 1.11), and expanding of HIV testing in
community health centers during the last 2 years.
Page
50
Figure 12. Percentage of men who have sex with men that have
received an HIV test in the past 12 months and know their results,
by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of men who have sex with men that have received an
HIV test in the past 12 months and know their results, by Age
(IBBS 2007, IBBS 2011)
100
92.0
92.3
91.8
80
e 60
g
a
t
n
e
cr
e 40
P
All
<25
33.7
31.4
35.1
25+
20
0
2007
2011
1.14. Indicator: percentage of men who have sex with men who are living
with HIV
A report on HIV and AIDS in Indonesia shows that only 4% of reported AIDS
cases identify the source of their infection as homosexual transmission. This
figure might reflect underreporting as a result of the unacceptability of
homosexuality in the community. Some male clients may be reluctant to
provide information about a male sexual partner.
In big cities such Jakarta, Bandung and Surabaya where prevalence among
MSM was high, it rose between 2007-2011 from 8% to 17.2%, from 2% to
10.4%, and from 6% to 9.6% respectively, over four years (IBBS 2007, IBBS
2011). The surveillance data indicates that young MSM tend to have
increasing HIV prevalence overtime (see Figure 13. Percentage of men who
Page 51
have sex with men who are living with HIV, by Age), thus the program must
reach each generation of MSM.
Figure 13. Percentage of men who have sex with men who are living
with HIV, by Age
(IBBS 2007, IBBS 2011)
20
15
e
g
a
t
n
e
rc 10
e
P
All
9.8
8.5
6.0
<25
25+
6.1
5.2
5
4.2
0
2007
2011
Target 2. Reduce transmission of HIV among people who inject drugs by 50
percent by 2015
Unfortunately it is not possible to disaggregate these data by gender since the
gender of respondents was not recorded in the 2011 IBBS questionnaire.
2.1. Number of syringes distributed per person who injects drugs per year
by needle and syringe program
The number of needles and syringes distributed by programs in 2011 was
690,000 to 61,637 PWID. The estimated PWID population is 105,784 (MoH
estimate 2009). The provision of needles and syringes should match the
demands of PWID. If surveillance data are used to calculate demand, the
Page
52
minimum number of needles and syringes needed is over 38,5 million, based
on 364 per PWID per year, based on an average of 7 needles and syringes
(IBBS 2011) per week per PWID. The current level of needles and syringes
distribution means that, on average, each PWID receives 7 needles and
syringes per year.
Surveillance data indicates drop in centers (33%), outreach workers (32%),
and CHC (20%) are the primary sources of sterile needles and syringes among
PWID. In Indonesia, harm reduction services are also embedded in the health
care system, with CHC services providing NSP and methadone substitution
therapy. Purchasing of sterile needles and syringes at pharmacies (and stores)
has proven the cheapest strategy for distribution to PWID globally (Geneva
2004) and is rising in importance in Indonesia. Purchase was reported by two
thirds (58%) of respondents in 2011 (MoH, IBBS 2011).
2.2. Percentage of people who inject drugs who report the use of a condom
at last sexual intercourse
Sexual behavior of PWID has high potential for HIV spread to non-injectors
because prevalence among PWID is still high and unprotected sex is common.
Some 36% of PWID are married or live with a steady sexual partner, 25%
reported having had sex with an irregular partner, and 24% with sex workers.
Reported condom use at last sex among PWID is not as good as among sex
workers and MSM, but much better than that of clients of sex workers.
Consistent condom use was reported by more than 40% of PWID who had sex
with sex workers, and nearly 50% of PWID who had sex with casual partners.
The report of protected sex with extra-marital partners is consistent with the
moderate syphilis rate (2%).
There was a dramatic increase in percentage of PWID who reported condom
use at last sex in Surabaya with both regular partner (from 16% to 49%) and
casual sex partner (27% to 45%) and in Jakarta with regular partner from 29%
Page 53
to 50%, while in Bandung condom use among MSM at last anal sex was were
decreasing from 42% to 34% (regular partner) and from 63% to 50% (casual
sex partner).
Figure 14. Percentage of people who inject drugs who report the use
of a condom at last sexual intercourse, by Sex
(IBBS 2007, IBBS 2011)
Percentage of people who inject drugs who report the use of a condom at
last sexual intercourse, by Age
(IBBS 2007, IBBS 2011)
100
80
e 60
g
a
t
n
e
rc
e 40
P
56.0
51.6
35.8
34.5
50.2
All
<25
36.3
25+
20
0
2007
2011
2.3. Percentage of people who inject drugs who reported using sterile
injecting equipment the last time they injected
Surveillance data suggests the positive impact of supportive regulation on
harm reduction. The reluctance to carry needles and sterile needles and
syringes because of fear of arrest for PWID has been reduced with the
subsequent increase of carrying needles and syringes (30% PWID carrying
needles and syringe in 2011, while 25% of PWID in 2007), and 50% of PWID
reported participating in NSP in the last week of survey. The number of
PWID receiving methadone is growing. Program records suggest a
proportion of injectors (39%), continue to inject while on MMT, particularly in
the early months of treatment (NAC, HCPI and AusAID, HIV Cooperation
Page
54
Program for Indonesia Annual Survey among Harm Reduction Program
Participants in 7 provinces, 2011)
Figure 15. Percentage of people who inject drugs who reported
using sterile injecting equipment the last time they injected, by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of people who inject drugs who reported using
sterile injecting equipment the last time they injected, by Age
(IBBS 2007, IBBS 2011)
100
88.0
87.0
88.5
88.6
87.0
82.2
80
e
g 60
a
t
n
e
cr
e
P
40
All
<25
25+
20
0
2007
2011
2.4. Percentage of people who inject drugs that have received an HIV test in
the past 12 months and know their results
Surveillance data, depicted in Figure 16. Percentage of people who inject
drugs that have received an HIV test in the past 12 months and know their
results, by Age) shows a great increase in the proportion of PWID reported to
have had a test for HIV after the increase of supportive regulations on harm
reduction and integration of NSP in CHCs services. Among NSP participants,
56% had had an HIV test. HIV test attendance among methadone clients was
nearly 100%, as enrollment in MMT service requires an HIV test. NSP and
methadone services clearly provide a good opportunity to reinforce
secondary prevention messages such HIV testing for PWID.
Page 55
Figure 16. Percentage of people who inject drugs that have
received an HIV test in the past 12 months and know their results,
by Age
(IBBS 2007, IBBS 2011)
Figure xx. Percentage of people who inject drugs that have received an HIV
test in the past 12 months and know their results, by Age
(IBBS 2007, IBBS 2011)
100
92.1
90.6
83.7
80
e 60
g
a
t
n
e
cr
e 40
P
All
47.6
44.2
<25
36.6
25+
20
0
2007
2011
2.5. Percentage of people who inject drugs who are living with HIV
Overall, HIV prevalence among PWID was lower in 2011 than in 2007. The
decrease in prevalence in 2011 compared to 2007 was mainly due to decreases
in Medan from 56% to 39%, in Surabaya from 56% to 49%, and in Bandung
from 43 to 25%. HIV prevalence was also lower among those injecting for two
years or less in Malang at 6% and in Bandung at 10%. In Medan there has
been significant progress since 2007 with a decrease in prevalence of 24%.
However, prevalence at the time of IBBS 2011 was still 17%. For PWID in the
same category (injecting for two years or less) prevalence reached 22% in
Surabaya and 38% in Jakarta. Among newer PWID (less than 1 year
involvement) there has been marked progress with infection declining from
27% (IBBS 2007) to 12.3% (IBBS 2011).
While gratified to see some improvements within the community of PWID,
nonetheless continuing work is needed and planned including more peer
Page
56
education, NSP, testing and treatment, and an increased availability of a
combination of harm reduction services in the community and in the prison
system, encourage and support maintenance of safe behavior thus preventing
new infection.
Although the sample size was small, subgroup analysis of people who have
been injecting less than two years in the city of Jakarta found that prevalence
rose from 33% to 44% over four years (2007 to 2011).
Figure 17. Percentage of people who inject drugs who are living
with HIV, by Age
(IBBS 2007, IBBS 2011)
100
Figure xx. Percentage of people who inject drugs who are living with HIV,
by Age
(IBBS 2007, IBBS 2011)
80
60
e
g
a
t
n 40
e
cr
e
P
58.0
52.4
43.9
41.5
All
36.4
<25
25+
20
11.6
0
2007
2011
Page 57
Target 3. Eliminate mother-to-child transmission of HIV by 2015 and
substantially reduce AIDS-related maternal deaths
3.1. Percentage of HIV positive pregnant women who receive antiretroviral
to reduce the risk of mother to child transmission
Figure 18. Percentage of HIV-positive pregnant women who
receive antiretrovirals to reduce the risk of mother-to child
transmission
(UA 2009, UA2010, UA2011)
40
35
Percentage of HIV-positve pregnant women who receive antiretrovirals to
reduce the risk of mother-to child transmission
(UA 2009, UA2010, UA2011)
30
25
e
ga
t
n20
e
cr
e
P
15
15.72
9.78
10
4.56
5
0
2009
2010
2011
The MoH estimated that there were 5,060,637 pregnant women in 2011, and
0.4% (21,103) of them has been tested for HIV and received the results (MoH
Program Monitoring 2011). Of those who were tested for HIV, 2.5% (534
pregnant women) were HIV positive. The proportion of pregnant women
known to have received ARV prophylaxis is increasing and the target by 2014
is 3,175 HIV-infected pregnant women (MoH, Program Monitoring in
Universal Access Report 2011).
Women, who are likely to visit antenatal clinics on their own, have generally
not thought about having an HIV test prior to being offered the opportunity
Page
58
as part of their antenatal care so most of these women have not talked with
their partner prior to having an HIV test. The 2007 IDHS showed low
involvement of a father during their partner’s pregnancy, with only 32% of
fathers talking to health care providers about the pregnancy care and health
of their wife during their wife’s last pregnancy.
The dilemmas women face when deciding whether or not to share results
with their sexual partners and family may be substantial, as ART requires lifelong adherence and is much more likely to be sustained in a supportive
situation.
To accelerate the elimination of mother to child transmission, more assertive
promotion of HIV testing and treatment among men is urgent to reduce
transmission of infection to wives or other sexual partner. The nation is also
challenged to promote counseling for couples, and community based
initiatives (leaders, clerk, priest, community volunteers) to assist women prior
to, during and post disclosure addressing negatives outcomes should they
occur (e.g. mediation, shelter environment for access social support and if
needed support for legal sanction in cases of severe violence). Without such
initiatives, the ARV treatment rate among (pregnant) women may remain
low.
3.1. Percentage of infants born to HIV-positive women receiving a
virological test for HIV within 2 months of birth
Indicator is relevant to Indonesia but national data are not available
3.2. Mother-to-child transmission of HIV (modeled)
Page 59
Target 4. Have 15 million people living with HIV on antiretroviral treatment
by 2015
4.1. Percentage of eligible adults and children currently receiving
antiretroviral therapy
Figure 19. Percentage of adults and children with advanced
HIV infection receiving antiretroviral therapy
(UA 2009, UA 2010, UA2011, MoH target by 2014)
100
87
90
84.1
80
70
e
ga 60
t
n 50
e
cr
e
P 40
38.40
38.8
30
20
10
Percentage of adults and children with advanced HIV infection receiving
antiretroviral therapy
(UA 2009, UA 2010, UA2011)
0
2009
2010
2011
2014
An estimated 186 thousand Indonesian were infected with HIV in 2009: In
2011 more than 24,410 HIV-positive people was receiving ARV treatments
(the MoH program monitoring 2011). Adults make up 96% (23,390 people) of
those receiving ARV treatment with children under the age of 14 make up 4%
(1,020 children) of the total. Of ARV patients, 23,274 people (95%) were on 1st
line ARV, and 1,136 people (5%) had been switched from first to second line
ARV. At this time, it is not possible to disaggregate these data by gender
(MoH, Program Monitoring in Universal Access Report 2011).
Page
60
To increase access to ART, Indonesia has been working to assure continuity of
supplies and address issues of adequate and sustainable financing, affordable
prices, and reliable supply systems.
Initially, external resources (Global Fund) funded a 100% anti retroviral
procurement for Indonesia. ART was provided through the public health
systems and private practices.
In terms of adequacy and affordability of the drugs, since 2000 there has been
a sharp drop in the global price of ARVs (resulting from better manufacturing
methods, negotiated drug deals and competition from generic producers).
This helped make the goal of universal access to ARVs more economically
feasible. In 2003, an Indonesian pharmaceutical company started to
manufacture ARV using imported materials. Although there are still
challenges, local manufacturing should mean drugs will be cheaper and more
easily accessed in cases of stock-outs.
Along with strong government involvement in prevention and treatment, by
2011 the costs for ARV in Indonesia were 100% covered by the national
budget. This gives significant savings and sustainable financing for the
nation’s growing treatment program.
4.2.
Percentage of adults and children with HIV known to be on
treatment 12 months after initiation of antiretroviral therapy
Death prior to treatment is still relatively high with 1 of 4 of HIV cases is not
identified until they present with AIDS (the MoH case report from 2007 to
2011). The number of PLHIV who are alive and receiving ART after one year
of initiating treatment has been 67.7% (2011) and 70% (2010). In addition to
the proportion of PLHIV who are receiving ART and are still alive, there are
those who are lost to follow up (18.6%), have stopped treatment (0.4%) or die
(12.7%) (MoH, Program Monitoring in Universal Access Report 2011).
Page 61
Great care needs to be used in hypothesizing or interpreting patients’ reasons
for not continuing ART. Thus far, local studies of this issue are limited.
However, some issues are easily identified which present challenges:
geographical distance, high cost associated with testing (laboratory tests,
transport, and lost wages due to travel time). These are among the issues for
those living in rural areas who do not continue ART. Providing equitable and
accessible ART to people in rural areas has not yet been adequately resolved.
The ART itself is no longer a problem as it is available for free. However,
other medication can present cost obstacles to low income PLHIV.
Figure 20. Percentage of adults and children with HIV known
to be on treatment 12 months after initiation of antiretroviral
therapy
(ART Monitoring, CDC MoH, 2008, 2010, 2011)
Figure xx: Percentage of adults and children with HIV known to be on
treatment 12 months after initiation of antiretroviral therapy
(ART Monitoring, CDC MoH, 2008, 2010, 2011)
100
80
69.8
67.7
2010
2011
64.9
e 60
g
a
t
n
e
rc 40
e
P
20
0
2008
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62
Target 5. Percentage of estimated HIV-positive incident TB cases that
received treatment for both TB and HIV
5.1. Percentage of estimated HIV positive incident TB cases that received
treatment for both TB ad HIV
Indonesia ranks third in number after India and China in term of the burden of
TB cases, and those three countries contribute over 50% of the overall cases in
the 22 high burden countries. WHO estimates that 4% of TB patients are HIV
positive people. Due to the lack of immunity of those with HIV, TB has been
the commonest opportunistic infection that leads to their death. Of the
estimated 450,000 incident cases of TB in 2010, 9.9 to 29 thousand (2% - 6%)
were among PLHIV, with a best estimate of 18 thousand (4%) (WHO 2011).
Between January to December 2011, the MoH reported a slight increase (1.3%)
of the estimated HIV positive incident TB cases that have received treatment
for both TB and HIV from 2008. To improve the accuracy of the number of
people reached by the program, the new National Strategy for TB Control
2010-2014 has revised the recording and reporting system (WHO 2011). There
are also 223 CHCs are providing HIV and TB integrated treatment for patients
(MoH, Year end Report on Situation of HIV and AIDS in Indonesia 2011). By
2014, all PLHIV receiving ART (100%) will be assessed for TB by anamnesis
and physical examination (MoH).
Page 63
Figure 21. Percentage of estimated HIV positive incident TB
cases that recieved treatment for both TB and HIV, by Sex
(UA 2009, UA 2011 the MoH)
20
Figure xx: Percentage of estimated HIV positive incident TB cases that
recieved treatment for both TB and HIV, by Sex
(UA 2009, UA 2011 the MoH)
15
e 10
g
ta
n
e
cr
e
P
All
Male
Female
5
3.9
2.6
2.7
2.5
2.4
1.4
0
2009
2011
Figure 22. Percentage of estimated HIV positive incident TB cases that received treatment
for both TB and HIV, by Age
(UA 2009, UA 2011 the MoH
20
Figure xx: Percentage of estimated HIV positive incident TB cases that
recieved treatment for both TB and HIV, by Age
(UA 2009, UA 2011 the MoH)
15
e
g
ta 10
n
e
cr
e
P
All
<15
15+
5
3.9
3.8
2.6
-
-
0.1
0
2009
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64
2011
Target 6. Reach a significant level of annual global expenditure (US$ 22-24
billion) in low and middle-income countries
6.1. Domestic and international AIDS spending by categories and financing
sources
Funding for AIDS program is measured and projected annually. The national
forum for planning and budgeting for AIDS was established in 2009 and is
coordinated by the National Board for Planning and Development. The board
is expected to be able to raise budget allocation for national government
sectors for their respective AIDS program. Mobilization of financial support
from international development partners is managed by the NAC so that all
support will be focused on priorities as mentioned in the National AIDS
Strategy and Action Plan 2010-2014.
The report on AIDS expenditure in Indonesia in 2009 and 2010 (NASA report)
explains funds spent for AIDS program from both government and
international sources of funds. That report indicates that in 2009 the country
spent USD 60,285,420 while in 2010 it spent USD 69,146,880. The report shows
that Indonesia spent more money in 2009-2010 compared to figures shown in
the previous years’ assessment.
Table 8. Annual AIDS expenditures 2006-2010 and source domestic or international
(Source: the NAC, NASA reports 2009-2010)
2006
2007
2008
2009
2010
Domestic
$ 15,038,057
$ 15,421,976
$19,839,380
$ 21,318,844
$ 27,779,280
International
$ 41, 538,530
$ 43,258,421
$ 30,991,725
$ 38,966,576
$ 41,367,600
TOTAL
$56,576,587
$ 58,671,397
$ 50,831,105
$ 60,285,420
$ 69,146,880
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In 2009, more than 65% of expenditures or USD 38,966,576 came from
international funds and 35% or USD 21,318,844 from government sources. In
2010, the proportion of government and international fund contribution
changed slightly, with the Indonesian government contribution increasing to
40% or USD 27,779,280 while international funding decreased to 60% or USD
41,367,600. In 2009 and 2010, government sectors as the member of NAC have
spent USD 13,883,455 and USD 17,731.539 respectively. The remaining
government budget is made up of Provincial, District and City funds. The
Ministry of Health spent most of their resources on treatment in the last 2
years. Information on local expenditure on AIDS in 2009 and 2010 were
obtained from 12 provinces and totaled was USD 7,435,388 and USD
10,047,741. Although data not gathered for this report, it should be mentioned
that all provinces in Indonesia (33) are now receiving some Global Fund
report and have allocated some dedicated AIDS budget as counterpart for
that support.
Funding from international partners either bilateral or multilateral in 2009
and 2010 totaled USD 38,966,576 and USD 41,367,600 respectively. In both
years, the proportion of expenditures for care, support and treatment
activities was 35% while previous NASA data showed prevention activities
absorbed most of the expenditures. In 2009-2010 spending assessment, 30% of
all expenditures were for prevention activities.
The NAC reported that during 2010 Indonesia’s national response to HIV and
AIDS focused primarily on prevention of HIV infection by sexual
transmission as well as injecting drug transmission and continued to support
care and treatment programs. Activities included improving the capacity to
provide ART, HIV testing, treatment of STIs and strengthening the capacity
for effective action among stakeholders working on sexual transmission.
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66
Figure 23. Percentage of AIDS Expenditure 2008 and 2010 by Category
100
(Source: the NAC, NASA reports 2009-2010)
2010
49.84
34.88
29.52
20.7919.39
14.78
20
40
60
Percentage
80
2008
9.96
9
4.52
0.03 0.19
0.72 1.34
0
0.06 0.19
4.76
Prevention
Care and
Treatment
OVC
Program
Human
Social
Enabling
Management
Resources
Incentives
Protection
Environment
Research
Target 7. Critical Enablers and Synergies with Development Sectors
7.1. Indicator: National Commitments and Policy Instruments
The National Commitments and Policy Instruments measures progress in the
development and implementation of national-level HIV regulations, laws,
policies as well as the national HIV Strategic Plan.
NCPI has always been an interesting process, as it provides an opportunity to
involve key players in the national response in taking stock of progress made
and to discuss what they think and perceive as to where we are in terms of
the program and what needs to be done to support an effective and efficient
HIV response. Each discussion was attended by different participants, with
different set of experiences and backgrounds, hence results are not
comparable among different years of UNGASS reporting. The results are
better understood by interpreting them in the context of the reporting period.
Page 67
We have learned over time that the results of the group discussion do not
necessarily accurately reflect progress and obstacles in the response.
Accordingly, the following discussion is not based exclusively on the
questionnaire related to NCPI but takes fuller stock of the issues discussed by
recording both results of the discussion and a record of relevant events during
the reporting period.
The discussion process to generate the consensus was based on the UNGASS
guideline. Prior to the report writing process, one workshop was held to
complete the NCPI. Participants were briefed about the previous NCPI result.
Four critical features about completion of the NCPI data are as follows:
1. There has been a change in the mode of posing some questions
compared to the previous instruments. However, the new system has
assisted the participants in reflecting on the existing situation.
2. Effective facilitators and more systematic questionnaires have helped
to minimize different perceptions and interpretations related to
questions among participants during the discussions. Nonetheless,
huge discrepancies in scoring specific items were inevitable amongst
the groups, and created difficulty in explaining the conclusion offered
on some of the issues under discussion.
3.
Participants agreed that lower grades in question scoring was not
always because the national HIV response was worsening, but also
resulted from participants setting a higher standard for the response.
4.
The data gathering processes prior to the workshop were not well done
due to time limitations. There was a lack of reliable of comprehensive
evidence which led to more reliance on information from staff of HIV
programs sometimes indicated who had been involved in the HIV
program only in the last two years. Consequently, discussions on some
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68
topics were driven more by individual information, experience, and
impression of the participants (subjectivity) and less by objective
discussion of the facts.
To portray results of the group discussion results, it is very important to
review the issues in a holistic manner rather than of taking only results of the
rating on selected question. We have understood of this issue we review them
in a holistic manner providing both comprehensive tables containing selective
critical questions with clear responses, as follows.
Table 9. Results of NCPI Part A (Government Officials) year 2011
Question & Response
I. Strategic Plan
Has the country developed a national multisectoral strategy to respond to HIV? Yes
Has the country integrated HIV into its general plans? Yes
Has the country evaluated the impact of HIV on its socioeconomic development for
planning? No
Does the country have a strategy for addressing HIV issues among its national
uniformed services? Yes
Has the country followed up on commitments made in the 2011 Political Declaration
on HIV/AIDS? Yes
II. Political Support and Leadership
Do the following high officials speak publicly and favorably about HIV effort in
major domestic forums at least twice a year
A. Government ministers Yes
B. Other high officials at sub-national level Yes
Does the country have an officially recognized national multisectoral HIV
coordination body? Yes
Does the country have a mechanism to promote interaction between government,
civil society organizations, and the private sector for implementing HIV
strategies/programs? Yes
What percentage of the national HIV budget was spent on activities implemented by
civil society in the past year? No Response
What kind of support does the National HIV commission provide to civil society
organizations for implementation of HIV-related activities?
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Yes for Capacity Building, Coordination with other implementing partners,
Information on priority needs, Procurement and distribution of medicine or other
supplies, and Technical Guidance
Has the country reviewed national policies and laws to determine which, if any, are
inconsistent with the National HIV Control policies? Yes
III. Human Rights
Does the country have non-discrimination laws or regulations which specify
protections for specific key populations and other vulnerable groups? Yes for PLHIV, Migrants/ mobile populations, OVC, People with disability,
PWID, Prison inmates, Women and girls, and Young women/young men
Does the country have general law on discrimination? Yes
Does the country have laws, regulations or policies that present obstacle to effective
HIV prevention, treatment, care and support for key populations and vulnerable
groups? Yes
IV. Prevention
Does the country have a policy or strategy that promotes information, education and
communication (IEC) on HIV to general population? Yes
Does the country have a policy or strategy to promote life-skills based HIV education
for young people? Yes
Does the country have a policy or strategy to promote information, education and
communication and other preventive health interventions for key or other vulnerable
sub-populations? Yes
Has the country identified specific need for HIV prevention programmes? Yes
V. Treatment, Care and Support
Has the country identified the essential elements of a comprehensive package of HIV
treatment, care and support services? Yes
Does the government have a policy or strategy in place to provide social and
economic support to people infected/affected by HIV? Yes
Does the country have a policy or strategy for developing/using generic medications
or parallel importing of medications for HIV? Yes
Does the country have access to regional procurement and supply management
mechanisms for critical commodities? Yes
Does the country have a policy or strategy to address the additional HIV-related
needs of orphans and other vulnerable children? Yes
VI. Monitoring and Evaluation
Does the country have one national Monitoring and Evaluation (M&E) plan for HIV?
Yes
Does the national Monitoring and Evaluation plan include? Yes to all items
Is there a budget for implementation of the M&E plan? Yes
Is there a functional national M&E unit? Yes
Is there a national M&E Committee or Working Group that meets regularly to
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70
coordinate M&E activities? Yes
Is there a central national database with HIV-related data? Yes
Does the country publish an M&E report on HIV, including HIV surveillance data at
least once a year? Yes
How are M&E data used?
Yes, For program improvement, In developing/revising the national HIV response,
For resource allocation, and for others
In the last year, was training in M&E conducted? Yes at the national level, and at sub-national level
Table 10. Results of NCPI Part B (Representatives of NGOs, bilateral
organizations and UN agencies) year 2011
Question & Response
I. Civil Society Involvement
On scale of 0-10, how would you rate the efforts to increase civil society participation
in 2011? 5
II. Political Support and Leadership
Has the Government, through political and financial support, involved people living
with HIV, key populations and/or other vulnerable sub-populations in governmental
HIV-policy design and program implementation? Yes
III. Human Rights
Does the country have non-discrimination laws or regulations which specify
protections for specific key populations and other vulnerable subpopulations?
Yes for PLHIV, MMP, OVC, People with disabilities, PWID, Prison inmates,
Women and girls, and other
Does the country have a general law on non-discrimination? Yes
Does the country have laws, regulations or policies that present obstacles to effective
HIV prevention, treatment, care and support for key populations and other
vulnerable subpopulations? Yes
Does the country have a policy, law or regulation to reduce violence against women,
including for example, victims of sexual assault or women living with HIV? Yes
Is the promotion and protection of human rights explicitly mentioned in any HIV
policy or strategy? Yes
Is there a mechanism to record, document and address cases of discrimination
experienced by PLHIV, key populations and vulnerable populations? Yes
Does the country have a policy or strategy of free services for the following?
Yes for ART and HIV prevention services; and provided but only at a cost for HIVrelated care and support interventions
Does the country have a policy or strategy to ensure equal access for women and
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men to HIV prevention, treatment, care and support? Yes
Does the country have a policy or strategy to ensure equal access for key populations
and/or other vulnerable sub-populations to HIV prevention, treatment, care and
support? Yes
Does the country have a policy or law prohibiting HIV screening for general
employment purposes? No
Does the country have the following human rights monitoring and enforcement
mechanism? No
In the last 2 years, have there been the following training and/or capacity-building
activities Yes
Are the following legal support services available in the country?
No for legal aid system for HIV casework, and Yes for private sector law firms or
university-based centers to provide free or reduced-cost legal services to PLHIV
Are the programmes in place to reduce HIV-related stigma and discrimination? Yes
IV. Prevention
Has the country identified the specific needs for HIV prevention programmes? Yes
V. Treatment, Care and Support
Has the country identified the essential elements of a comprehensive package of HIV
treatment, care and support services? Yes
Agree response for The majority of people in need have access to:
PEP, Psychosocial support for PLHIV and their families, STI management, TB
infection control HIV treatment and care facilities, TB preventive therapy for
PLHIV, TB screening for PLHIV, and treatment of common HIV-related infections
Does the country have a policy or strategy to address the additional HIV-related
needs of orphans and other vulnerable children? Yes, Ministry of Social Affairs
provide support on financial and microfinance activities to poor families of
infected or affected by HIV
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72
Following are highlights of some topics where participants discussion and
scores indicate need for additional attention in the future: the role of civil
society, law and regulations and universal access.
1.
Civil society participation
Strategic action formulated by the government of Indonesia has involved civil
society from the planning stage to the monitoring and evaluation process.
This involvement of civil society, endorsed by Presidential Regulation (No.
75/2006), was part of the formulation stage of the National Strategy and
National Action Plan 2007-2010 and National Strategy and Action Plan
(SRAN) 2010-2014.
Unlike the previous NCPI response where civil society representatives
criticized their involvement as being merely symbolic, in the last 2 years
comments they indicate appreciation that civil society has been consulted at
all levels of decision making within the NAC. In a broader context, civil
society still feels they have more limited access than they wish to national
forums in finalizing the government-wide work plans related to HIV and
AIDS. This forum is an occasion for National Development Planning Body to
outline the draft government-wide work plan and to solicit any changes at the
margin, as well as an important input to district/city governments’ budget
formulation
process.
These
observations
were
was
discussion
was
commented on by the representative of the representative of the National
Development Planning Body in group discussion. It was explained that at
each step of the process in developing the National Development Plan,
including follow up and finishing the sector work plans, a forum for
consultation with the civil society was, in fact, always consulted.
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At the local level, it is also reported that some districts/cities have adopted
transparent practice in the local budgeting process and civil society
organization were reported active participate in these forums.
In relation to the use of strategic information, representative of civil society
mentioned that they have been facing a dilemma between the need to develop
evidence-based program/action plans with and limited timely access to
national surveillance data especially from the MoH. It should be noted that
issues related to the release of data were shared by all actors in the response.
2. Law and Regulations
Indonesia has a number of laws and government regulations to protect
particular categories of people who inject drugs and vulnerable people such
as youth, prisoners, and migrant populations from any discriminatory acts.
Most participants in government group and some participants in civil society
group were familiar with the essence of large number of regulations, both
some long standing and some newer products of regulations:
•
Law no. 7/1984 (ratification of CEDAW: Convention on the Elimination
of all forms of discrimination against women)
•
Law
5/1998 on
the
Ratification
against Torture and Degrading
Treatment
of the
Convention
or Punishment is cruel,
inhuman or degrading (CAT)
•
Law no. 39 year 1999 on Human Rights;
•
Child Protection Act No. 23/2002
•
Elimination of Domestic Violence Act No. 23/2004
•
Anti-trafficking Law no 21/2007
•
Regulation No 2/2007 on harm reduction among injecting drug users
issued by the Coordinating Minister for People’s Welfare
•
National Law no 35/2009 on narcotic drugs about decriminalizing
PWID and recognizing PWID as victims entitled to treatment
•
National Law No 36/2009 on Health
•
Government Regulation no.9/1999 on gender mainstreaming Head of
National Police Regulation No 8/2009 on human rights approach in
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74
carrying out National Police tasks. Article no. 20 in this regulation
particularly emphasizes the special approach to women
•
Presidential Instruction 1/2010 on Pro Poor Development
•
Presidential Instruction 3/2010 on Just Development to accelerate MDGs
achievement for the period of 2011-2015
•
Circular Letter of the Supreme Court No. 3 year 2011 about the
employment of
victims
of
substance
abuse in the
Rehabilitation Institute;
There is a continuing concern about the lack of documentation about
discrimination both AIDS related and more general discrimination
experienced by PLHIV of people of key affected populations as well as their
families. There are efforts to improve documentation of discriminations
through a variety of procedures and bodies. As suggested by the discussion
group, they are potentially able to assist the NAC in monitoring complaints
mechanism and ensuring the effective application of regulations and laws.
The groups:
1. National Human Rights Commission
2. The Ad HOC Court as judicial bodies against human rights violations
3. The Indonesian Child Protection Commission
4. The National Commission on Violance against Women
5. Service Center for Women’s Empowerment and Child Protection
(P2TP2A/Pusat Pelayanan Terpadu Pemberdayaan Perempuan dan
Anak).
Despite existing provisions to protect vulnerable groups of people, both
participants of civil society and the government in NCPI discussions deemed
bylaws based on religious law which prohibiting sex work to be counterproductive, and impediments to HIV prevention efforts. Repressive methods
and discriminating statements by a few high level officials (ministerial,
community, and faith based leaders) are at odds with instructions of the
President and Vice President to fight the disease from the in the past 2 years.
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Advocacy, coordination and education among government and law
enforcements bodies needs to be increased as well as assuming affective legal
protection to KAPs and vulnerable groups to reduce violations of human
rights.
3. Universal Access
Despite some domestic funding having been made available, the total
presently available from domestic sources cannot support the entire needs for
a comprehensive HIV response in Indonesia. ARV drugs are directly
supervised by the AIDS Directorate of the MoH and are freely available
across the country. A hundred per cent of ARV drugs are locally produced
and budget allocated from the national government budget. However, the
group observed that death among people of reproductive age and the number
of orphan and other vulnerable children (OVC) is increasing. Early infant
diagnosis remains a challenge as it only available in 2 sites across the country
(both are in Tanah Papua).
Comprehensive services should be made more widely available in particular
at district/city levels. However, decentralization leaves much of the decision
making about funding and service provision in the hands of over 500
district/city level officials, some of whom are newly appointed and may have
very limited skill or familiarity with epidemiological analyses and health
planning and financing skills. Local legislators likewise, may not understand
or support the need to provide services to people of key affected population.
Despite what the group discussion had come up with, it is important to also
note the progress in fields. As of December 2010, a total of 1,609 female health
providers and 1,163 male health providers out of hospitals, mental hospitals,
public clinics, lung clinics, prisons, NGOs, private sectors and other clinics. A
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76
total of 500 VCT sites in 142 districts/cities are providing their services as of
June 2011. Mobile testing provided by the health offices in some location has
now been adds as of method to reach people who have difficulties to access
the public services at conventional times and places. Provider Initiated
Counseling and Testing (PICT) also holds promise to contribute early
detection particularly when the patients are not aware of their risks to HIV
infection. As of 228 health care providers, and a mix of professionals from
seven provinces8 had been PICT training. As of June 2011, 21,775 people were
regularly receiving ARV.
7.2. Proportion of ever-married or partnered women aged 15-49 who
experienced physical or sexual violence from a male intimate partner in the
past 12 months
Indicator is relevant to Indonesia but national data are not available.
According to the 2011 annual report of National Commission on the
Elimination of Violence against Women, women victims numbered about
105,103, during the year violence pattern against women is still dominated by
Domestic Violence (KDRT) and Courtship Violence (KRP) at about 96% (equal
to 101,128 victims). The report identifies VAW perpetrator as husbands, exhusbands, boyfriends and ex-boyfriends (Komnas Perempuan 2011).
Globally, violence is one common reason for women avoiding disclosure of
HIV positive status to their partner. While this has not been investigated in
Indonesia, one might hypothesize this is also true in Indonesia.
7.3.
Current school attendance among orphans & non orphans aged 10-14
Data shows that 0.7% of children in Indonesia (118 children) between 10-14
years have lost both parents. In the same age group, 80 % of children are
8
Aceh, West Sumatera, DKI Jakarta, Central Java, East Java, West Kalimantan, and NTT
Page 77
living with both parents, and 6.4% children have two parents alive but are
living with at least one parent. School attendance of orphans is 10% lower
than attendance by non orphans (IDHS 2007).
A survey among PLHIV households indicates the school drop-out rates for
boys (66%) is much higher that girls (34%), without distinguishing between
children who lost both parents or lost only one. Data are not available to
explain reasons for high drop out of boys but it may due to them seeking
employment, due to behavioral difficulties or other reasons (JOTHI, et al.
2009).
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78
Figure 24. Current school attendance rate of orphans aged 10-14 , by Sex
(IDHS 2002-2003, IDHS 2007)
Figure xx: Current school attendance rate of orphans aged 10-14 , by
Sex
(IDHS 2002-2003, IDHS 2007)
100
82.7
83.3
82.1
87.2
91.2
83.8
80
e 60
g
a
t
n
e
rc
e 40
P
All
Male
Female
20
0
2002-2003
2007
Figure 25. Current school attendance rate of orphans aged 10-14 both of whose
parents are alive and who live with at least one parent, by Sex
(IDHS 2002-2003, IDHS 2007)
Current school attendance rate of orphans aged 10-14 both of whose
parents are alive and who live with at least one parent, by Sex
(IDHS 2002-2003, IDHS 2007)
100
91.7
91.3
92.1
92.6
91.8
93.5
80
e 60
g
ta
n
e
cr
e 40
P
All
Male
Female
20
0
2002-2003
2007
Page 79
7.4. Proportion of the poorest households who received external economic
support in the last 3 months
The national socio-economic impact of HIV at the individual and household
levels survey calculated that the average amount of financial assistance
received by PLHIV households was more than double compared to the
support received by non-PLHIV households. The amount of external
economic support makes a clear contribution to meeting the needs of PLHIV
households yet has not overcome the burden of greater medical expenditures
on PLHIV households compared to non PLHIV households.
The majority of PLHIV have to resort to borrowing from friends/relatives
(60%) and assistance from NGOs (57%) to address economic difficulties
(JOTHI, et al. 2009). One kind of assistance was skill development. One of
NGO working with PLHIV reported the skills development was offered to
29,300 active PLHIV in support groups in the course of 2011 (Spiritia 2011).
Thirty-seven percent of PLHIV participate in the existing national health
insurance scheme for the poor to cover their medical expenditures. Although
unfortunate liquidation of savings (64%) and assets (34%) is the most common
way of resolving financial difficulties, this sacrifices the economic future of
other family members. Adult women (wife or other elder female members)
often become breadwinner in PLHIV households (25%) compared to nonPLHIV households (15%).
Unemployment is higher among PLHIV households than non PLHIV
households. It has also been found that family income can be reduced by 55%
through a combination of factors related to caring for the sick. This highlights
the economic vulnerability of PLHIV households to fall into irreversible
poverty (JOTHI, et al. 2009).
The following data suggest that specific support programs for PLHIV have
been combined in the last 2 year with broader anti poverty and development
program in order to strengthen the ability of PLHIV households to cope with
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80
challenges they encounter. Social, food and livelihood assistance is provided
to PLHIV households by NGOs and government institution such as Ministry
of Social Affairs. In 2011, this Ministry added a staple food program for 1,500
PLHIV into their existing government support program. In 2011, the
Indonesian social security for people who work in the formal sectors
(JAMSOSTEK, including coverage the health insurance and other aspects of
social security) has provided cash transfers at US $ 1,075 per year for their
members and/or their dependent who are PLHIV.9
Presidential regulation 15/2010 on Accelerating Poverty Reduction is another
example of the national commitment for poverty reduction and the
development of national programs for social protection. In 2010, of 25.2
million poor households of Indonesian, 70% have received subsidized rice
and 3.2% have received conditional cash transfers. Details of provisions to the
poor targeting and benefit individuals and community are presented in Table
11. Social Protection Framework.
9
Based on JAMSOSTEK Board Decree 310/10-2011
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Table 11. Social Protection Framework
(Source: ILO Report 2011)
Target group
Poor
Types of benefits
Free health care
Program
Jamkesmas
Supervisory Ministries
Ministry of Health
households
2010 Target
76.4 million
beneficiaries
Subsidized rice
Conditional cash
Raskin
PKH, PKSA
transfer for
Coordinating Ministry
17,500,000
of People’s Welfare
households
Ministry of Social
Affairs
816,0000
households
households and
children**
Cash assistance (IDR
JSPACA
Ministry of Social
300,000 /month) for
and JSLU
Affairs
Scholarships for
Scholarships
Ministry of Education
poor students
for the poor
Small and
Small and micro
KUR
Ministry of Economy
micro
enterprise
enterprise
empowerment
Free childbirth care
Jampersal
Ministry of Health
Block grants to
BOS
Ministry of Education
the disabled and
vulnerable elderly
4,100,000
students*
through micro-credit
program
Universal
44,100,000 students
schools
*The Conditional Cash Transfer National Coordination meeting suggests that all students that are
covered by the Conditional Cash Transfer program should also receive the scholarship
** Recipient households are 3.83 percent less likely to be poor compared to their counterparts
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82
IV. Best Practices
4.1.
Building a comprehensive approach to prevention of sexual
transmission of HIV in Indonesia
The Challenge
Sexual transmission of HIV infection can take place through heterosexual and
homosexual sex. It takes place in the context of commercial sexual
transactions, in mutually consensual, casual situations, and within the
confines of formal marriage. There are efforts to prevent sexual transmission
of HIV in Indonesia to eliminate the risk of infection for people in all of these
settings giving particular attention to those who are at highest risk.
The importance of sexual transmission in the HIV epidemic is growing in
Indonesia. In 2011 sexual transmission was the cause of 54.3% of new
reported HIV and 74.9% of new AIDS cases. The Ministry of Health’s most
recent estimate of people at risk of infection (2009) totaled 6,396,187 people –
including PWID, sex workers (female, trans-gender, and males) and their
clients, MSM, prisoners, and regular sex partners of all (including husbands
and wives). But in Indonesia, calculation of people at risk needs to be
expanded to include the floating domestic workforce, made up largely of men
between the ages of 15 and 50, responding to growing employment resulting
from more widely distributed investment opportunities across the country in
commercial agriculture, mining, forestry, manufacturing and related
networks of land, sea, and air transportation. Many of these men, our 4Ms –
mobile men with money in macho environments – become involved in high
risk sex.
In the early years of the national response, with support of the World Health
Organization and others, Indonesia invested considerable effort in the
approach called “100% condom use” which had been successfully pioneered
and implemented in some areas of Thailand. The principle aspects of this
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approach in Thailand had included: 1) restriction of the sale of sexual services
to specific locations; 2) requirement that condoms be used in all risky sex; 3)
requirement that sex workers have regular check-ups for sexually transmitted
infections; 4) fining of the management of a sex worker’s place of employment
if he/ she were found to be infected and responsibility of the management to
pay for treatment. Furthermore, according to the law, the place of business
could be closed if they do not comply.
In Indonesia, appropriate policy was put in place and 100% condom use was
included as a strategy in the Indonesian National AIDS Strategy of 2003 –
2007. By 2008, however, results of the IBBS (2007) suggested that 100%
condom use was having little impact on infection levels in Indonesia. Various
unresolved challenges were identified: (1) condom use among clients of sex
workers remained low even when readily available; (2) in other locations, the
mechanisms for distribution of condoms and lubricants continued to fall short
of need; (3) public opinion and local leadership often didn’t support
promotion of condoms and in some areas were explicitly hostile to discussion
of the topic. In addition, sex workers who were less well organized than those
working in brothel complexes – street sex workers (female, male, and
transgender), informal sex workers based in bars and massage parlors, men
who had sex with men, and their clients – all continued to be deeply
disadvantaged in their access to information, supplies, and services.
The response
Acting on these observations and while preparing a major new proposal to
seek funding from Global Fund, the Secretary of the National AIDS
Commission called an urgent consultation meeting with partners in the
national response to brainstorm together for a more effective approach to
sexual transmission in Indonesia. Participants included individuals and
representatives of organizations with experience in the field of sexual
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84
transmission, representatives of relevant government departments and
members of the secretariat of the NAC. Participants analyzed obstacles to
100% condom use in Indonesia and discussed experience internationally and
in a few locations in Indonesia where there had been rising levels of condom
use and declining rates of sexually transmitted infections.
By April 2009 a preliminary model was agreed upon and a small pilot
program was begun in 6 locations. Drawing on results of those pilot locations
and supplementary discussions during the 9th International Congress on AIDS
in Asia and the Pacific (2010), a new and consolidated approach to prevention
of sexual transmission of HIV was formulated which came to be known as
PMTS, an abbreviation of the Indonesian name - Pencegahan HIV Melalui
Transmisi Seksual.
PMTS was designed as a structural intervention (working to bring about
change in the existing systems and the local environment). The policy and
program concerns and components made a comprehensive package. Its
management and operations were broadly inclusive with participation from
local authorities, the community health service, sex workers and others
involved in the sex industry. It was built around 4 mutually supportive action
components:
1. Mobilizing a wide range of stakeholders in areas where sexual
transactions took place – sex worker, community leaders, condom sales
people, local officials - to share concern and responsibility for creating the
regulatory and social climate to facilitate and promote condom use as part
of a common effort to improve community health;
2. Implementation of behavior change communication to raise concern of sex
workers for their own health as well as empowering them with the
knowledge and skill to increase their efficacy in negotiating condom use
thus protecting their own health and that of their clients;
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3. Improved management and availability of condoms and lubricants
achieved through development much increased numbers of condom
outlets
4. Comprehensive management – diagnosis and treatment - of sexually
transmitted infections
The final, critical component was and continues to be close monitoring and
evaluation by program managers from local to national level.
As graphically portrayed in the box below, close partnership is essential for
effective implementation and sustainability of PMTS. In Indonesia’s Global
Fund-supported PMTS the partners are the NAC, two NGOs, and the
Ministry of Health. In other setting institutional partners might be different
but the components and the need for a clear division of labor and mechanisms
to facilitate collaboration among partners would be the same.
Figure 26. Schematic representation of partnership in structural intervention
for prevention of sexual transmission in Indonesia
Although initially Indonesia used Global Fund resources for scale-up, some
aspects of this program are now jointly funded with support coming from the
national government budget (APBN) and an Indonesian basket fund, the
Indonesian Partnership Fund for HIV and AIDS.
Additional support for
implementation of PMTS has also come in the form of condoms contributed
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86
by the National Population and Family Planning Board (BKKBN) and Family
Health International.
Training, retraining, of all actors in PMTS and supportive supervision have
played an important role in establishment of this work now in 159 locations
across Indonesia. In 2011, alone more than a thousand sex workers from 66
different locations in 23 provinces were trained, as were 144 members of the
local civil defense force (Satpol PP) from 16 provinces; 3-person management
teams from 76 districts/ cities including members of local AIDS Commission,
local Health Departments, and NGO partners. Likewise managers of 263
condom outlets were trained, 64 of whom were women.
Beginning in 2011 efforts to bring sexual transmission under control were
broadened still further specifically to reach these “high risk men” –
previously mention who, out of boredom and egged on by co-workers may
become involved in recreational sex, excessive consumption of alcohol, drugs,
and sex stimulants. Working with employers, the Ministry of Manpower,
local AIDS Commissions and linking with PMTS where it they already
underway a combination of activity and services have been identified and
launched with the goal of accelerating reductions in new infection among
men.
Impact
By June of 2011, with the exception of MSM, outreach/coverage was making
good progress toward the targets set for 2014.
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Table 12. 2011 coverage against 2009 estimate and 2014 target of key affected
populations
(NAC 2011, MoH 2009, MoH 2008-2014)
People Covered
Number covered
% of total
estimated
population
2014 Coverage
target
Female sex workers - direct
82,384
78%
90%
Female sex workers – indirect
58,244
54%
90%
Transgender people
23,269
73%
100%
MSM
54,836
8%
80%
Recognizing the importance of doing better with the MSM community a
combined research and action program was undertaken with the national
MSM network, several local branches, and a number of leading universities to
learn more about the MSM community and to improve the design and
implementation of the response.
Given the important role of the condom in prevention of sexual transmission
we have also been monitoring condom use closely. Although condom use
rates in Indonesia are still considered low relative to total population,
nonetheless, information on condom distribution (Table 13. Condom PMTS
operations, July 2009 – June 2011, below) and sales suggest that the structural
approach of PMTS and new efforts to improve outreach to high risk men is a
beginning to have a positive impact.
Table 13. Condom PMTS operations, July 2009 – June 2011
(NAC Program Monitoring 2011)
Distribution
Jul 2009 – Dec 2011
Global Fund
Support
Lubricants (1)
1,937,228
Male condoms (2)
17,961,141
Female condoms (3)
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88
None
Other support
Outlets
6,724
No of
prov.
No of
Dist/
Cities
33
137
1,712,686
7,235
33
137
619,025
1,000
33
137
Commercial condom sales are encouraging with total condom sales rising
from 69,587,608 pieces in 2006 to 158,500,289 by the end of 2011 with a
particularly large increase beginning in 2009 and continuing through 2011.
This would seem to suggest possible ”demand creation” as increasing
numbers of men have positive experience with condoms and become more
willing to buy and use them on their own initiative.
What lies ahead?
Basic systems are in place for the prevention of the sexual transmission of
HIV infection.
Close monitoring of both program and epidemiological
indicators will continue to determine whether the basic design and
operationalization of existing interventions is “about right” and sustainable or
if and what fine tuning might increase positive impacts still further.
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4.2. HIV Intervention in Prisons and Detention Centers in Indonesia
Prisons and detention centres are considered high risk environments for the
transmission of HIV (WHO Europe 2005). The Indonesian Ministry of Law
and Human Rights has produced a National Action Plan for HIV and AIDS
Control in Prisons and Detention Centres, 2010 to 2014 to address harm
reduction in prisons and detention centres and is based on public health
principles and human rights. Current HIV prevention, care and treatment
programs that are in some prisons and detention centres in Indonesia include:
educational programs; voluntary counseling and testing (VCT) services;
MMT; referral for anti retroviral therapy (ART); support and rehabilitation
groups; condoms; and bleach for sterilizing equipment for injecting, tattooing
and piercing activities.
A national biological and behavior survey was conducted in Indonesian
prisons and detention centers in 2010. This study provided baseline
information for the Government of Indonesia about the national HIV and
syphilis prevalence in prisoners as well as prisoner knowledge, risk behaviors
and access to HIV related services, based on a random selection of prisons
and detention centers and male and female prisoners. The HIV prevalence
was 1.1% in male and 6.0% in female respondents and the prevalence of
syphilis was 5.1% in male and 8.5% in female respondents. Factors associated
with HIV for male respondents included having a history of injecting drugs
and for females included testing positive for syphilis and illicit drug use. Of
those who had a history of injecting drugs, almost twice the proportion of
female respondents (12.0%) tested positive for HIV compared to male
respondents (6.7%). Knowledge of the main HIV risk factors was high
although common misconceptions were also high. Half the male and 64% of
female respondents had previously received HIV information with a higher
proportion of females having comprehensive knowledge of HIV than males.
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90
Access to educational programs in prison was under 50% with 41% of male
and 35% of female respondents receiving information from a prison officer.
HIV test had been offered to 40% of the female and 29% of the male
respondents with most receiving the offer in prison or detention. Those who
had received training about HIV were almost six times more likely to have
had an HIV test than those who had not (Ministry of Law and Human Rights
2010).
A study is planned for 2012 in Indonesian prisons designated for prisoners
sentenced for drug-related crimes including producing, dealing, possessing or
using any type of illicit drug. The narcotic prisoner population has
significantly increased from 7,122 (10% of prisoners) in 2002 to 37,295 (26% of
prisoners) by the end of September 2009 (Ministry of Law and Human Rights
October 2009). Results of a National Narcotics Bureau (BNN) and Central
Bureau of Statistics (BPS) study about narcotics prisoners in nine prisons in
nine provinces found that almost 90% of “narcotic prisoners” had consumed
an illicit drug and more than one third had injected heroin (BNN and BPS
2004). Few prisoners reported injecting in prison in the 2010 Indonesian
prisoner survey (Ministry of Law and Human Rights 2010). Other research
has shown that some prisoners who are IDUs are still injecting drugs in
prison, although the frequency is decreased, and that some of them stop
injecting while in prison (HCPI October 2009 and Shewan D 1994). There are
some prisoners who injected drugs for the first time while in prison due to the
psychological problems they encounter while in prison (HCPI October 2009
and Hughes RA 2000). In Indonesia, based on the IBBS conducted in 20072009 among the PWID population in 10 cities, 0.5% - 4% of IDUs injected for
the first time while in prison (MoH, IBBS 2011)
There has been advocacy for needles and syringes programs (NSP) to be
provided to prisoners in Indonesia. There are over 19 prison-based NSPs in
Europe9 and evaluations of these programs found less sharing of needles and
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syringes in prisons and no newly identified cases of HIV, hepatitis B, or
hepatitis C (Dolan K 2003) or problems with needles and syringes being used
as weapons (Nelles J 1998). Needles and syringes have usually been available
through dispensing machines or prison health personnel in prison programs
(University of California San Francisco April 2006).
Current regulations in Indonesia prohibit tattooing, piercing, inserting genital
accessories, sexual activities as well as injecting drugs in prison and detention.
As these activities are in fact occurring in prisons and detention centers
(Ministry of Law and Human Rights 2010) regulations may need to be
reviewed to allow a more realistic response to the current situation. More
enabling regulations are recommended to ensure that prisons and detention
centers can provide safer and healthier environments for prisoners.
A collaboration between the Ministry of Health and The Indonesian Ministry
of Law and Human Rights has ensured a better HIV recording and reporting
system and a better partnership with the Ministry of Health has developed to
improve the health care of inmates. The monthly monitoring system in
prisons for HIV-related data has shown a gradual decrease in the number of
deaths of prisoners from AIDS and increased access to ART since 2010. There
are now more comprehensive services available for female prisoners as well
as male prisoners.
There has been advocacy for achieving better access to national and local
budgets for HIV-related activities in prisons so that adequate funding is
provided for programs and to ensure sustainability.
UNODC has produced a framework for a national response to HIV in prisons,
HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings (WHO,
Joint United Nations Program on HIV/AIDS 2006). The framework outlines 11
principles and 100 actions to promote an effective national response to
HIV/AIDS in prisons. In 2008 UNODC released a toolkit for policymakers,
program managers, prison officers and health care providers in prison
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92
settings based on requirements of international law and standards, scientific
evidence and best practice experience. It recommends comprehensive HIV
prevention measures, provision of ART, equivalent health services to those
available in the community, and reducing prison populations and improving
prison conditions. Indonesia has most of the elements of comprehensive HIV
prevention measures in prisons including: education on HIV and AIDS;
voluntary HIV testing and counseling; condom provision; drug-dependence
treatment and substitution treatment; and provision of bleach (UNODC 2008).
Programs that are still not available in Indonesian prisons include NSP, STI
detection and treatment and preventive measures for mother-to-child
transmission for the women prisoners although there is advocacy for these
measures to be provided in the future. It is hoped that diversion sentencing of
drug users will increase in the future which would help decrease the
overcrowding in Indonesian prisons.
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V.
Major Challenges and Remedial Actions
During the last two years since the previous UNGASS country progress
report, which was submitted in 2010, some progress has been made. In the
report of 2010, program coverage for most at risk populations did not meet
the Universal Access targets and were considered inadequate. There have
been improvements in program coverage of people who inject drugs although
coverage among MSM and clients of FSW, as well as their respective partners,
remains very low. However, the difference between the previous reporting
period and now is that programs addressing these populations are now in
place. The impact of programs for the previous two years of implementation
is evident for PWIDs and indirect FSWs when looking at IBBS results for
those recently starting to inject or commencing sex work and we expect to see
better outcomes for all high risk populations in the next few years.
Program coverage has already been discussed in this report, and special
attention is recommended to increase coverage of programs that prevent
mother to child transmission given the concern about low coverage. Although
progress is still limited and not reaching the numbers needed, an increase in
coverage has been reported.
The 2010 UNGASS report raised the issue of barriers in scaling up prevention
programs for sexual transmission of HIV. Specifically, programs were dealing
with a lack of support from local authorities. The situation is somewhat
improved now that the Government of Indonesia had responded to this
situation, a response which started in 2008. By making an effort to draw a
pool of experts and resources to assist programs to increase the level of
consistent condom use among those involved in transactional sex, programs
have now reached an implementation phase building on lessons learnt and
improvements are now underway. The concept of a comprehensive approach
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94
to prevention of sexual transmission of HIV is now better understood by local
implementers as well as by different level of authorities. Guidelines, extensive
training and a system to provide technical assistance, particularly from the
province to district level have been made available. Strong support from the
Ministry of Home Affair all the way through to local governments is now in
place, including local police who have now become an important part of the
program, backing HIV and STI prevention programs amongst people who
engage in sex work. More details about this endeavor is in the best practice
section on “Building a comprehensive approach to prevention of sexual
transmission of HIV in Indonesia”.
With references to program sustainability, which was discussed in the
previous UNGASS report, there is modest but steady progress domestic
resources available for programs have increased from 39% (2008) to 42%
(2010). Although the rise in the proportion of available domestic funds is not
so dramatic compared to that of two years ago, the work towards that end has
been increased and the Ministry of National Planning and Development is
taking the lead in the process. Further discussion is presented below.
Effectiveness of the health care system and the community system to support
HIV and AIDS people and programs in the response, as well as other
diseases, may not differ significantly to those two years ago and is raised as
one of the challenges. Positive changes in community health providers have
been in some areas observed and they now work more closely with the key
affected populations. This is not however the case in all locations across the
country. More work is needed to build systems in an integrated manner, as
discussed below.
The quality of program implementation at the field level, which was
questioned in the previous report, is improving. The leadership of District
AIDS Commissions is stronger: logistic management is better, particularly for
ARV, condoms, and sterile needles and syringes supplies; coordination and
Page 95
partnerships among local stakeholders have now become a routine-based
activity and networks are broader; progress on the M&E is also apparent.
AIDS Commission in many areas has earned wider recognition in both
government and community circles. More information on M&E will be
discussed in Chapter VII.
The challenges
Work to be accomplished in the future and some challenges that lie ahead
include:
1. Policy, resources and institutional structure to assure an effective and
sustainable response:
In Presidential Regulation 75/2006 (art. 15) and Regulation of the Minister of
Home Affairs 20/2007 (art. 13) it is written that:
(1) all of the costs required for carrying out the work of the NAC shall be
borne by the State Budget.
(2) all of the costs required for carrying out the work of the Provincial
AIDS Commission shall be borne by the Provincial Budget.
(3) all of the costs required for carrying out the work of the District/City
AIDS Commission shall be borne by the District/City Budget.
For the period 2010-2014, planning and budgeting of the national response
has been integrated in the National Mid-Term Development Plan 2010-2014 as
well as Presidential Instruction 3/2010 on Just Development. This will assure
some measure of support from APBN through to 2014. Nonetheless, however,
the amount allocated has been inadequate to meet the needs of the national
response. If external resources (GFATM, AusAID, USAID etc.) were to decline
or stop altogether the current comprehensive work would be seriously
threatened. Although domestic budgets, particularly APBD, are increasing
and in several areas planning and budgets for AIDS are integrated in RPJMD
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96
(Local Mid-Term Development Plans), sustainability of the response is not yet
adequately guaranteed.
At this time there are only 16 Provinces and 34 district/ cities with regulations
on HIV and AIDS; this means the AIDS budget depends mostly on the
personal commitment of the governor, district head, mayor, and members of
the legislature. In other words, continuity and sustainability of the Indonesian
response is not assured. Because of this, mobilization of resources and
institutional strengthening to that end are of great importance during the next
five years and beyond.
2. Prevention:
Prevention continues to need priority attention and on going, well focused
strengthening during the next five years with attention to coverage,
effectiveness, and sustainability of work with and for people of key affected
populations.
Prevention among PWID has had considerable success, but the use of drugs
will continue to need attention, especially outreach and provision of effective
harm reduction activity, in particular NSP and methadone services, treatment
of addiction, as well as community based medical and social rehabilitation
and treatment. Prevention and treatment for abuse of ATS will also need to be
strengthened in cooperation with various partners such as the National
Narcotics Board, Police, and Ministry of Health, Ministry of Social Affairs,
and others. This is a field of growing interest and activity by KPA.
Comprehensive
prevention
of
sexual
transmission
with
structural
intervention (PMTS): Prevention of sexual transmission needs strengthening
of outreach programs and improvement in the quality of activity. Expansion
of the comprehensive PMTS approach is also needed to assure adequate
coverage and service. In “hotspots”, locations known for sexual and other
transactions such as ports, transport terminals and brothels, placing people at
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high risk of infection with STIs including HIV. PMTS will also scale up work
related to high risk men, including: migrant workers; sailors and other crew
members; police and military with long term assignments away from their
family; miners; construction workers; commercial estate agriculture workers;
and MSM. Prevention of sexual transmission of HIV is needed whether sex is
between husband and wife, casual heterosexual sex, homosexual sex, or
bisexual sex. In an effort to understand and assure access to the widest
possible range of options for prevention, the NAC is will also to explore new
preventive technologies (for example tenofovir gels etc.) through research and
information sharing with appropriate partners.
Prevention of transmission of infection from parents (via the mother) to
baby (PMTCT): There is wide agreement on the importance of expanding
coverage and quality of PMTCT for the women and families and as part of the
comprehensive response to HIV and AIDS. PMTCT is also important for the
contribution it will make to the overall effort to bring the epidemic under
control. In line with this, the MoH is planning to expand integration of
PMTCT services into basic Mother and Child services along with the
necessary staff training.
3. Health system strengthening for care, support, and treatment of PLHIV:
During the past five years the MoH and health services at provincial and
district/city level have been increasing the number and quality of sites for
voluntary counseling and testing (VCT), provider initiated counseling and
testing (PICT), skills for medical diagnosis, support and treatment for people
who are HIV positive. They have also developed the necessary regulations,
guidelines, and manuals to promote consistent application of proven good
practices and established policy. In the five years to come, comprehensive
health system strengthening will need to focus on expanding availability and
strengthening the quality of services for key affected populations including
services related STIs, HIV-related illnesses and ARV. Comprehensive services
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98
for PLHIV, including health promotion, prevention of infection, treatment
and rehabilitation, need to be provided within a health care setting free of
stigma and discrimination. The health care system needs to function with a
high level of professionalism both technically and in terms of human relations
welcoming and encouraging people of the key affected populations.
Strengthening of the public health care system needs to be accompanied by
strengthening of community based support systems for PLHIV including:
family support, peer support groups of PLHIV , organizations of people who
are HIV positive and the community in general. Income generation and other
activities to mitigate the socioeconomic impact of the HIV epidemic will need
to be strengthened, as well.
4. Partnership of government and civil society:
The number of civil society organizations and activists and the importance of
their role in the response to HIV and AIDS has grown significantly in the past
five years –
1) Some AIDS-related NGOs and community groups are members of the
NAC and local AIDS Commissions, although not yet in all provinces
and district/ cities;
2) Individuals have become members of AIDS Commission secretariat
and are in the technical and policy working groups;
3) Five national networks of key affected populations – IPPI, GWL-Ina,
JOTHI, PKNI and OPSI – have been formed each of which has received
financial support (operational costs and activities) from the secretariat
of the NAC;
4) Since Presidential Regulation 75/2006 went into effect, AIDS NGOs and
the networks of key affected populations, including PLHIV, have been
included in key activities of the NAC such as mapping, planning,
resource mobilization, monitoring and evaluation.
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5) NGOs and civil society groups are members of the supervisory/
oversight body (badan pengawas) and advisory boards of various AIDS
– related bodies such as the Country Coordinating Mechanism (CCM)
for GFATM, the Indonesian Partnership Fund (IPF);
6) In the management structure of Indonesia’s GFATM resources two
civil society groups are Principle Recipients (PR) and many more are
sub-recipients, sub-sub-recipients, and implementing partners;
7) During the period 2005-2011 support reported to the secretariat of the
NAC for civil society including NGOs came from 8 sources and totaled
US$ 29,610,335.
In short, civil society and government have been partners in the
comprehensive response to HIV and AIDS from local to national level.
As health care system strengthening is needed in the coming five years, so
community system strengthening is also needed to reinforce and consolidate
the capacity for continuing effective and collaborative work at all levels to
achieve the shared goals and targets related to HIV and AIDS laid out in
Indonesia’s National AIDS Strategy and Action Plan.
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100
VI. Support from the Country’s Development Partners
Support from a range of international development partners, both bilateral
and multilateral has been crucial to Indonesia’s scale-up of the response to
HIV and AIDS during the past five years. When Indonesia’s own AIDS
budget was still very limited they supported the development of some of the
social, management, technical, and financial systems needed for an effective,
accountable, sustainable and comprehensive national response. Funding from
the Indonesian Partnership Fund provided support to the proposal
development process leading to new multi-year grants for Indonesia from the
Global Fund for the period 2009-2015, a profoundly important step towards
implementation of a truly national response as contrasted with a scattering of
local responses.
During the first three years of Presidential Regulation 75/ 2006, three bilateral
donors -- the UK, USAID, and AusAID -- provided the most substantial
financial support for the national response, US$ 35.3 million, US$ 24.4 million,
and US$ 20.9 million respectively. Support from the Global Fund (US$ 19.9
million), the fourth major contributor, during the same period became more
important in the following years (see Table 14).
The bi-lateral support of the United Kingdom was invaluable direct support
to the Government of Indonesia and gave birth to the Indonesian Partnership
Fund, managed by the secretariat of the NAC with UNDP hired as Fund
Manager until such time as the NAC secretariat was ready to assume that
responsibility (2012). The bilateral support of both Australia and the United
States was directed to work carried out primarily by Indonesian NGOs in 11
provinces but also included some work with local government, AIDS
Commissions of all levels, and national and local Health Departments. While
the scope of the programs was not sufficient to have the impact needed on the
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epidemic, important lessons were learned, local organizations and capacity
were strengthened all of which have contributed to building of the national
response.
International support has been diverse - provided to individual projects, to
research and studies, to capacity building within Indonesia and abroad, to
development and strengthening of the overall AIDS management system and
many other kinds of activities. It has taken different forms at different times sometimes designated project funding for activities designed by a donor’s
own design team, sometimes provision of supplies or services. At times,
international donors provide full funding for activities and at other times they
join with Indonesia or others for co-financing of activities.
Increasingly, as international partners seek maximum impact for their
investment in the national response they consult with the NAC at the national
level and local AIDS Commissions at provincial, district, and city levels
regardless of the form of support they are offering or the nature of the activity
to be supported.
The principle change in international participation in HIV and AIDS work in
Indonesia before and after Presidential Regulation 75/ 2006 has been the
introduction of 1) the role of NAC secretariat leading overall coordination and
management of the response as well as 2) the existence of the comprehensive
framework for action provided by the two successive National Strategies and
Action Plans (2007-2010 and 2010-2014), and the National M & E Framework.
The NAC secretariat has had an inclusive and proactive approach towards the
work of international partners, calling for both harmonization of work under
the umbrella of the national response (as set forth in the action plans) and
conformity with Indonesian standards, guidelines, and practices. In addition,
the secretariat of the NAC often involved international partners in technical
discussions or teams assembled for operational program development, field
evaluation, mentoring and monitoring. The combination of these actions has
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102
made this five years a period of much increased synergy, focus, and
effectiveness in work with and by international partners.
Beyond coordination of existing activity, the NAC secretariat led a
participatory process conceptualizing and formulating overall national plans.
Additional work has included design and development of supplementary
activity to assure successful implementation of the national plans, and
redesign for scale-up of work to address particular issues within the response.
Among international partners, the United Kingdom (funds managed through
the Department for International Development, DFID) was the largest
contributor to the national response “inherited” by the NAC designated by
Presidential Regulation 75/2006 with the grant agreement having been signed
in 2005.
For mobilization of new resources two critical factors were (1) development of
logical, fully developed proposals; and (2) responsible management of funds
demonstrated by full, accurate and timely accounting and reporting. For this
reason the secretariat of the NAC gave high priority to management of its
own finances and capacity building of AIDS Commissions at provincial and
district/ city level in this field.
The Global Fund, which had provided support to Indonesia since 2003,
announced a new opportunity for applications for funds in 2007. The new
AIDS Commission, as a member of the Country Coordinating Mechanism
(CCM) managing Indonesia’s work supported by Global Fund, urged
development of a proposal to start the scale-up of a coordinated, multi
sectoral, comprehensive national response. The idea was accepted and the
Secretary of the NAC was asked to chair the Technical Working Group to
prepare the proposal in line with the National Strategy and Action Plan 20072010. The proposal, in final form, was subsequently put forward for
consideration in Global Fund Round 8 and approved for the period 2009-2014.
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Table 14. Global Fund support to phased development of Indonesian national response
Province
GF Round
Years
Source: NAC
Grant Support
5 Prov
19 Prov
GF 1
GF 4
2003 - 2007
2005 – 2010
US$ 12 million
US$ 65 million
12 Prov
GF 8
2009 – 2014
23 Prov
SSF yr 1
2010 – 2015
US$ 130
million
US$ 87 million
33 Prov
SSF Phase 2
2012 – 2015
US$ 83 million
Launching
Date
Launch Jul
2009
Launch Jul
2010
Requested for
2012-2015
Program Focus
Prevention
Care Support
and Treatment
Comprehensive
Comprehensive
Comprehensive
Shortly thereafter, the Technical Working Group, still chaired by the Secretary
of the NAC, continued work and proceeded to develop a proposal for Global
Fund Round 9. Given the wide distribution of reported HIV infections, high
mobility of Indonesia’s population, the increasingly well documented fact
that there were cases in all 33 provinces districts/ cities (“hot spots”), priority
areas needing attention in the response as well as Indonesia’s increasingly
integrated transportation networks on land, sea, and air and the decision was
taken to opt for national coverage of strategically selected locations in all
provinces.
At the same time the Global Fund proposals were in preparation, the
secretariat of the NAC continued work with partners, in particular USAID
and AusAID, to consolidate and focus their respective activities to assure
synergy and harmonization of the multiple in-puts to the national response,
particularly in areas of geographic overlap. In the end USAID, their
contractors, and partners gave particular attention to activity related to sexual
transmission while AusAID focused on a full range of issues related to
injecting drug use in community settings and prison as well as support for
institutional strengthening in 14 provinces.
Mobilization of resources was only step one of what needed to be done to
build a comprehensive, national response. Resources made action possible
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104
although they provided no guarantee of effectiveness. Program and financial
management capacity and systems need to be developed and systematized if
Indonesia’s response is to be effective and sustainable in the long run.
Page 105
VII. Monitoring and Evaluation Environment
The second national monitoring and evaluation assessment of M&E systems
for HIV in Indonesia was conducted in November 2010. The assessment
aimed to determine the status, gaps and corresponding recommended
strategies to improve the 12 components of the M&E system as guided by the
M&E System Strengthening (MESS) tool. The points below reflect the status of
current M&E systems, including some key results from the M&E assessment.
Organizational Structure for HIV M&E Systems and Human Capacity
The Indonesian NAC is coordinating the M&E of the HIV national response in
Indonesia. Currently there are 33 provinces and 172 districts that use the
national M&E guideline as reference and report progress relative to national
indicators regularly. These reports provide information related to program
coverage, including line ministries and local NGOs. The guideline provides
information on setting and defining indicators, applying routine and nonroutine reporting systems, and the timing of data collection and reporting.
Collation of national HIV program data is conducted by the NAC M&E team.
There is 6 full time professional M&E staff working for NAC, as well as 33
program staff in provinces and 172 staff in districts who have M&E
responsibilities.
Partnership to Plan, Coordinate and Manage the HIV M&E System
The mechanism for M&E planning, coordination and data sharing is through
routine M&E working group meetings. The working group is comprised of
members of the NAC including government sectors, civil society and
international partners and representatives of key affected populations and
PLHIV. Each meeting involves discussions about many M&E topics,
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106
including: coordination of M&E activities; harmonizing indicators; data
sharing for preparing country reports; and M&E update among members.
Critical issues to improve M&E system implementation are also discussed.
National, Multi-sectoral HIV M&E Plan and Costed HIV M&E Workplan
The NAC has developed the national HIV strategic action plan which
includes the M&E work plan. Some ministries have also developed their own
action plan including an M&E work plan including the Ministry of Health
(MoH), the Ministry of Law and Human Right, and the Ministry of Social
Affairs. The NAC and MoH allocate 7-10% of the national HIV budget for
M&E activities. The other ministries do not have dedicated budgets for M&E
activities.
Advocacy, Communication and Culture of HIV M&E
The NAC uses collated data for advocacy and sharing information on
progress of the national response progress to different stakeholders. M&E
advocacy is routinely conducted by the NAC and international development
partners through different mechanisms, including: the NAC executing team
meetings; the Country Coordinating Mechanism (Global Fund); and Technical
Working Groups of the GFATM and IPF management committees.
Surveys and Surveillance
A 2000 review of HIV-related information in Indonesia led to a decision by
the the MoH in 2001 to build up a Second Generation Surveillance system.
Indonesia has conducted Behavior Surveillance Surveys among the key
affected populations in 2002 and 2004 and three Integrated BiologicalBehavior Surveys (IBBS) in 2007, 2009 and 2011. The IBBS for general
population was conducted in Tanah Papua in 2006, and was scheduled to
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have the similar IBBS in 2012. In 1998, the Sub-Directorate for AIDS and STDs
at the Ministry of Health established guidelines for standardized sampling,
unlinked anonymous testing, and routine reporting of HIV surveillance. By
2012, 64 sentinel sites among FSW and 2 sites among ANC services operated
around the country. Size estimation among key affected populations and
PLHIV has been conducted four times (2002, 2004, 2006 and 2009), and the
upcoming estimation is scheduled for 2012. A Mathematical modeling report
was produced by the MoH in 2008 using the Asian Epidemic Model. The
NAC conducts both rapid surveys about the impact of HIV prevention
programs for sexual transmission for sex workers, and rapid surveys among
people who inject drugs to complement the national data. Annual client
behavior and service satisfaction surveys are also conducted for clients of
health services and NGOs HIV prevention programs.
Routine HIV Program monitoring
Routine program monitoring related to HIV prevention, including financing
and policy development, is coordinated by the NAC. Program coverage is
well defined and results of monitoring are disseminated regularly through the
M&E Working Group and also the GFATM TWG. Data from health facilities
related to care, support and treatment are coordinated by the MoH.
Integration of reporting and recording formats from different stakeholders
remains a challenge. Reporting flow of data and information starts from the
district to the province and finally to the national level. At district and
province level, regular meeting are conducted to validate and verify data
before sending it to the national level. This is to ensure good quality data is
being collected. Data analysis is done at each level and this increases sense of
ownership and the use of M&E results to improve programs.
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108
While this analysis is already part of the formal reporting and M & E system,
local skill and benefit from this is unknown. This is an issue which will
receive continuing attention in the coming period.
National and Sub-National HIV Databases
The M&E team monitors the input, process, output, outcome and impact
indicators laid out in the National AIDS Strategy and Action Plan and
accompanying M & E framework. Since mid 2011, routine output data from
137 districts are reported using a web-based system known as “online
recording and reporting”. Indonesia also contributes to the Asia data hub
website that can be found at www.aidsdatahub.org.
Supportive Supervision and Data Auditing
Supervision guidelines are included in the national M&E guideline.
Supervision activities are conducted regularly at sub-national level.
Supervision results are recorded and fed back to those providing data. Joint
supervision among stakeholders is still a challenge. Although data auditing is
regularly conducted, there is not yet a plan for continues data auditing.
HIV Evaluation and Research
The HIV related national research agenda has been developed and is
regularly updated. Research activities are coordinated by the NAC through
the National Research Working Group. Research results are disseminated and
discussed regularly. Annual, mid-term and end term reviews of National
Strategic and Action Plans are conducted regularly.
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Data Dissemination and Use
The use of M&E results to inform policies and program direction is
increasing. The main national indicators include UNGASS input indicators,
Universal Access indicators and Millennium Development Goals indicators.
At national level, indicators provide information to assist program
improvement and are used to inform the new AIDS strategic action plans,
decision making and resources mobilization. For the last two years, key line
ministries have begun to realize the importance of using these data, to
understand the progress HIV programs within their respective institution and
in the context of the national AIDS response. At local level, the M&E results
become valuable information for local authorities to better respond to the
AIDS situation in their respective area. International partners need M&E
results to inform the development of plans for HIV-related assistance to the
country. Mechanisms for the dissemination of data are through: the NAC
executing team meetings; the NAC working groups; the NAC website;
dissemination of printed reports and fact sheets.
Capacity Building
Capacity building at the sub-national level is of paramount importance.
Program sustainability is a matter of increasing human resource capacity in
managing and conducting HIV-related programs. Due to the geographical
variation and uneven availability of training, the capacity among managers
varies. To help address this situation, the NAC organizes annual district/city
meetings among all provincial M&E program managers and district program
managers to learn about various M&E topics, and provide updates on new M
& E issues, as well as to discuss lessons learned and gaps in implementing
M&E in the field. Those topics discussed include data analysis, mapping high
risk populations, writing a good report, and developing fact sheets. Those
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110
skills support the respective local government to optimize the use of data for
both program improvement and advocacy related to policy design, funding
and program.
Page 111
Annexes
Annex A: Completed Questionnaires of NCPI Part A and B
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112
Annex A: National Commitments and P olicy
Instrument (NCPI) 2012
COUNTRY:
Name of the National AIDS Committee Officer in charge of NCPI submission and who can be contacted
for questions, if any:
Nafsiah Mboi, MD.Ped, MPH
Postal address:
Menara Topas 9th floor, Jalan. MH Thamrin, Kav.9 Jakarta 10350 Indonesia
Tel: 62.21 3901758
Fax: 61.213902665
E-mail: [email protected]
Date of submission:
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113
Instructions
The following instrument measures progress in the development and implementation of national HIV
policies, strategies and laws. It is an integral part of the core indicators and is to be completed and
submitted as part of the 2012 Country Progress Report.
This fifth version of the NCPI is the first revised version since the tool’s name changed from the National
Composite and Policy Index (NCPI) to the National Commitments and Policy Instrument (NCPI), The
NCPI has been updated to reflect new HIV programmatic guidance and to be consistent with the new
2011 Political Declaration on HIV/AIDS. Additional guidance has been included to increase validity of the
responses and comparability across different countries. The majority of questions are identical to the 2005,
2007 and 2009 NCPI to allow for trend analyses. Countries are strongly advised to conduct a trend analysis
and include a description of progress made in (a) policy, strategy and law development and (b)
implementation of these in support of the country’s HIV response. Comments on the agreements or
discrepancies between overlapping questions in Parts A and B should also be included as well as a trend
analysis on the key NCPI data since 2003, where available30.
I.
STRUCTURE OF THE QUESTIONNAIRE
The NCPI is divided into two parts, (the different sections under part A and part B have been slightly
reorganized since last reporting round).
Part A to be administered to government officials.
Part A covers:
I. Strategic plan
II. Political support and leadership
III. Human Rights
IV. Prevention
V. Treatment, care and support
VI. Monitoring and evaluation
Part B to be administered to representatives from civil society organizations, bilateral agencies, and
UN organizations.
Part B covers:
I. Civil Society involvement
II. Political support and leadership
III. Human rights
IV. Prevention
V. Treatment, care and support
Some questions occur in both Part A and Part B to ensure that the views of both the national government
and nongovernmental respondents, whether in agreement or not, are obtained.
For questions that pertain to key populations at higher risk for HIV (heretofore referred to as “key
populations” and other vulnerable populations, the following definition is applied: Key populations are
defined as most at risk for HIV (heretofore referred to as “key populations”) within a defined
epidemiological context, that have: significantly higher levels of risk of acquiring and transmitting HIV;
higher rates of mortality and/or morbidity; limited access or uptake of relevant services. Population groups
that require explicit attention i n c l u d e people who inject drugs, sex workers, and men who have sex
30 Compare NCPI in Guidelines on construction of core indicators, UNAIDS 2003, 2005, 2007, 2009 respectively, for selecting questions for which trends
can be calculated.
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114
with men. Other populations that may be vulnerable to HIV are women and girls; transgender persons;
clients of sex workers; prisoners; refugees, migrants or internally displaced populations; adolescents, and
young people; vulnerable children and orphans; people; ethnic minorities; people in low-income groups;
people living in rural or geographically isolated settings or other group(s) specific to the country context.
It is important to submit a fully completed NCPI. Please check the relevant standardized responses as well
as provide further information in the open text boxes where requested. This will facilitate a better understanding of the current country situation, provide examples of good practice for others to learn from,
and pin-point some issues for further improvement. NCPI responses reflect the overall policy, strategy,
legal and programme implementation environment of the HIV response. The open text boxes provide
an opportunity to comment on anything that is perceived to be important but insufficiently captured by
the standardized questions (e.g. important sub-national variations; the level of implementation of laws,
policies or regulations; explanatory notes; comments on data sources etc). In general, draft strategies,
policies, or laws are not considered ‘in existence’ (i.e. there is no opportunity yet to expect their influence
on programme implementation) so questions about whether such a document exists should be answered
with ‘no’. It would, however, be useful to state that such documents are in draft form and any specifics
about them in the relevant open text box.
The overall responsibility for collating and submitting the information requested in the NCPI lies with the
national government, through officials from the National AIDS Committee (NAC) (or equivalent).
II. PROPOSED STEPS FOR DATA GATHERING AND DATA VALIDATION
The NCPI is ideally completed in the last 6 months before submission (i.e. between October 2011
and March 2012 for the 2012 reporting round). As a variety of stakeholders need to be consulted, it is
important to allow adequate time for the data gathering and data consolidation process.
1. Designate two technical coordinators (one for part A; one for part B)
Technical coordinators should be given responsibility to undertake the desk review, to carry out
interviews as needed, to bring together relevant stakeholders, and to facilitate collating and
consolidating the NCPI data. Preferably, the technical coordinator for Part A is from the NAC (or
equivalent) and for Part B is a person outside the government. They should ideally have
understanding of the national policy and legal environment, a monitoring and evaluation
background, and knowledge of the main actors in the national HIV response.
2. Agree with stakeholders on the NCPI data gathering and validation process
Accurate completion of the NCPI requires the involvement of a range of stakeholders including
representatives of a variety of civil society organizations. It is strongly recommended to organize
an initial workshop with key stakeholders to agree on the NCPI data-gathering process including
relevant documents for desk review, organizational representatives to be interviewed, the process to
be used for determining final responses, and the timeline.
3. Obtain data
The submitted NCPI data should represent the most recent stock-taking of the policy, strategic and
legal environment. As the process involves a range of stakeholders and data need to be consolidated
before official submission to UNAIDS, it is important to allow adequate time for completion.
Each section should include completion of the following tasks:
(i). Desk review of relevant documents.
If not already the case, it is useful to collate all key documents (i.e. policies, strategies, laws,
guidelines, reports etc) related to the HIV response in one place which allows easy access by
all stakeholders (such as a website).This will not only facilitate validation of NCPI responses
but, even more importantly, increase awareness about and encourage use over time of these
important documents in the implementation of the national HIV response.
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115
(ii). Interviewing (or other ways of obtaining the information efficiently) key people most
knowledgeable about the specific topic including, but not restricted to the following:
• For Strategic Plan and Political Support sections: the Director or Deputy Director of the
National AIDS Programme or National AIDS Committee (or equivalent), the Heads of the
AIDS Programme at provincial and at district levels (or equivalent decentralised levels).
• For Monitoring and Evaluation section: Officers of the National AIDS Committee (or equivalent), Ministry of Health, HIV focal points of other ministries, the national monitoring and
evaluation technical working group.
• For Human Rights questions: Ministry of Justice officials and human rights commissioners
for questions in Part A; representatives of human rights and other civil society organizations,
including representatives from networks of people living with HIV and from key populations
and other vulnerable sub-populations , and legal aid centres/institutions working in the area
of HIV for questions in Part B.
• For Civil Society Participation section: key representatives of major civil society organizations
working in the area of HIV. These specifically include representatives from networks of people
living with HIV and from key populations and other vulnerable sub-populations.
• For Prevention and Treatment, Care and Support sections: Ministries and major implementing
agencies/organizations in those areas, including nongovernmental organizations and networks of
people living with HIV.
Note that interviewees are requested to provide responses as representatives of their
institutions or constituencies, not their own personal views.
4. Validate, analyse and interpret data
Once the NCPI is fully completed, the technical coordinators need to carefully review all responses
to determine if additional consultations or review of more documents are needed.
It is important to analyse the data for each of the NCPI sections and include a write-up in the
Country Progress Report in terms of progress made in policy/strategy development and
implementation of programmes to tackle the country’s HIV epidemic. Comments on the
agreements/discrepancies between overlapping questions in Part A and Part B should also be
included, as well as a trend analysis on the key NCPI data since 2003, where available.
It is strongly recommended to organize a final workshop with key stakeholders to present, discuss
and validate the NCPI responses and the write-up of the findings before official submission. It is
expected that representatives from civil society organizations working in the area of HIV are invited
to participate. These specifically include representatives from networks of people living with HIV
and from key populations and other vulnerable sub-populations. It is also important that persons
with gender expertise and expertise with other key populations be involved in the review and
validation process. Ideally, the workshop would review the results from the last reporting round
highlighting changes since that time and focus on validation of the NCPI data. Agreement on the
final NCPI data does not require that discrepancies, if any, between overlapping questions in Part
A and Part B be reconciled; it simply means that when there are different perspectives, that Part A
respondents agree on their responses, Part B respondents agree on their responses, and that both are
submitted. If there are no established mechanisms in place, the workshop can also provide an
opportunity to discuss further collaboration between relevant stakeholders to address key gaps
identified through the NCPI process.
5. Enter and submit data
Submit the final NCPI data before 31 March 2012, using the dedicated software provided on the
Global AIDS Progress reporting website (www.unaids.org/AIDSReporting). If this is not possible,
an electronic version of the completed questionnaire should be submitted as an appendix to the
Country Progress Report before 15 March 2012 to allow time for the manual entry of data in
Geneva.
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116
National Commitments and Policy Instrument
(NCPI)
Data Gathering and validation process
Describe the process used for NCPI data gathering and validation:
In filling out the form NCPI, participants were divided into two groups,
Government (Part A) and Non-Government (Part B). Each group was guided by
two facilitators who were members of the group. Each group was subdivided,
the group A into 5 sub-groups and group B into two sub-groups. The choice of
sub-groups was based on their specialization.
In sub-groups, each question was discussed.
Once discussions were completed, the sub-group results were then discussed in a
large group, and the group agreed on a final position.
Describe the process used for resolving disagreements, if any, with respect to the responses
to specific questions:
Discussions were open with each sub-group member free to give their opinion
without pressure. If no agreement was reached within sub-groups with a wide
variation in opinions, these differences were noted, although participants
appreciated a joint decision about questions.
Highlight concerns, if any, related to the final NCPI data submitted (such as data quality,
potential misinterpretation of questions and the like):
Some data and information still requires confirmation, for example data about
orphans. But in general the participants agreed with the final outcomes of the
meetings.
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117
NCPI Respondents
[Indicate information for all whose responses were compiled to fill out (parts of ) the NCPI in the below table;
add as many rows as needed]
NCPI - PART A [to be administered to government officials]
Respondents to Part A
Organization
Names/Positions
[indicate which parts each respondent was queried on]
A.I
A.II
A.III
Kemenkes
Trijoko
Kemdagri
Sri Wahyuni
Kemhukham
Tholib
V
V
TNI
Ghufron S.
V
V
Kemhan
Adi Priyono
A.IV
A.V
V
V
V
V
Kemnakertrans Muzakir
V
Kemenag
Hamim
Kemenpora
Abdul Rafur
BKKBN
Djafar
Bappenas
Nurul
Kemlu
Risha Julian
V
V
KPPPA
Dessy Oktarina
V
V
Kemsos
Enang Rochana
Set. KPAN
Suriadi G.
Kemdagri
Herman M
Kemhukham
Diah Ayu N.H
Kemhukham
Emi
V
V
V
V
V
V
V
V
V
V
V
V
V
V
Add details for all respondents.
Notes:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Kemenkes: Ministry of Health
Kemdagri: Ministry of Home Affairs
Kemhukham: Ministry of Law and Human Rights
TNI: Indonesia Armed Forces
Kemhan: Ministry of Defense
Kemnakertrans: Ministry of Man Power and Transmigration
Kemenag: Ministry of Religion Affairs
Kemenpora: Ministry of Youth and Sports
BKKBN: National Population and Family Planning Board
Bappenas: National Development Planning Board
Kemlu: Minstry of Foreign Affairs
KPPPA: Ministry of Women’s Empowerment and Child Protection
Kemsos: Ministry of Social Affairs
Sekretariat KPAN: Indonesian National AIDS Commission Secretariat
Page 118
A.VI
NCPI - PART B [to be administered to civil society organizations, bilateral agencies, and UN
organizations]
Respondents to Part B
Organization
Names/Positions
[indicate which parts each respondent was queried on]
B.I
B.II
B.III
B.IV
B.V
IPPI
Cia Wibisono
V
V
PKNI
Meike Teja
V
V
OPSI
Aldo
V
V
GWL Ina
Tono Permana
V
V
YPI
Husein Habsyi
V
V
V
YKB
Siti Hidayati
V
V
V
PMI
Eka Wulan
V
V
V
PKBI
IBCA
Nanang
Munajat
Helwiyah
Umniyati
Yuli
W
V
V
V
IKAI
Erry
V
V
V
IPIPPI
Puji Suryantini
V
V
V
UNAIDS
Lely Wahyuniar
V
V
V
UNFPA
Deni A.F
V
V
V
UNESCO
Ahmed Afzal
V
V
UNODC
Gray Sattler
V
V
SUM1
Nasrun Hadi
V
V
ILO
Risya Kori
V
v
NU
V
V
V
V
Add details for all respondents.
Notes:
•
•
•
•
•
•
•
•
•
•
•
•
•
IPPI: Indonesia Association of Positive HIV Women
PKNI: Indonesia Association of Drug User Victims
OPSI: Indonesia Association of Sex Workers
GWL Ina: Indonesia Association 0f Gay, Transgender and MSM
YPI: Pelita Ilmu Foundation
YKB: Kesuma Buana Foundation
PMI: Indonesia Red Cross
PKBI: Indonesia Family Planning Association
NU: Nahdatul Ulama (Indonesia Islamic Organization)
IBCA: Indonesia Business Coalition on AIDS
IKAI: Indonesia Addiction Counselor Association
IPIPPI: Indonesia Behavior Changes Practitioner Association
SUM1: Scaling Up Most at Risk Population (FHI)
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119
National Commitments and Policy Instrument
(NCPI)
Part A
[to be administered to government officials]
I. STRATEGIC PLAN
1.
Has the country developed a national multisectoral strategy to respond to HIV?
(Multisectoral strategies should include, but are not limited to, those developed by Ministries such as
the ones listed under 1.2)
Yes√
IF YES, what was the period covered [write in]:
No
2007
IF YES, briefly describe key developments/modifications between the current national strategy
and the prior one.
IF NO or NOT APPLICABLE, briefly explain why.
• 2010 - 2014 = Strategies and action plans are combined in one document with
the title SRAN (Strategy and Action Plan) for HIV and AIDS in Indonesia.
• 2007 - 2010 = Strategies and action plans separately in 2
(two) documents the Strategic Plan for HIV / AIDS in Indonesia and the
National Action Plan for HIV / AIDS in Indonesia.
• 2003 - 2007 Strategic Plan = HIV / AIDS in Indonesia
• 2000 - 2003 = No policy as Minister Coordination of Peoples Welfare was
disbanded
• 1994 - 1999 = Strategic Plan for HIV / AIDS in Indonesia
IF YES, complete questions 1.1 through 1.10; IF NO, go to question 2.
1.1. Which government ministries or agencies have overall responsibility for the development and
implementation of the national multi-sectoral strategy to respond to HIV?
Name of government ministries or agencies [write in]:
Indonesia National AIDS
1.2. Which sectors are included in the multisectoral strategy with a specific HIV budget for their
activities?
SECTORS
Page
Included in Strategy
Earmarked Budget
Education
Yes√
No
Yes√
No
Health
Yes√
No
Yes√
No
Labour
Yes√
No
Yes√
No
Military/Police
Yes√
No
Yes√
No
Transportation
Yes√
No
Yes√
No
Women
Yes√
No
Yes√
No
Young People
Yes√
No
Yes√
No
Other [write in]: Justice and Human
Rights
Yes√
No
Yes√
No
120
IF NO earmarked budget for some or all of the above sectors, explain what funding is used to
ensure implementation of their HIV-specific activities?
1.3. Does the multisectoral strategy address the following key populations/other vulnerable
populations, settings and cross-cutting issues?
KEY POPULATIONS AND OTHER VULNERABLE
POPULATIONS
Men who have sex with men
Yes√
No
Migrants/mobile populations
Yes√
No
Orphans and other vulnerable children
Yes√
No
People with disabilities
Yes
No√
People who inject drugs
Yes√
No
Sex workers
Yes√
No
Transgendered people
Yes√
No
Women and girls
Yes√
No
Young women/young men
Yes√
No
Other specific vulnerable subpopulations31
Yes√
No
Prisons
Yes√
No
Schools
Yes√
No
Workplace
Yes√
No
Addressing stigma and discrimination
Yes√
No
Gender empowerment and/or gender equality
Yes√
No
HIV and poverty
Yes√
No
Human rights protection
Yes√
No
Involvement of people living with HIV
Yes√
No
SETTINGS
CROSS-CUTTING ISSUES
IF NO, explain how key populations were identified?
31 Other specific vulnerable populations other than those listed above, that have been locally identified as being at higher risk of HIV infection (e.g. (in
alphabetical order) bisexual people, clients of sex workers, indigenous people, internally displaced people, prisoners and refugees)
1.4. What are the identified key populations and vulnerable groups for HIV programmes in the
Page 121
country [write in]?
KEY POPULATIONS
1.
2.
3.
4.
5.
6.
7.
8.
Injecting drug users
Sex worker
Sex Workers clients
Transgender/waria
MSM
Prisoners
Youth
PLWHA
1.5. Does the multisectoral strategy include an operational plan?
Yes√
No
1.6. Does the multisectoral strategy or operational plan include:
a) Formal programme goals?
Yes√
No
N/A
b) Clear targets or milestones?
Yes√
No
N/A
c) Detailed costs for each programmatic area?
Yes√
No
N/A
d) An indication of funding sources to support
programme implementation?
Yes√
No
N/A
e) A monitoring and evaluation framework?
Yes√
No
N/A
1.7. Has the country ensured “full involvement and participation” of civil society32 in the development of the multisectoral strategy?
√Active
involvement
Moderate
involvement
No
involvement
IF ACTIVE INVOLVEMENT, briefly explain how this was organised:
In preparation SRAN 2010 - 2014 civil society representatives were involved
from the design up to the finalization of the document so that the various needs
of civil society is reflected in the programs set SRAN.
IF NO or MODERATE INVOLVEMENT, briefly explain why this was the case:
32 Civil society includes among others: networks and organisations of people living with HIV,women, young people, key affected groups (including
men who have sex with men, transgendered people, sex workers, people who inject drugs, migrants, refugees/displaced populations, prisoners);
faith-based organizations; AIDS service organizations; community-based organizations; ; workers organizations, human rights organizations;
etc. Note: The private sector is considered separately.
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122
1.8. Has the multisectoral strategy been endorsed by most external development partners
(bi-laterals, multi-laterals)?
Yes√
No
N/A
1.9. Have external development partners aligned and harmonized their HIV-related programmes
to the national multisectoral strategy?
√Yes,
all
partners
Yes, some
partners
No
N/A
IF SOME PARTNERS or NO, briefly explain for which areas there is no alignment/harmonization
and why:
2.
Has the country integrated HIV into its general development plans such as in: (a) National
Development Plan; (b) Common Country Assessment / UN Development Assistance
Framework; (c) Poverty Reduction Strategy; and (d) sector-wide approach?
Yes√
No
N/A
2.1. IF YES, is support for HIV integrated in the following specific development plans?
SPECIFIC DEVELOPMENT PLANS
Common Country Assessment/UN Development
Assistance Framework
Yes√
No
N/A
National Development Plan
Yes√
No
N/A
Poverty Reduction Strategy
Yes√
No
N/A
Sector-wide approach
Yes√
No
N/A
Other [write in]:
Yes√
No
N/A
2.2. IF YES, are the following specific HIV-related areas included in one or more of the
development plans?
HIV-RELATED AREA INCLUDED IN PLAN(S)
HIV impact alleviation
Yes√
No
N/A
Reduction of gender inequalities as they relate to
HIV prevention/treatment, care and/or support
Yes√
No
N/A
Reduction of income inequalities as they relate to
HIV prevention/ treatment, care and /or support
Yes√
No
N/A
Reduction of stigma and discrimination
Yes√
No
N/A
Treatment, care, and support (including social
security or other schemes)
Yes√
No
N/A
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123
Women’s economic empowerment (e.g. access to
credit, access to land, training)
Yes√
Other[write in below]:
3.
Yes
No
N/A
No
N/A
Has the country evaluated the impact of HIV on its socioeconomic development for planning
purposes?
Yes
No√
N/A
3.1. IF YES, on a scale of 0 to 5 (where 0 is “Low” and 5 is “High”), to what extent has the
evaluation informed resource allocation decisions?
LOW
0
4.
HIGH
1
2
3
4
Does the country have a strategy for addressing HIV issues among its national uniformed
services (such as military, police, peacekeepers, prison staff, etc)?
Yes√
5.
5
No
Has the country followed up on commitments made in the 2011 Political Declaration on
HIV/AIDS? 33
Yes√
No
5.1. Have the national strategy and national HIV budget been revised accordingly?
Yes
No√
5.2. Are there reliable estimates of current needs and of future needs of the number of adults and
children requiring antiretroviral therapy?
√Estimates
of Current
and Future
Needs
Estimates
of Current
Needs Only
No
5.3. Is HIV programme coverage being monitored?
Yes√
No
Yes√
No
Yes√
No
(a) IF YES, is coverage monitored by sex (male, female)?
(b) IF YES, is coverage monitored by population groups?
33 Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS, A/RES/65/277, 10 June 2011
Page 124
IF YES, for which population groups?
1.
2.
3.
4.
5.
6.
7.
Injecting drug users
Sex worker
Sex Workers clients/High risk man
Transgender
MSM
Prisoners
PLWHA
Briefly explain how this information is used:
For program planning and resources mobilization
(c) Is coverage monitored by geographical area?
Yes√
No
IF YES, at which geographical levels (provincial, district, other)?
National, Provincial and district Level
Briefly explain how this information is used:
For program planning and resources mobilization
5.4. Has the country developed a plan to strengthen health systems?
Yes√
No
Please include information as to how this has impacted HIV-related infrastructure, human
resources and capacities, and logistical systems to deliver medications:
The MoH has approved over 270 hospitals and 80 satellite (smaller and private
hospital) to provide ART.
The Staff in the hospitals have been trained to promote ART. ARV is provide
free of charge.
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125
6.
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate strategy planning efforts in your country’s HIV programmes in 2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
8
9
10
Since 2009, what have been key achievements in this area:
1.
The existence of a national strategy that involves multisector coordination by Bappenas
2.
Expansion of the scope and coverage, particularly IDUs,
prisoners, MSM and High Risk Youth Man
3.
Increased allocation of domestic funds (state budget and regional
budgets)
4.
Increasing the number of district /municipal bylaw and allocated
funds for HIV-AIDS programs
What challenges remain in this area:
Domestic funding for HIV- AIDS prevention program in the District / City is
still inadequate
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126
II. POLITICAL SUPPORT AND LEADERSHIP
Strong political support includes: government and political leaders who regularly speak out about
HIV/AIDS and demonstrate leadership in different ways: allocation of national budgets to support
HIV programmes; and, effective use of government and civil society organizations to support HIV
programmes.
1.
Do the following high officials speak publicly and favourably about HIV efforts in major
domestic forums at least twice a year?
A. Government ministers
Yes√
No
Yes√
No
B. Other high officials at sub-national level
1.1. In the last 12 months, have the head of government or other high officials taken action that
demonstrated leadership in the response to HIV?
(For example, promised more resources to rectify identified weaknesses in the HIV response,
spoke of HIV as a human rights issue in a major domestic/international forum, and such activities as visiting an HIV clinic, etc.)
Yes√
No
Briefly describe actions/examples of instances where the head of government or other high
officials have demonstrated leadership:
On World AIDS Day 2011, Vice President officially opened and gave a speech
in Jakarta, capital city of Indonesia
2.
Does the country have an officially recognized national multisectoral HIV coordination body
(i.e., a National HIV Council or equivalent)?
Yes√
No
IF NO, briefly explain why not and how HIV programmes are being managed:
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2.1. IF YES:
IF YES, does the national multisectoral HIV coordination body:
Have terms of reference?
Yes√
No
Have active government leadership and participation?
Yes√
No
Have an official chair person?
Yes√
No
IF YES, what is his/her name and position title? HR. Agung Laksono, MD. (Ministry Coordinator
of Peoples Welfare
Have a defined membership?
Yes√
No
IF YES, how many members? 32 member, consist of Minister and Head of Government Body, key population
network, privat sector
Include civil society representatives?
Yes√
No
Yes√
No
IF YES, how many?3organizations
Include people living with HIV?
IF YES, how many?2 national network of people living with HIV and AIDS
Include the private sector?
Yes√
No
Strengthen donor coordination to avoid parallel funding and
duplication of effort in programming and reporting?
Yes√
No
3. Does the country have a mechanism to promote interaction between government, civil society
organizations, and the private sector for implementing HIV strategies/programmes?
Yes√
No
N/A
IF YES, briefly describe the main achievements:
1. Coordination meeting of the Cabinet / Minister led by
Coordinating Minister of People's Welfare
2. Every three months a meeting of the Implementation Team
3. There are regular reporting mechanisms for each sector, which contains
the program and related activities on AIDS prevention.
4. National AIDS Conference every 4 years
What challenges remain in this area:
Financial support from the state budget is still low. In addition, in
coordination meetings, officials representing each sector often change
affecting the continuity of the program of the Ministry/Agency.
Lack of socialization of important issues related to HIV / AIDS.
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128
4.
What percentage of the national HIV budget was spent on activities implemented by civil
society in the past year?
%
5.
What kind of support does the National HIV Commission (or equivalent) provide to civil
society organizations for the implementation of HIV-related activities?
Capacity-building
Yes√
No
Coordination with other implementing partners
Yes√
No
Information on priority needs
Yes√
No
Procurement and distribution of medications or other supplies
Yes√
No
Technical guidance
Yes√
No
6.
Has the country reviewed national policies and laws to determine which, if any, are inconsistent with the National HIV Control policies?
Yes√
No
6.1. IF YES, were policies and laws amended to be consistent with the National HIV Control
policies?
Yes√
No
IF YES, name and describe how the policies / laws were amended
Eg Law. 22/1997 converted into Law No.35/2009 on Narcotics.
Name and describe any inconsistencies that remain between any policies/laws and the National
AIDS Control policies:
1. Law no. 22/1997 does not include rehabilitation for drug addicts, while the
Law. 35/2009 includes an obligation for the rehabilitation of drug addicts.
2. The issuance of Circular Letter Supreme Court No. 3/2011 on
Narcotics Abuse Victims Placement in Rehabilitation Institutions;
3. Reviewing local regulations that are incompatible with national policy.
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7.
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the political support for the HIV programme in 2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
8
9
10
Since 2009, what have been key achievements in this area:
Policy formulation ministerial decree, Commander of the Armed forces, and
other regulations that support the HIV / AIDS program.
2. Increased proportion of domestic resources for the national budget on HIV
/ AIDS (40% compared to the international financial support).
1.
What challenges remain in this area:
1. There are still policy makers (Minister-level officials) who do
not understand HIV / AIDS comprehensively, for example, some still
consider that HIV / AIDS is the responsibility of the Ministry of Health.
2. The lack of information for religious leaders and community members who
do not understand the impact of HIV AIDS, resulting in stigma in the
community.
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130
III. HUMAN RIGHTS
1.1. Does the country have non-discrimination laws or regulations which specify protections for
specific key populations and other vulnerable groups? Circle yes if the policy specifies any of
the following key populations and vulnerable groups:
KEY POPULATIONS and VULNERABLE GROUPS
People living with HIV
Yes√
No
Men who have sex with men
Yes
Migrants/mobile populations
Yes√
No
Orphans and other vulnerable children
Yes√
No
People with disabilities
Yes√
No
People who inject drugs
Yes√
No
Prison inmates
Yes√
No
Sex workers
Yes
No√
Transgendered people
Yes
No√
Women and girls
Yes√
No
Young women/young men
Yes√
No
Other specific vulnerable subpopulations [write in]:
Yes
No
No√
1.2. Does the country have a general (i.e., not specific to HIV-related discrimination) law on nondiscrimination?
Yes√
No
IF YES to Question 1.1. or 1.2., briefly describe the content of the/laws:
1. Law no. 7/1984 (ratification of CEDAW: Convention on the Elimination of
2.
3.
4.
5.
6.
7.
all forms of discrimination against women
Law no. 39/1999 on Human Rights;
Law no. 5/1998 on the Ratification of the Convention
against Torture and Degrading Treatment or Punishment is cruel,
inhuman or degrading (CAT);
Circular Letter Supreme Court. No 3/2011 concerning the placement of victims
of substance abuse in the Rehabilitation Institute;
Regulation of Gender Responsive Budget Planning
Child Protection Act No. 23/2002
Elimination of Domestic Violence Act No. 23/2004
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131
Briefly explain what mechanisms are in place to ensure these laws are implemented:
1. Establishment of National Human Rights Commission as a watchdog of human
rights implementation in Indonesia;
2. Establishment of the Ad HOC Court as judicial bodies against human rights
violations
3. Establishment of the Indonesian Child Protection Commission
4. Establishment of the National Commission for Women, National Commission
for the Elderly, etc.
Briefly comment on the degree to which they are currently implemented:
Mechanism is already running and still in the process of optimization.
2.
Does the country have laws, regulations or policies that present obstacles34 to effective HIV
prevention, treatment, care and support for key populations and vulnerable groups?
Yes√
No
Yes
No
IF YES, for which key populations and vulnerable groups?
People living with HIV
Men who have sex with men
Yes√
No
Migrants/mobile populations
Yes
No
Orphans and other vulnerable children
Yes
No
People with disabilities
Yes
No
People who inject drugs
Yes√
Prison inmates
Yes
No
No
Sex workers
Yes√
No
Transgendered people
Yes√
No
Women and girls
Young women/young men
35
Other specific vulnerable populations [write in below]:
Yes
No
Yes
No
Yes
No
34 These are not necessarily HIV-specific policies or laws. They include policies, laws or regulations which may deter people from or make it difficult for
them to access prevention, treatment, care and support services. Examples cited in country reports in the past have include: “laws that criminalize same
sex relationships”, “laws that criminalize possession of condoms or drug paraphernalia”; “loitering laws”; “laws that preclude importation of generic
medicines”; “policies that preclude distribution or possession of condoms in prisons”; “policies that preclude non-citizens from accessing ART”;
“criminalization of HIV transmission and exposure”, “inheritance laws/rights for women”, “laws that prohibit provision of sexual and reproductive health
information and services to young people”, etc.
35 Other specific vulnerable populations other than above, may be defined as having been locally identified as being at higher risk of HIV infection (e.g.
(in alphabetical order) bisexual people, clients of sex workers, indigenous people , internally displaced people, prisoners, and refugees)
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132
Briefly describe the content of these laws, regulations or policies:
Some local bylaws in certain districts and municipals forbid prostitution,
which complicates efforts to control the spread of HIV / AIDS and is
not in line with the national policy.
Bylaw in Aceh province prohibit homosexuality.
Police still criminalize drugs user in certain areas.
Briefly comment on how they pose barriers:
These policies make it difficult to access group who are fearful of
persecution. There is a need to harmonize local legislation with
the legislation / national policy, for example, through the Ministry of the
Interior (close to the regional government to repeal laws that are
not aligned) and the Regional AIDS Commission.
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133
IV. PREVENTION
1.
Does the country have a policy or strategy that promotes information, education and
communication (IEC) on HIV to the general population?
Yes√
No
IF YES, what key messages are explicitly promoted?
Abstain from injecting drugs
Yes√
No
Avoid commercial sex
Yes√
No
Avoid inter-generational sex
Yes√
No
Be faithful
Yes√
No
Be sexually abstinent
Yes√
No
Delay sexual debut
Yes√
No
Engage in safe(r) sex
Yes√
No
Fight against violence against women
Yes√
No
Greater acceptance and involvement of people living with HIV
Yes√
No
Greater involvement of men in reproductive health programmes
Yes√
No
Know your HIV status
Yes√
No
Males to get circumcised under medical supervision
Yes√
No
Prevent mother-to-child transmission of HIV
Yes√
No
Promote greater equality between men and women
Yes√
No
Reduce the number of sexual partners
Yes√
No
Use clean needles and syringes
Yes√
No
Use condoms consistently
Yes√
No
Other [write in below]:
Yes
No
1.2. In the last year, did the country implement an activity or programme to promote accurate
reporting on HIV by the media?
Yes√
2.
Does the country have a policy or strategy to promote life-skills based HIV education for
young people?
Yes√
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134
No
No
2.1.
Is HIV education part of the curriculum in:
Primary schools?
Yes
No√
Secondary schools?
Yes
No√
Teacher training?
Yes√
No
2.2. Does the strategy include age-appropriate, gender-sensitive sexual and reproductive health
elements?
Yes√
No
2.3. Does the country have an HIV education strategy for out-of-school young people?
Yes√
3.
No
Does the country have a policy or strategy to promote information, education and
communication and other preventive health interventions for key or other vulnerable subpopulations?
Yes√
No
Briefly describe the content of this policy or strategy:
Indonesia has mapped vulnerable sub-populations and has conducted
educational and promotional information and health interventions.
Related to the curriculum in schools, including boarding schools, there are
some provinces that already includes the basic information of HIV in the
education curriculum, such as Papua, East Java and Bali.
3.1. IF YES, which populations and what elements of HIV prevention does the policy/strategy
address?
Check which specific populations and elements are included in the policy/strategy
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135
IDU36
MSM37
Condom promotion
√
√
Drug substitution therapy
√
HIV testing and counseling
√
Needle & syringe exchange
√
Reproductive health,
including sexually
transmitted infections
prevention and treatment
Stigma and discrimination
reduction
Targeted information on
risk reduction and HIV
education
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Vulnerability reduction (e.g.
income generation)
Sex
Customers Prison
Other
of Sex
workers
inmates populations38
Workers
[write in]
√
√
3.2. Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate policy efforts in support of HIV prevention in 2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
8
9
10
Since 2009, what have been key achievements in this area:
In the prevention program:
1. AIDS National Strategic Action Plan 2010-2014
2. National AIDS Commission and government sectors have establish Working
Groups
What challenges remain in this area:
1.
2.
3.
4.
5.
Condom use program is still not accepted in the community
Still a lack of coordination of various sectors
Reporting and the documentation is still not optimal
Low levels of support from policy makers at the central and local levels.
Most of the sector still facing difficulties to allocate budgets for HIV/AIDS
in state as well as regional budgets.
36 IDU = People who inject drugs
37 MSM = men who have sex with men
38 Other vulnerable population other than those listed above, that have been locally identified as being at higher risk of HIV infection
(e.g. (in alphabetical order) bisexual people, clients of sex workers, indigenous people , internally displaced people, prisoners, and refugees)
Page
136
4.
Has the country identified specific needs for HIV prevention programmes?
Yes√
No
IF YES, how were these specific needs determined?
Providing IEC to the following groups:
1. Youth group
2. Workers at the seaport, bus terminals, truck stops, airports, industrial centers –
based on the high prevalence of HIV in FSWs and their clients
3. Prison inmates – based on the high risk behaviour of prisoners as indicated by the
2010 prison survey
4. Vulnerable groups, such as street children, vagrants and beggars
IF NO, how are HIV prevention programmes being scaled-up?
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137
4.1. To what extent has HIV prevention been implemented?
Strongly
disagree
Disagree
Agree
Blood safety
1
2
3
Condom promotion
1
Harm reduction for people who inject
drugs
1
HIV prevention for out-of-school young
people
1
HIV prevention in the workplace
1
HIV testing and counseling
1
2√
IEC on risk reduction
1
IEC on stigma and discrimination
reduction
1
Prevention of mother-to-child
transmission of HIV
1
Prevention for people living with HIV
1
2√
Reproductive health services including
sexually transmitted infections
prevention and treatment
1
Risk reduction for intimate partners of
key populations
1
Risk reduction for men who have sex
with men
1
2
Risk reduction for sex workers
1
2
School-based HIV education for young
people
1
Universal precautions in health care
settings
1
2
3
Other[write in]:
1
2
3
The majority of people in need have
access to…
39
5.
Strongly
agree
N/A
4√
N/A
3
4
N/A
4
N/A
4
N/A
4
N/A
3
4
N/A
2√
3
4
N/A
2√
3
4
N/A
4
N/A
3
4
N/A
2√
3
4
N/A
2√
3
4
N/A
3√
4
N/A
3√
4
N/A
4
N/A
2√
2
3√
3
2√
2
3√
2
3√
3
2√
N/A
4√
4
N/A
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts in implementation of HIV prevention programmes in 2011?
Very
Poor
0
Excellent
1
2
39 IEC = information, education, communication.
Page
138
3
4
5
6√
7
8
9
10
V. TREATMENT, CARE AND SUPPORT
1.
Has the country identified the essential elements of a comprehensive package of HIV
treatment, care and support services?
Yes√
No
If YES, Briefly identify the elements and what has been prioritized:
1. ARV drugs provide free of charge (MoH)
2. Integrated prevention, treatment, care and support of HIV
Briefly identify how HIV treatment, care and support services are being scaled-up?
1.
2.
3.
4.
278 PLWHA referral hospitals for ART
Satellite health centers and hospitals increased to 87 unit
342 Test and counseling Clinics (including prisons)
The existence of a comprehensive and integrated service SOP
1.1. To what extent have the following HIV treatment, care and support services been
implemented?
Strongly
disagree
Disagree
Agree
Antiretroviral therapy
1
2
ART for TB patients
1
2
Cotrimoxazole prophylaxis in people
living with HIV
1
2
Early infant diagnosis
1
2√
HIV care and support in the workplace
(including alternative working
arrangements)
1
2√
HIV testing and counselling for people
with TB
1
2
HIV treatment services in the workplace
or treatment referral systems through
the workplace
1
2
Nutritional care
1
2
Paediatric AIDS treatment
1
2
The majority of people in need have
access to…
Strongly
agree
N/A
3
4√
N/A
3
4√
N/A
4
N/A
3
4
N/A
3
4
N/A
3√
3
4
3√
3
3√
N/A
4√
N/A
N/A
4√
4
N/A
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139
Strongly
disagree
Disagree
Post-delivery ART provision to women
1
2
Post-exposure prophylaxis for
non-occupational exposure (e.g., sexual
assault)
1
2
Post-exposure prophylaxis for
occupational exposures to HIV
1
2
3
4√
N/A
Psychosocial support for people living
with HIV and their families
1
2
3
4√
N/A
Sexually transmitted infection
management
1
TB infection control in HIV treatment
and care facilities
1
2
3
4√
N/A
TB preventive therapy for people living
with HIV
1
2
3
4√
N/A
TB screening for people living with HIV
1
2
3
4√
N/A
Treatment of common HIV-related
infections
1
2
3
4√
N/A
Other[write in]:
1
2
3
The majority of people in need have
access to…
2.
Agree
Strongly
agree
N/A
3√
4
N/A
3√
4
N/A
3
2√
4
N/A
4
N/A
Does the government have a policy or strategy in place to provide social and economic support
to people infected/affected by HIV?
Yes√
No
Please clarify which social and economic support is provided:
1. Economic empowerment of PLWHA through Productive Enterprises
2. Social assistance for the fulfillment of basic needs of PLWHA
3.
Does the country have a policy or strategy for developing/using generic medications or
parallel importing of medications for HIV?
Yes√
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140
No
N/A
4.
Does the country have access to regional procurement and supply management mechanisms
for critical commodities, such as antiretroviral therapy medications, condoms, and
substitution medications?
Yes√
No
N/A
IF YES, for which commodities?
1.
2.
3.
4.
5.
ART
Condoms
STI and opportunistic infection drugs
Oral substitution (Methadone)
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts in the implementation of HIV treatment, care, and support programmes in
2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
8
9
10
Since 2009, what have been key achievements in this area:
1. ARVs are free
2. Condoms are available and distributed
3. The drugs are always available
4. ARV recipients more than the target set in 2011
(target 45% achievement of 87%)
5. Counseling and testing target Above 15 years 800.000, 600
000 achievement
What challenges remain in this area:
1. More sources of funding from domestic sources the present proportion of
government to foreign funding is 1: 2
2. The persistence of stigma and discrimination
3. ARV adherence levels vary, approximately 60% - 70%
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141
6.
Does the country have a policy or strategy to address the additional HIV-related needs of
orphans and other vulnerable children?
Yes√
No
N/A
6.1. IF YES, is there an operational definition for orphans and vulnerable children in the country?
Yes√
No
6.2. IF YES, does the country have a national action plan specifically for orphans and vulnerable
children?
Yes√
No
6.3. IF YES, does the country have an estimate of orphans and vulnerable children being reached
by existing interventions?
Yes√
No
6.4. IF YES, what percentage of orphans and vulnerable children is being reached?
%
7.
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts to meet the HIV-related needs of orphans and other vulnerable children in
2011?
Very
Poor
0
Excellent
1
2
3
4
5
6√
7
8
9
10
Since 2009, what have been key achievements in this area:
Ministry of Social Affairs provide support on financial and microfinance activities
to poor families of infected or affected by HIV
What challenges remain in this area:
1.
2.
3.
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142
PLWHA referred to hospitals has a 100% target but only 20% achieved
Geographical natural and social conditions are not the same in all provinces
Government policy on health is not the same as in all provinces/district due
to decentralized authority.
VI. MONITORING AND EVALUATION
1.
Does the country have one national Monitoring and Evaluation (M&E) plan for HIV?
Yes√
In Progress
No
Briefly describe any challenges in development or implementation:
Not all partners have a M&E system or plan due to their different policies. In
addition, infrastructures to support M&E related activities still needs to be
improved.
1.1. IF YES, years covered [write in]:
2010
1.2. IF YES, have key partners aligned and harmonized their M&E requirements (including
indicators) with the national M&E plan?
Yes, all
partners
Yes, some
partners√
No
N/A
Briefly describe what the issues are:
Some partners do not have a M&E unit, M&E system or plan, making
integration of their M&E activities into the national M&E plan difficult,
including indicators harmonization.
2.
Does the national Monitoring and Evaluation plan include?
A data collection strategy
Yes√
No
Behavioural surveys
Yes√
No
Evaluation / research studies
Yes√
No
HIV Drug resistance surveillance
Yes√
No
HIV surveillance
Yes√
No
Routine programme monitoring
Yes√
No
IF YES, does it address:
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143
A data analysis strategy
Yes√
No
A data dissemination and use strategy
Yes√
No
A well-defined standardised set of indicators that includes sex and
age disaggregation (where appropriate)
Yesv
No
Guidelines on tools for data collection
Yes√
No
In Progress
No
3.
Is there a budget for implementation of the M&E plan?
Yes√
3.1. IF YES, what percentage of the total HIV programme funding is budgeted for M&E activities?
10%
4.
Is there a functional national M&E Unit?
Yes√
In Progress
No
Briefly describe any obstacles:
Limitation in resources (human, financial and supportive facilities) for
national M&E related activities management in order to improve quality
of implementation of national M&E system.
4.1. Where is the national M&E Unit based?
In the Ministry of Health?
Yes√
No
In the National HIV Commission (or equivalent)?
Yes√
No
Elsewhere [write in]?
Yes
No
4.2. How many and what type of professional staff are working in the national M&E Unit?
POSITION [write in position titles in spaces below]
Permanent Staff [Add as many as needed]
Page
Fulltime
Part time
Since when?
6
ME Coordinator
1
2007
ME Coordinator Assistant for Sumatra
1
2009
ME Coordinator Assistant for Java-Bali
1
2008
ME Coordinator Assistant for Kalimantan
1
2007
ME Coordinator Assistant for Eastern Indo
1
2011
ME Coordinator Assistant for National
Partners
1
2007
144
MoH (AIDS Sub-Directorat)
17
Fulltime
Part time
Since when?
Temporary Staff [Add as many as needed]
4.3. Are there mechanisms in place to ensure that all key partners submit their M&E data/reports
to the M&E Unit for inclusion in the national M&E system?
Yes√
No
Briefly describe the data-sharing mechanisms:
Implementing partners at district level submit their report regularly (once a
month) to District AIDS Commission which is then compiled and sent to the
National AIDS Commission.
National implementing partners submit their report regularly (quarterly) to
National AIDS Commission using standardized formats.
All reports are reviewed and the highlights are shared in the national report.
What are the major challenges in this area:
Some partners are not yet committed to share their reports regularly because
they do not have a M&E officer, no budget to conduct M&E activities, and
no M&E system.
5.
Is there a national M&E Committee or Working Group that meets regularly to coordinate
M& activities?
Yes√
No
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145
6.
Is there a central national database with HIV- related data?
Yes√
No
IF YES, briefly describe the national database and who manages it.
The national database is being managed and is limited to data on program
coverage performed by key stakeholders. This needs improvement to ensure
all important data can be recorded into a national database.
The database is managed by national M&E staff.
Each partner manages their ownb database related to implementation of
their program.
6.1. IF YES, does it include information about the content, key populations and geographical
coverage of HIV services, as well as their implementing organizations?
Yes, all of the
above√
Yes, but only
some of the
above
No, none of
the above
IF YES, but only some of the above, which aspects does it include?
6.2. Is there a functional Health Information System40?
At national level
Yes√
No
At subnational level
Yes√
No
IF YES, at what level(s)? [write in]
7.
Does the country publish an M&E report on HIV, including HIV surveillance data at least
once a year?
Yes√
No
40 Such as regularly reporting data from health facilities which are aggregated at district level and sent to national level; data are analysed and used at
different levels)?
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146
8.
How are M&E data used?
For programme improvement?
Yes√
No
In developing / revising the national HIV response?
Yes√
No
For resource allocation?
Yes√
No
Other [write in]:
•
Development of National Strategy
•
Development of Government policy for HIV AIDS prevention
•
Advocacy for HIV AIDS prevention
Yes
No
Briefly provide specific examples of how M&E data are used, and the main challenges, if any:
Quarterly reports on HIV & AIDS published by the Ministry of Health shows
the epidemic situation in all regions. This epidemic data is used for developing
prevention strategies either for that specific region or for national policy
makers. One of the examples is epidemic data for the improvement of the AIDS
budget.
Challenges: AIDS program sometimes not included in list of program priorities
in a region so it will take some time for the region to decide to increase their
budget allocation for AIDS.
9. In the last year, was training in M&E conducted
At national level?
Yes√
No
IF YES, what was the number trained:
Training on National AIDS Spending Assessment, 3-6 May 2011, Participant 34
Persons
At subnational level?
Yes√
No
Yes√
No
IF YES, what was the number trained
At service delivery level including civil society?
IF YES, how many?
9.1. Were other M&E capacity-building activities conducted other than training?
Yes√
No
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147
IF YES, describe what types of activities
Workshops, seminar, congress and national meeting on AIDS
10. Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how
would you rate the HIV-related monitoring and evaluation (M&E) in 2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
8
9
10
Since 2009, what have been key achievements in this area:
•
•
•
•
•
•
Development of online reporting and recording system for 33 provinces.
Mapping of MARP at district/city level.
Integrated Bio Behavioral Survey 2009 and 2011
Rapid Behavioral Survey for FSW and IDUs in 2009 and 2010
Annual Epidemiology Surveillance
National AIDS Spending Assessment 2009-2010
What challenges remain in this area:
•
•
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148
Harmonization of program indicators among program implementers
Commitment for sharing reports regularly.
National Commitments and Policy Instrument
(NCPI)
Part B
[to be administered to representatives from civil society organizations, bilateral agencies,
and UN organizations]
I. CIVIL SOCIETY41 INVOLVEMENT
1.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) has civil society
contributed to strengthening the political commitment of top leaders and national
strategy/policy formulations?
LOW
0
HIGH
1
2√
3
4
5
Comments and examples:
Civil society (CS) is defined as: KAP/MARP, women, youth, faith-based organizations. The
emphasis is still on KAPs.
CS’ contribution in terms of its relation to the NAC has been great as at all levels of decisionmaking at the NAC, CS were consulted. But in the AIDS response in general, the contribution of
CS has been limited. This is clear as there are still some regulations, laws and rules that are
violating human rights, in particular those of marginalized groups (ie.MSM, IDUs, PLWHIV, etc)
either at national or local levels. At the national level, the role of CS has been limited to the NAC,
while other sectors rarely involve KAP groups in decision making meetings.
2.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) have civil society
representatives been involved in the planning and budgeting process for the National Strategic
Plan on HIV or for the most current activity plan (e.g. attending planning meetings and
reviewing drafts)?
LOW
0
HIGH
1
2√
3
4
5
Comments and examples:
The involvement of civil society can be described as follows, according to the stages of planning:
During the formulation of the National AIDS Strategy, civil society had full involvement
and consultation.
In terms of implementation of programs, the role of civil society is increasing.
But in terms of budgeting, particularly at the national level, the system doesn’t provide a
forum for civil society to be involved in the decision making process. At local level,
civil society groups in some districts are involved in the formulation of the AIDS
budget.
41 Civil society includes among others: networks and organisations of people living with HIV, women, young people, key affected groups (including men
who have sex with men, transgendered people, sex workers, people who inject drugs, migrants, refugees/displaced populations, prisoners); faith-based
organizations; AIDS service organizations; community-based organizations; ; workers organizations, human rights organizations; etc. Note: The private
sector is considered separately.
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149
3.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) are the services provided
by civil society in areas of HIV prevention, treatment, care and support included in:
a. The national HIV strategy?
LOW
HIGH
0
1
2
3
5
4√
b. The national HIV budget?
LOW
HIGH
0
1
3
2√
4
5
c. The national HIV reports?
LOW
HIGH
0
1
2
3
5
4√
Comments and examples:
NGOs are providing services, mostly using international funds.
These are included in the National Strategy (please refer to No.2, and the
budgeting (please refer to No.2).
In terms of reports, NGOs have been reporting to International funders or to
national NGOs. At regional level, they report to local KPA which in turn reports
to National KPA.
4.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) is civil society included
in the monitoring and evaluation (M&E) of the HIV response?
a. Developing the national M&E plan?
LOW
0
HIGH
2
1√
3
4
5
b. Participating in the national M&E committee / working group responsible for coordination
of M&E activities?
LOW
0
HIGH
1
2
3
4
5
c. Participate in using data for decision-making?
LOW
0
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150
HIGH
1
2√
3
4
5
•
•
•
5.
Civil society is encouraged to use data/evidence/scientific analysis. Some examples:
o GWL used data to formulating the GWL National AIDS Strategy and Action Plan
o JOTHI uses data and actively carries out research
o IPPI has limited usage of data.
Civil society is not accustomed to using data for decision making, as they are lacking the
necessary skills. More technical assistance is needed for civil society groups to increase the
capacity to collect, analyze and use data.
Data from MOH needs to be made available and published in reports.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) is the civil society sector
representation in HIV efforts inclusive of diverse organizations (e.g. organisations and
networks of people living with HIV, of sex workers, and faith-based organizations)?
LOW
0
HIGH
1
2
3√
4
5
Comments and examples:
Compared to prior periods, the role of civil society is increasing but greater
efforts and emphasis to push for an active involvement. Capacity building is
needed here.
6.
To what extent (on a scale of 0 to 5 where 0 is “Low” and 5 is “High”) is civil society able to
access:
a. Adequate financial support to implement its HIV activities?
LOW
0
HIGH
1
2
3√
4
5
b. Adequate technical support to implement its HIV activities?
LOW
0
HIGH
1
2
3√
4
5
Comments and examples:
•
•
•
There is transparancy in terms of funds used through the CCM forum for
GFATM funded projects. All PRs which are the MOH, KPAN, PKBI and
NU are open and transparent.
Proposals submitted by civil society for funding usually get revised with
decreased funds made available than that proposed in budgets
Civil society is lacking information and capacity to initiate some HIV
activities.
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151
7.
What percentage of the following HIV programmes/services is estimated to be provided by
civil society?
Prevention for key-populations
People living with HIV
<25%
25-50%
51–75%
>75%
Men who have sex with men
<25%
25-50%
51–75%
>75%
People who inject drugs
<25%
25-50%
51–75%
>75%
Sex workers
<25%
25-50%
51–75%
>75%
Transgendered people
<25%
25-50%
51–75%
>75%
Testing and Counselling
<25%
25-50%
51–75%
>75%
Reduction of Stigma and Discrimination
<25%
25-50%
51–75%
>75%
Clinical services (ART/OI)*
<25%
25-50%
51–75%
>75%
Home-based care
<25%
25-50%
51–75%
>75%
Programmes for OVC**
<25%
25-50%
51–75%
>75%
*ART = Antiretroviral Therapy; OI=Opportunistic infections
**OVC = Orphans and other vulnerable children
8.
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts to increase civil society participation in 2011?
Very
Poor
0
Excellent
1
2
3
4
5√
6
7
8
9
10
Since 2009, what have been key achievements in this area:
What challenges remain in this area:
•
•
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152
The Minister of Social Affairs has made statements naming prostition as
societal diseases (penyakit masyarakat) and some brothels have been closed
down, making it more difficult to reach sex workers
Stigma and discrimination of MARPS still exists
POLITICAL
SUPPORT
AND LEADERSHIP
II.II.
POLITICAL
SUPPORT
AND LEADERSHIP
1.
Has the Government, through political and financial support, involved people living with
HIV, key populations and/or other vulnerable sub-populations in governmental HIV-policy
design and programme implementation?
Yes√
No
IF YES, describe some examples of when and how this has happened:
•
•
Greater involvement in terms of program design particularly supported by GFATM from planning to
implementation through the CCM forum
Involvement at the national level has been optimal with all groups involved in meetings and policy
making
III.III.
HUMAN
RIGHTS
HUMAN
RIGHTS
1.1 Does the country have non-discrimination laws or regulations which specify protections for
specific key populations and other vulnerable subpopulations? Circle yes if the policy specifies
any of the following key populations:
KEY POPULATIONS and VULNERABLE SUBPOPULATIONS
People living with HIV
Men who have sex with men
Yes√
Yes
No
No√
Migrants/mobile populations
Yes√
No
Orphans and other vulnerable children
Yes√
No
People with disabilities
Yes√
No
People who inject drugs
Yes√
No
Prison inmates
Yes√
No
Sex workers
Yes
No√
Transgendered people
Yes
No√
Women and girls
Young women/young men
Other specific vulnerable subpopulations [write in]:
Yes√
Yes
Yes√
No
No√
No
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153
1.2. Does the country have a general (i.e., not specific to HIV-related discrimination) law on nondiscrimination?
Yes√
No
IF YES to Question 1.1 or 1.2, briefly describe the contents of these laws:
•
Review laws and regulations that discriminate KAP: Laws on human
rights, health, domestic violence, etc.
Briefly explain what mechanisms are in place to ensure that these laws are implemented:
•
•
The role of civil society in terms of control and monitoring of law
enforcement has been minimum, due to lack of capacity.
Parliamentarians (DPR, DPD) do not represent neither do they articulate
the problems of civil society especially KAPs
Briefly comment on the degree to which they are currently implemented:
•
2.
Enforcement of laws is limited and in some cases non-existent
Does the country have laws, regulations or policies that present obstacles42 to effective HIV
prevention, treatment, care and support for key populations and other vulnerable subpopulations?
Yes√
No
42 These are not necessarily HIV-specific policies or laws. They include policies, laws, or regulations which may deter people from or make it difficult for
them to access prevention, treatment, care and support services. Examples cited in country reports in the past have include: “laws that criminalize same
sex relationships”, “laws that criminalize possession of condoms or drug paraphernalia”; “loitering laws”; “laws that preclude importation of generic
medicines”; “policies that preclude distribution or possession of condoms in prisons”; “policies that preclude non-citizens from accessing ART”;
“criminalization of HIV transmission and exposure”, “inheritance laws/rights for women”, “laws that prohibit provision of sexual and reproductive health
information and services to young people”, etc
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154
2.1. IF YES, for which sub-populations?
KEY POPULATIONS and VULNERABLE SUBPOPULATIONS
People living with HIV
Yesv
No
Men who have sex with men
Yes√
No
Migrants/mobile populations
Yesv
No
Orphans and other vulnerable children
Yes
No√
People with disabilities
Yes
No√
People who inject drugs
Yes√
Prison inmates
Yes
No
No√
Sex workers
Yes√
No
Transgendered people
Yes√
No
Women and girls
Yes√
No
Young women/young men
Yes
43
Other specific vulnerable populations [write in]:
Yes
No√
No
Briefly describe the content of these laws, regulations or policies:
•
•
Local rules and regulations (PERDA) that criminalize PLWHIV (Jatim,
Bali), Pornographic laws,
Laws concerning migrant workers and the Narcotics Law (contains many
contradictions)
Briefly comment on how they pose barriers:
•
3.
Laws that are criminalizing provide a difficult environment for harm
reduction programs
Does the country have a policy, law or regulation to reduce violence against women, including
for example, victims of sexual assault or women living with HIV?
Yes√
No
43 Other specific vulnerable populations other than above, may be defined as having been locally identified as being at higher risk of HIV infection
(e.g. (in alphabetical order) bisexual people, clients of sex workers, indigenous people , internally displaced people, prisoners, and refugees)
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155
Briefly describe the content of the policy, law or regulation and the populations included.
•
•
4.
Women the Domestic law No: 23/2004
Sexual harassment towards men, transgender
Is the promotion and protection of human rights explicitly mentioned in any HIV policy or
strategy?
Yes√
No
IF YES, briefly describe how human rights are mentioned in this HIV policy or strategy:
•
5.
The 2010-2014 National AIDS Strategy and Action Plan, one of the
principles of good response to AIDS includes : “law enforcement”: to
embody rule of law that is fair for all parties, without
exception/discrimination, upholding human rights and local values.
Is there a mechanism to record, document and address cases of discrimination experienced by
people living with HIV, key populations and other vulnerable populations?
Yes
No√
IF YES, briefly describe this mechanism:
•
•
•
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156
Documentation of human rights violation is done by civil society for drug
users and HIV positive people. No process exists for sex workers.
The National Human Rights Commission has the authority to investigate
reported violations.
Workplace regulations to protect the rights of workers exist.
6.
Does the country have a policy or strategy of free services for the following? Indicate if these
services are provided free-of-charge to all people, to some people or not at all (circle “yes” or
“no” as applicable).
Provided free-ofcharge to all people
in the country
Provided free-ofcharge to some
people in the
country
Provided, but only at
a cost
Antiretroviral treatment
Yes√
No
Yes
No
Yes
No
HIV prevention services44
Yes√
No
Yes
No
Yes
No
No
Yes
No
HIV-related care and
support interventions
Yes
Yes√
No
If applicable, which populations have been identified as priority, and for which services?
•
•
•
•
•
7.
All service are free including HIV testing, harm reduction and needle syringe
programs, except for administrative fees
There are no standard administrative fees, it varies among hospitals (private
hospitals)
Follow up treatments are not free
TB treatments are free, but tests and other related needs are not free
There are no set priorities
Does the country have a policy or strategy to ensure equal access for women and men to HIV
prevention, treatment, care and support?
Yes√
No
7.1. In particular, does the country have a policy or strategy to ensure access to HIV prevention,
treatment, care and support for women outside the context of pregnancy and childbirth?
Yes√
8.
No
Does the country have a policy or strategy to ensure equal access for key populations and/or
other vulnerable sub-populations to HIV prevention, treatment, care and support?
Yes√
No
IF YES, Briefly describe the content of this policy/strategy and the populations included:
There are no differences, there is equal access
44 Such as blood safety, condom promotion, harm reduction for people who inject drugs, HIV prevention for out-of-school young people, HIV
prevention in the workplace, HIV testing and counseling, IEC on risk reduction, IEC on stigma and discrimination reduction, prevention of motherto-child transmission of HIV, prevention for people living with HIV, reproductive health services including sexually transmitted infections prevention
and treatment, risk reduction for intimate partners of key populations, risk reduction for men who have sex with men, risk reduction for sex workers,
school-based HIV education for young people, universal precautions in health care settings.
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157
8.1. IF YES, does this policy/strategy include different types of approaches to ensure equal access
for different key populations and/or other vulnerable sub-populations?
Yes√
No
IF YES, briefly explain the different types of approaches to ensure equal access for different
populations:
Refer to the SRAN 2010-2014.
9.
Does the country have a policy or law prohibiting HIV screening for general employment
purposes (recruitment, assignment/relocation, appointment, promotion, termination)?
Yes
No√
IF YE,S briefly describe the content of the policy or law:
•
•
Law No.39/2004 concerning migrant workers ongoing amendment process
Between laws and regulation related to AIDS in the workplace, there are
contradictions in terms of screening and it being a reason for dismissal.
10. Does the country have the following human rights monitoring and enforcement mechanisms?
a. Existence of independent national institutions for the promotion and protection of human
rights, including human rights commissions, law reform commissions, watchdogs, and
ombudspersons which consider HIV-related issues within their work
Yes
No√
b. Performance indicators or benchmarks for compliance with human rights standards in the
context of HIV efforts
Yes
IF YES on any of the above questions, describe some examples:
•
•
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158
National commission for the protection of women and children
But none at other commissions such as: Human rights, Ombudsman
No√
11. In the last 2 years, have there been the following training and/or capacity-building activities:
a. Programmes to educate, raise awareness among people living with HIV and key populations concerning their rights (in the context of HIV)45?
Yes√
No
b. Programmes for members of the judiciary and law enforcement46 on HIV and human rights
issues that may come up in the context of their work?
Yes√
No
Yes
No√
12. Are the following legal support services available in the country?
a. Legal aid systems for HIV casework
b. Private sector law firms or university-based centres to provide free or reduced-cost legal
services to people living with HIV
Yes√
No
13. Are there programmes in place to reduce HIV-related stigma and discrimination?
Yes√
No
IF YES, what types of programmes?
Programmes for health care workers
Yes√
No
Programmes for the media
Yes√
No
Programmes in the work place
Yes√
No
Other [write in]:
Yes√
No
14. Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the policies, laws and regulations in place to promote and protect human rights in
relation to HIV in 2011?
Very
Poor
0
Excellent
1
2
3√
4
5
6
7
8
9
10
45 Including, for example, Know-your-rights campaigns – campaigns that empower those affected by HIV to know their rights and the laws in context of
the epidemic (see UNAIDS Guidance Note: Addressing HIV-related law at National Level, Working Paper, 30 April 2008)
46 Including, for example, judges, magistrates, prosecutors, police, human rights commissioners and employment tribunal/ labour court judges or
commissioners
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159
Since 2009, what have been key achievements in this area:
Amendment to the Narcotics Law, regulatory improvement in terms of harm
reduction.
What challenges remain in this area:
•
•
•
Sex workers need protection with brothels closed down
Inconsistency in laws and regulations
Dependence on the political situation and individual leadership
15. Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the effort to implement human rights related policies, laws and regulations in 2011?
Very
Poor
0
Excellent
1
2√
3
4
5
6
7
8
9
10
Since 2009, what have been key achievements in this area:
There are no significant improvement or obstacles
What challenges remain in this area:
•
•
•
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160
Contradictory laws and regulations
Law enforcement
Formal government documents such as planning documents (RENSTRA)
are not being implemented appropriately
IV. PREVENTION
1.
Has the country identified the specific needs for HIV prevention programmes?
Yes√
No
IF YES, how were these specific needs determined?
•
•
NAC has done initial assessments to map out the AIDS epidemic based on
transmission risks and patterns, focusing on prevention efforts
NAC also mapped out resources available
IF NO, how are HIV prevention programmes being scaled-up?
1.1 To what extent has HIV prevention been implemented?
HIV prevention component
The majority of people in need have access to…
Strongly
disagree
Disagree
Blood safety
1
2
Condom promotion
1
Harm reduction for people who inject
drugs
1
HIV prevention for out-of-school young
people
1
2√
HIV prevention in the workplace
1
2√
HIV testing and counseling
1
IEC47 on risk reduction
1
2√
IEC on stigma and discrimination
reduction
1
Prevention of mother-to-child
transmission of HIV
1
Agree
Strongly
agree
N/A
4
N/A
4
N/A
4
N/A
3
4
N/A
3
4
N/A
4
N/A
3
4
N/A
2√
3
4
N/A
2√
3
4
N/A
3√
3
2√
2
2
3√
3√
47 IEC = information, education, communication
Page
161
The majority of people in need have access to…
HIV prevention component
Strongly
disagree
Disagree
Prevention for people living with HIV
1
2
Reproductive health services including
sexually transmitted infections
prevention and treatment
1
2
Risk reduction for intimate partners of
key populations
1
Risk reduction for men who have sex
with men
1
Risk reduction for sex workers
1
2v
School-based HIV education for young
people
1
2v
Universal precautions in health care
settings
1
2
Other[write in]:
1
2
2.
Agree
Strongly
agree
N/A
3√
4
N/A
3√
4
N/A
4
N/A
4
N/A
3
4
N/A
3
4
N/A
4
N/A
4
N/A
3
2√
2
3√
3√
3
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts in the implementation of HIV prevention programmes in 2011?
Very
Poor
0
Excellent
1
2
3
4
5
6√
7
8
9
10
Since 2009, what have been key achievements in this area:
•
•
•
•
•
•
PMTS or Prevention of sexual transmission has started
A special strategy for high risk men and MSM has started
There are preventive strategies for migrant workers but not all are being appropriately
implemented
Program for youth, in particular through peer educators, has started
Increasing coverage across all provinces
More companies (IBCA) are showing attention and implementing AIDS in the workplace
programs
What challenges remain in this area:
•
•
•
•
Page
162
Condom promotion is still problematic: in brothels, nightclubs, use of
condoms is still low. Some of the obstacles are perceptions and advocacy by
religious leaders. Young people and unmarried adults are having difficulties
accessing condoms
Local regulations and the closing down of brothels
Lack of networks, united efforts to mobilize resources
Sustainability of programs
V. TREATMENT, CARE AND SUPPORT
1.
Has the country identified the essential elements of a comprehensive package of HIV
V. TREATMENT,
CARE AND SUPPORT
treatment, care and support services?
Yes√
No
IF YES, Briefly identify the elements and what has been prioritized:
ARV treatment: government covers ARV costs of 60%
There are 175 referral hospitals providing ARV
Briefly identify how HIV treatment, care and support services are being scaled-up?
•
•
•
PMTCT services
CD4 needs to be increased
Services should be made more accessible in particular at disctrict/city levels
1.1. To what extent have the following HIV treatment, care and support services been implemented?
The majority of people in need have access to…
HIV treatment, care and support service
Strongly
disagree
Disagree
Antiretroviral therapy
1
2
ART for TB patients
1
Cotrimoxazole prophylaxis in people
living with HIV
1
Early infant diagnosis
1
2√
HIV care and support in the workplace
(including alternative working
arrangements)
1
HIV testing and counselling for people
with TB
Agree
Strongly
agree
N/A
3√
4
N/A
2
3√
4
N/A
2
3√
4
N/A
3
4
N/A
2√
3
4
N/A
1
2√
3
4
N/A
HIV treatment services in the workplace
or treatment referral systems through
the workplace
1
2√
3
4
N/A
Nutritional care
1
2√
3
4
N/A
Paediatric AIDS treatment
1
2√
3
4
N/A
Post-delivery ART provision to women
1
2√
3
4
N/A
Page
163
The majority of people in need have access to…
HIV treatment, care and support service
Strongly
disagree
Post-exposure prophylaxis for
non-occupational exposure (e.g., sexual
assault)
1
Post-exposure prophylaxis for
occupational exposures to HIV
1
2
Psychosocial support for people living
with HIV and their families
1
Sexually transmitted infection
management
Disagree
Agree
Strongly
agree
N/A
3
4
N/A
3√
4
N/A
2
3√
4
N/A
1
2
3√
4
N/A
TB infection control in HIV treatment
and care facilities
1
2
3√
4
N/A
TB preventive therapy for people living
with HIV
1
2
3√
4
N/A
TB screening for people living with HIV
1
2
3√
4
N/A
Treatment of common HIV-related
infections
1
2
3√
4
N/A
Other[write in]:
1
2
4
N/A
2√
3
1.2. Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how would you
rate the efforts in the implementation of HIV treatment, care and support programmes in
2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7√
Since 2009, what have been key achievements in this area:
There are no significant improvement or obstacles
What challenges remain in this area:
Page
164
8
9
10
2.
Does the country have a policy or strategy to address the additional HIV-related
needs of orphans and other vulnerable children?
Yes √
V. TREATMENT, CARE AND SUPPORT
No
2.1. IF YES, is there an operational definition for orphans and vulnerable children in the
country?
Yes √
No
2.2. IF YES, does the country have a national action plan specifically for orphans and
vulnerable children?
Yes √
No
2.3 . IF YES, does the country have an estimate of orphans and vulnerable children being
reached by existing interventions?
Yes √
No
2.4. IF YES, what percentage of orphans and vulnerable children is being reached?
%
3.
Overall, on a scale of 0 to 10 (where 0 is “Very Poor” and 10 is “Excellent”), how
would you rate the efforts in the implementation of HIV treatment, care and
support programmes in
2011?
Very
Poor
0
Excellent
1
2
3
4
5
6
7
8√
9
10
Since 2009, what have been key achievements in this area:
•
•
Ministry of social affairs has carried out programs at provincial levels, in
particular for PLWHIV.
NGOs efforts
What challenges remain in this area:
•
•
•
Migrant workers have no access to support and ARV treatment yet
OVC and mitigation are still dependent on NGOs, no national program has
been made available, not yet a priority.
Increasing number of cases, no permanent monitoring system has been set
Page
165
Annex B: National AIDS Spending Assessment (NASA) Matrix
Page
166
Cover Sheet Indicator 6.1: National Funding Matrix — 2009, 2010 & 2011
Country
INDONESIA
Date of Data Entry
29-Mar-12
day/month/year example: 20/02/2012
1) Which institutions/entities were responsible for filling out the indicator forms?
NAC or equivalent
If Others, please specify:
(NAC or equivalent, NAP or Others)
2) Who is the person responsible for submission of the report and for follow-up if there are questions regarding Indicator No. 1?
Name / title:
Address:
Email:
Telephone:
Yanti Susanti
National AIDS Commission-Menara Topas Floor 9, Jl. MH Thamrin Kav 9, Central Jakarta
[email protected]
62213901758
Indonesian Rupiah
3) Name of Local Currency:
4) Amounts reported in:
2009:
2010:
2011:
US Dollars
US Dollars
(Local Currency or US Dollars)
(Local Currency or US Dollars)
(Local Currency or US Dollars)
5) Amounts expresed in:
2009:
2010:
2011:
Units ( x 1)
Units ( x 1)
Units ( x 1)
(Units ( x 1), Thousands (x 1,000) or Millions (x 1,000,000) )
(Units ( x 1), Thousands (x 1,000) or Millions (x 1,000,000) )
(Units ( x 1), Thousands (x 1,000) or Millions (x 1,000,000) )
6) Average exchange rate with US dollars during the reporting cycle:
2009:
9000.00
2010:
9000.00
2011:
7) Reporting cycle:
2009: Calendar Year
2010: Calendar Year
2011:
Local Currency per 1 US Dollar
Local Currency per 1 US Dollar
Local Currency per 1 US Dollar
(Calendar Year or Fiscal Year)
(Calendar Year or Fiscal Year)
(Calendar Year or Fiscal Year)
Page 167
8) Please indicate month and year (M/YYYY) of reporting cycle:
2009
Month
From:
To:
2010
Month
From:
To:
2011
Month
From:
To:
9) Methodology used:
Year
1
12
2009
2009
Year
1
12
2010
2010
Year
2009: National AIDS Spending Assessment (NASA)
(National AIDS Spending Assessment (NASA), National Health Accounts/AIDS Subaccount, UNAIDS/UNFPA/NIDI Resource Flow Surveys or Other)
2010: National AIDS Spending Assessment (NASA)
(National AIDS Spending Assessment (NASA), National Health Accounts/AIDS Subaccount, UNAIDS/UNFPA/NIDI Resource Flow Surveys or Other)
2011:
(National AIDS Spending Assessment (NASA), National Health Accounts/AIDS Subaccount, UNAIDS/UNFPA/NIDI Resource Flow Surveys or Other)
10) Unaccounted Expenditures:
(Please specify if there were expenditures for activities
in any of the AIDS Spending Categories or subcategories that are not included in the National
Funding Matrix and explain why these expenditures
were not included.)
11) Budget Support: Is general budget support from an international source reported under Public Sources of financing (e.g. a bilateral donor to Ministry of Finance)?
2009:
No
(Yes or No)
2010:
No
(Yes or No)
2011:
(Yes or No)
Page 168
Country:
Reporting cycle:
INDONESIA
Calendar Year
National AIDS Spending
Assessment (NASA)
Data Measurement Tool
US Dollars
Amounts reported in:
Please indicate month and year (M/YYYY)
Month
From:
To:
Name of Local Currency
Currency expressed in:
Average Exchange Rate for the year (local currency to USD)
1
12
Indonesian Rupiah
Units ( x 1)
9000.000
Financing Sources
Year
2009
2009
Public Sources
2009
TOTAL
AIDS Spending Categories
US Dollars
TOTAL
US Dollars
1. Prevention (sub-total)
1.01 Communication for social and behavioural change
1.02 Community mobilization
1.03 Voluntary counselling and testing (VCT)
1.04 Risk-reduction for vulnerable and accessible populations
1.05. Prevention - Youth in school
1.06 Prevention - Youth out-of-school
1.07 Prevention of HIV transmission aimed at people living with HIV
1.08 Prevention programmes for sex workers and their clients
1.09 Programmes for men who have sex with men
1.10 Harm-reduction programmes for injecting drug users
1.11 Prevention programmes in the workplace
1.12 Condom social marketing
1.13 Public and commercial sector male condom provision
1.14 Public and commercial sector female condom provision
1.15 Microbicides
1.16 Prevention, diagnosis and treatment of sexually transmitted infections (STI)
1.17 Prevention of mother-to-child transmission
1.18 Male Circumsicion
1.19 Blood safety
1.20 Safe medical injections
1.21 Universal precautions
1.22 Post-exposure prophylaxis
1.98 Prevention activities not disaggregated by intervention
1.99 Prevention activities not elsewhere classified
2. Care and Treatment (sub-total)
2.01 Outpatient care
2.01.01 Provider- initiated testing and counselling
2.01.02 Opportunistic infection (OI) outpatient prophylaxis and treatment
2.01.03 Antiretroviral therapy
2.01.04 Nutritional support associated to ARV therapy
2.01.05 Specific HIV-related laboratory monitoring
2.01.06 Dental programmes for PLHIV
2.01.07 Psychological treatment and support services
2.01.08 Outpatient palliative care
2.01.09 Home-based care
2.01.10 Traditional medicine and informal care and treatment services
2.01.98 Outpatient care services not disaggregated by intervention
2.01.99 Outpatient Care services not elsewhere classified
2.02 In-patient care
2.02.01 Inpatient treatment of opportunistic infections (OI)
2.02.02 Inpatient palliative care
2.02.98 Inpatient care services not disaggregated by intervention
2.02.99 In-patient services not elsewhere classified
2.03 Patient transport and emergency rescue
2.98 Care and treatment services not disaggregated by intervention
2.99 Care and treatment services not-elsewhere classified
3. Orphans and Vulnerable Children (sub-total)
3.01 OVC Education
3.02 OVC Basic health care
3.03 OVC Family/home support
3.04 OVC Community support
3.05 OVC Social services and Administrative costs
3.06 OVC Institutional Care
3.98 OVC services not disaggregated by intervention
3.99 OVC services not-elsewhere classified
4. Program Management and Administration Strengthening (sub-total)
4.01 Planning, coordination and programme management
4.02 Administration and transaction costs associated with managing and disbursing funds
4.03 Monitoring and evaluation
International Sources
Private Sources (optional for UNGASS reporting)
Multilaterals
Public
Sub-Total
Central / National
Dev. Banks
Reimbursable
(e.g. Loans)
Sub- National
Social Security
International SubTotal
All Other Public
UN
Agencies
Bilaterals
Dev. Bank NonReimburseable
(e.g. Grants)
Global Fund
All Other
Multilateral
All Other
International
For-profit
institutions /
Corporations
Private
Sub-Total
Household funds
All Other Private
60,285,420
19,411,106
21,318,844
13,883,455
7,435,388
0
38,966,576
14,894,922
0
0
0
24,071,654
0
0
0
0
3,795,143
1,568,977
2,226,166
0
0
0
15,615,963
6,432,103
0
0
0
9,183,860
0
0
0
0
1,731,400
1,092,976
189,448
308,564
452,061
320,573
398,001
604,968
23,211
1,474,163
111,176
4,785
35,775
164,780
0
140,536
107,532
0
20,889
27,859
53,760
3,556
0
12,145,084
21,082,574
908,186
534,716
373,470
0
0
0
823,214
555,313
267,901
0
489,268
200,605
288,663
0
0
0
603,709
475,308
128,401
0
129,907
41,308
219,620
42,160
177,460
0
0
0
88,943
0
88,943
0
186,817
0
186,817
0
0
0
265,245
44,265
220,980
0
37,167
0
37,167
0
0
0
283,406
0
283,406
0
125,212
72,518
52,694
0
272,789
263,653
9,136
0
353,520
92,304
261,215
0
0
0
251,448
68,039
183,410
0
0
0
0
0
0
0
23,211
23,211
0
0
173,009
132,321
40,688
0
0
0
1,301,155
1,194,425
106,730
0
106,176
53,892
52,284
0
0
0
5,000
0
5,000
0
4,785
1,111
3,674
0
0
0
0
0
0
0
0
134,289
221,701
129,126
11,280,191
79,577
870,867
0
189,222
0
27,900
39,446
48,927
0
8,061,327
1,605,076
0
0
6,456,251
0
0
0
82,261
39
0
0
82,222
0
0
0
0
9,162,412
1,460,585
958,021
827,481
88,599
0
0
0
0
0
0
0
59,541
25,898
33,643
0
5,689
0
5,689
30,086
0
30,086
164,780
133,715
31,065
0
0
0
0
0
0
0
0
0
0
117,003
0
117,003
23,533
0
23,533
0
62,532
0
62,532
45,000
0
45,000
0
0
0
0
0
0
0
0
20,889
0
20,889
0
0
0
0
27,859
0
27,859
0
0
0
0
53,760
7,290
46,470
0
0
0
0
3,556
0
3,556
0
0
0
0
0
0
0
0
0
0
0
633,259
257,037
376,222
11,511,825
3,781,992
14,139,312
11,079,721
3,059,590
0
0
0
6,943,262
2,473,071
0
0
0
7,729,833
4,470,191
0
0
0
0
0
61,958
0
61,958
0
0
0
72,332
72,332
0
0
0
0
0
0
0
0
0
0
149,369
22,222
127,147
72,332
72,332
0
0
0
0
0
0
0
0
0
0
0
56,794
0
56,794
72,332
72,332
11,207,859
11,057,499
150,360
72,332
72,332
0
0
79,577
0
79,577
0
0
0
0
261,680
0
261,680
0
609,187
609,187
0
0
0
0
0
0
189,222
0
0
0
0
0
0
0
0
189,222
0
0
0
0
27,900
27,900
0
0
39,446
39,446
0
0
48,927
48,927
0
0
2,016,578
0
1,605,076
2,016,578
0
0
0
1,605,076
0
0
6,044,749
0
1,574,558
0
0
0
4,470,191
0
411,502
0
0
0
6,044,749
0
0
0
0
0
0
0
39
7,261
0
0
0
39
0
0
75,000
0
1,574,558
4,470,191
0
0
0
0
0
0
0
0
75,000
0
7,222
0
0
0
0
0
0
7,222
0
0
0
411,502
7,261
0
0
0
75,000
75,000
0
0
0
0
0
0
0
0
0
0
0
2,114,454
861,301
1,253,153
690,312
414,525
416,964
403,585
0
0
0
0
0
7,047,959
3,558,354
0
0
0
3,489,605
0
275,787
770,273
128,777
641,496
0
172,139
244,825
541,057
424,179
116,878
0
0
155,901
247,684
423,896
306,553
117,343
0
Page 169
4.04 Operations research
4.05 Serological-surveillance (Serosurveillance)
4.06 HIV drug-resistance surveillance
4.07 Drug supply systems
4.08 Information technology
4.09 Patient tracking
4.10 Upgrading and construction of infrastructure
4.11 Mandatory HIV testing (not VCT)
4.98 Program Management and Administration Strengthening not disaggregated by type
4.99 Program Management and Administration Strengthening not-elsewhere classified
5. Incentives for Human resources (sub-total)
5.01 Monetary incentives for human resources
5.02 Formative education to build-up an HIV workforce
5.03 Training
5.98 Incentives for Human Resources not specified by kind
5.99 Incentives for Human Resources not elsewhere classified
6. Social Protection and Social Services excluding Orphans and Vulnerable Children (sub-total)
6.01 Social protection through monetary benefits
6.02 Social protection through in-kind benefits
6.03 Social protection through provision of social services
6.04 HIV-specific income generation projects
6.98 Social protection services and social services not disaggregated by type
6.99 Social protection services and social services not elsewhere classified
7. Enabling Environment (sub-total)
7.01 Advocacy
7.02 Human rights programmes
7.03 AIDS-specific institutional development
7.04 AIDS-specific programmes focused on women
7.05 Programmes to reduce Gender Based Violence
7.98 Enabling Environment and Community Development not disaggregated by type
7.99 Enabling Environment and Community Development not elsewhere classified
8. Research (sub-total)
8.01 Biomedical research
8.02 Clinical research
8.03 Epidemiological research
8.04 Social science research
8.05 Vaccine-related research
8.98 Research not disaggregated by type
8.99 Research not elsewhere classified
6,058
68,811
0
834,721
74,886
103,685
22,503
56
0
4,805,606
1,528,423
0
0
0
0
0
243,101
16,767
10,667
42,472
81,994
0
91,201
8,017,047
607,585
221,281
1,750,670
19,503
0
0
5,418,007
758,495
0
0
2,296
77,916
0
216,189
462,094
6,058
0
0
0
68,811
0
0
0
0
0
0
0
0
0
136,029
2,103
133,926
698,692
698,692
0
0
67,122
21,761
45,361
7,764
0
7,764
0
103,685
81,016
22,669
0
68,811
22,503
56
0
0
6,058
0
0
22,503
0
0
56
0
0
0
0
0
199,329
13,855
185,474
648,614
250,155
398,459
4,606,277
0
0
0
2,000,153
879,810
2,606,124
0
0
0
879,810
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
184,851
16,767
0
16,767
0
0
10,667
0
10,667
0
0
42,472
3,200
39,272
0
0
81,994
55,050
26,944
0
0
0
0
0
0
91,201
0
27,990
240,509
264,007
27,990
236,017
0
0
0
0
0
0
0
0
0
0
0
0
0
343,578
78,638
0
0
0
5,576,460
0
0
264,939
0
221,281
0
47
47
1,750,623
1,750,623
3,111
16,392
15,826
566
0
5,416,674
327,000
5,089,674
0
656,034
259,306
102,461
37,061
65,400
0
0
0
0
0
0
0
0
0
0
0
396,728
0
0
0
46,000
46,000
67,788
0
37,061
30,727
394,306
0
0
0
0
0
2,296
215,728
0
0
31,916
461
0
0
2,296
461
0
0
0
31,916
0
0
0
0
1,333
0
0
0
0
0
0
2,172,088
3,111
1,333
0
0
7,748,548
221,281
0
0
0
58,250
268,499
0
0
0
243,101
91,201
0
0
0
0
259,306
215,728
0
135,000
0
Page 170
Country:
Reporting cycle:
INDONESIA
Calendar Year
National AIDS Spending
Assessment (NASA)
Data Measurement Tool
US Dollars
Amounts reported in:
Please indicate month and year (M/YYYY)
Month
From:
To:
Name of Local Currency
Currency expressed in:
Average Exchange Rate for the year (local currency to USD)
1
12
Indonesian Rupiah
Units ( x 1)
9000.000
Financing Sources
Year
2010
2010
Public Sources
2010
TOTAL
AIDS Spending Categories
US Dollars
TOTAL
US Dollars
1. Prevention (sub-total)
1.01 Communication for social and behavioural change
1.02 Community mobilization
1.03 Voluntary counselling and testing (VCT)
1.04 Risk-reduction for vulnerable and accessible populations
1.05. Prevention - Youth in school
1.06 Prevention - Youth out-of-school
1.07 Prevention of HIV transmission aimed at people living with HIV
1.08 Prevention programmes for sex workers and their clients
1.09 Programmes for men who have sex with men
1.10 Harm-reduction programmes for injecting drug users
1.11 Prevention programmes in the workplace
1.12 Condom social marketing
1.13 Public and commercial sector male condom provision
1.14 Public and commercial sector female condom provision
1.15 Microbicides
1.16 Prevention, diagnosis and treatment of sexually transmitted infections (STI)
1.17 Prevention of mother-to-child transmission
1.18 Male Circumsicion
1.19 Blood safety
1.20 Safe medical injections
1.21 Universal precautions
1.22 Post-exposure prophylaxis
1.98 Prevention activities not disaggregated by intervention
1.99 Prevention activities not elsewhere classified
2. Care and Treatment (sub-total)
2.01 Outpatient care
2.01.01 Provider- initiated testing and counselling
2.01.02 Opportunistic infection (OI) outpatient prophylaxis and treatment
2.01.03 Antiretroviral therapy
2.01.04 Nutritional support associated to ARV therapy
2.01.05 Specific HIV-related laboratory monitoring
2.01.06 Dental programmes for PLHIV
2.01.07 Psychological treatment and support services
2.01.08 Outpatient palliative care
2.01.09 Home-based care
2.01.10 Traditional medicine and informal care and treatment services
2.01.98 Outpatient care services not disaggregated by intervention
2.01.99 Outpatient Care services not elsewhere classified
2.02 In-patient care
2.02.01 Inpatient treatment of opportunistic infections (OI)
2.02.02 Inpatient palliative care
2.02.98 Inpatient care services not disaggregated by intervention
2.02.99 In-patient services not elsewhere classified
2.03 Patient transport and emergency rescue
2.98 Care and treatment services not disaggregated by intervention
2.99 Care and treatment services not-elsewhere classified
3. Orphans and Vulnerable Children (sub-total)
3.01 OVC Education
3.02 OVC Basic health care
3.03 OVC Family/home support
3.04 OVC Community support
3.05 OVC Social services and Administrative costs
3.06 OVC Institutional Care
3.98 OVC services not disaggregated by intervention
3.99 OVC services not-elsewhere classified
4. Program Management and Administration Strengthening (sub-total)
4.01 Planning, coordination and programme management
4.02 Administration and transaction costs associated with managing and disbursing funds
4.03 Monitoring and evaluation
International Sources
Private Sources (optional for UNGASS reporting)
Multilaterals
Public
Sub-Total
Central / National
Dev. Banks
Reimbursable
(e.g. Loans)
Sub- National
Social Security
International SubTotal
All Other Public
UN
Agencies
Bilaterals
Dev. Bank NonReimburseable
(e.g. Grants)
Global Fund
All Other
Multilateral
All Other
International
For-profit
institutions /
Corporations
Private
Sub-Total
69,146,880
20,413,354
27,779,280
17,731,539
10,047,741
0
0
0
41,367,600
13,173,742
0
0
0
28,193,858
0
5,373,017
1,155,301
4,217,717
0
0
0
15,040,337
4,130,815
0
0
0
10,909,522
0
1,930,279
1,361,603
175,151
656,069
692,578
356,635
600,042
1,045,229
149,713
2,059,758
93,812
7,821
279,137
751,402
0
252,339
85,364
0
21,651
0
16,974
3,556
0
9,874,342
24,120,328
1,064,105
498,213
565,892
866,174
611,174
255,000
0
670,495
185,260
485,235
691,108
449,606
241,502
0
14,527,975
1,151,801
188,932
14,494,180
134,770
284,424
0
104,228
0
25,922
127,402
0
0
84,496
1,184,456
0
0
0
0
0
6,078,428
128,658
0
881
0
127,778
0
0
0
0
13,405,850
2,866,124
1,366,459
1,377,397
89,225
0
0
0
0
0
0
0
0
89,225
85,926
55,693
30,233
0
0
184,980
471,089
0
471,089
0
298,001
20,498
277,503
394,577
148,890
245,687
0
271,515
0
24,333
60,787
271,515
0
249,100
0
249,100
350,942
323,535
27,407
0
256,994
19,952
237,042
788,235
38,087
750,148
0
26,286
20,055
6,231
123,427
77,575
45,852
68,712
26,315
42,397
1,991,046
1,436,627
554,419
91,875
14,803
77,072
1,937
1,937
7,821
0
7,821
0
119,787
119,296
491
159,350
126,111
126,111
0
625,291
0
247,080
0
0
0
0
159,350
0
0
625,291
0
0
0
35,660
247,080
5,259
0
0
5,259
0
35,660
49,704
0
0
0
0
21,651
21,651
0
0
0
49,704
0
0
0
0
16,974
16,974
0
0
3,556
3,556
0
0
0
All Other Private
0
184,980
85,120
Household funds
0
0
1,709,585
100,566
1,609,019
8,164,757
987,691
17,707,923
14,266,685
3,441,238
0
0
0
6,412,405
1,505,723
0
0
0
4,906,682
0
0
0
0
0
14,384,489
14,266,685
117,804
0
0
0
143,486
143,486
0
0
0
0
0
0
0
0
0
143,486
143,486
0
0
0
0
0
0
0
0
0
1,008,315
1,008,315
45,446
14,350,694
14,266,685
134,770
22,642
45,446
143,486
143,486
84,009
143,486
143,486
134,770
0
22,642
261,782
0
104,228
104,228
0
7,177,066
0
0
0
0
0
261,782
0
0
0
0
0
0
0
25,922
25,922
0
0
127,402
127,402
0
0
0
0
0
0
84,496
0
1,184,456
84,496
0
0
0
1,184,456
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
501,748
501,748
53,658
0
53,658
0
0
0
0
881
0
0
5,576,680
669,998
75,000
0
4,906,682
0
0
0
75,000
0
0
0
0
0
52,778
75,000
0
0
52,778
0
0
881
0
75,000
0
0
0
0
0
0
0
0
0
0
0
0
3,211,597
1,834,192
1,377,405
611,563
325,370
820,322
587,984
0
0
0
0
10,194,253
4,751,891
0
0
0
5,442,362
0
286,192
2,254,561
249,335
2,005,226
0
597,952
222,370
546,137
155,450
390,687
0
0
342,833
245,151
789,413
338,535
450,878
0
Page 171
4.04 Operations research
4.05 Serological-surveillance (Serosurveillance)
4.06 HIV drug-resistance surveillance
4.07 Drug supply systems
4.08 Information technology
4.09 Patient tracking
4.10 Upgrading and construction of infrastructure
4.11 Mandatory HIV testing (not VCT)
4.98 Program Management and Administration Strengthening not disaggregated by type
4.99 Program Management and Administration Strengthening not-elsewhere classified
5. Incentives for Human resources (sub-total)
5.01 Monetary incentives for human resources
5.02 Formative education to build-up an HIV workforce
5.03 Training
5.98 Incentives for Human Resources not specified by kind
5.99 Incentives for Human Resources not elsewhere classified
6. Social Protection and Social Services excluding Orphans and Vulnerable Children (sub-total)
6.01 Social protection through monetary benefits
6.02 Social protection through in-kind benefits
6.03 Social protection through provision of social services
6.04 HIV-specific income generation projects
6.98 Social protection services and social services not disaggregated by type
6.99 Social protection services and social services not elsewhere classified
7. Enabling Environment (sub-total)
7.01 Advocacy
7.02 Human rights programmes
7.03 AIDS-specific institutional development
7.04 AIDS-specific programmes focused on women
7.05 Programmes to reduce Gender Based Violence
7.98 Enabling Environment and Community Development not disaggregated by type
7.99 Enabling Environment and Community Development not elsewhere classified
8. Research (sub-total)
8.01 Biomedical research
8.02 Clinical research
8.03 Epidemiological research
8.04 Social science research
8.05 Vaccine-related research
8.98 Research not disaggregated by type
8.99 Research not elsewhere classified
731
204,787
0
2,215,619
256,999
161,448
35,636
0
48,889
4,871,764
3,132,355
0
0
0
0
0
134,091
30,278
556
46,464
15,022
41,771
0
6,886,595
475,837
0
1,964,301
92,805
0
0
4,353,651
925,649
0
0
0
77,833
0
389,544
458,272
731
0
0
0
172,972
731
91,947
81,025
31,815
31,815
0
0
0
0
0
0
0
59,820
0
59,820
2,155,799
2,155,799
222,664
87,171
135,493
34,335
26,135
161,448
98,933
62,515
0
0
35,636
0
0
35,636
0
0
0
0
0
48,889
0
48,889
0
489,571
289,987
199,584
4,382,193
1,794,822
868,703
322,527
546,176
2,263,652
9,394
0
0
0
0
8,200
0
0
0
2,587,370
0
0
0
2,254,258
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
134,091
74,797
59,294
30,278
27,778
2,500
556
556
46,464
46,464
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15,022
0
0
41,771
0
285,975
188,820
5,089
183,731
0
0
0
0
25,581
3,359
2,401,317
287,017
77,257
0
0
0
4,190,855
0
209,760
0
22,222
1,938,720
1,936,316
34,661
58,144
58,144
2,404
0
0
45,361
0
0
0
4,308,290
329,600
789,783
374,602
3,978,690
0
0
0
415,181
0
0
0
0
0
0
0
0
31,833
0
9,444
94,589
60,145
34,444
0
0
0
46,000
46,000
0
0
9,444
0
0
0
0
31,833
0
0
0
66,277
0
0
0
69,589
0
0
0
45,361
0
0
0
135,866
0
0
6,592,172
0
34,661
0
0
0
8,448
0
0
0
41,771
294,423
0
0
0
15,022
0
0
0
380,100
160,000
220,100
0
363,683
214,602
149,081
0
Page 172
Country:
Reporting cycle:
INDONESIA
0
0
Data Measurement Tool
0
Amounts reported in:
Please indicate month and year (M/YYYY)
Month
From:
To:
Name of Local Currency
Currency expressed in:
Average Exchange Rate for the year (local currency to USD)
0
0
Indonesian Rupiah
Units ( x 1)
0.000
Financing Sources
Year
0
0
Public Sources
2011
TOTAL
AIDS Spending Categories
0.00
International Sources
Private Sources (optional for UNGASS reporting)
Multilaterals
Public
Sub-Total
Central /
National
Dev. Banks
Reimbursable
(e.g. Loans)
Sub- National
Social Security
International SubTotal
All Other Public
UN
Agencies
Bilaterals
Dev. Bank NonReimburseable
(e.g. Grants)
Global Fund
All Other
Multilateral
All Other
International
For-profit
institutions /
Corporations
Private
Sub-Total
Household funds All Other Private
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1. Prevention (sub-total)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1.01 Communication for social and behavioural change
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1.99 Prevention activities not elsewhere classified
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2. Care and Treatment (sub-total)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2.01 Outpatient care
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2.99 Care and treatment services not-elsewhere classified
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3. Orphans and Vulnerable Children (sub-total)
0
0
0
0
0
3.01 OVC Education
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
0.00
1.02 Community mobilization
1.03 Voluntary counselling and testing (VCT)
1.04 Risk-reduction for vulnerable and accessible populations
1.05. Prevention - Youth in school
1.06 Prevention - Youth out-of-school
1.07 Prevention of HIV transmission aimed at people living with HIV
1.08 Prevention programmes for sex workers and their clients
1.09 Programmes for men who have sex with men
1.10 Harm-reduction programmes for injecting drug users
1.11 Prevention programmes in the workplace
1.12 Condom social marketing
1.13 Public and commercial sector male condom provision
1.14 Public and commercial sector female condom provision
1.15 Microbicides
1.16 Prevention, diagnosis and treatment of sexually transmitted infections (STI)
1.17 Prevention of mother-to-child transmission
1.18 Male Circumsicion
1.19 Blood safety
1.20 Safe medical injections
1.21 Universal precautions
1.22 Post-exposure prophylaxis
1.98 Prevention activities not disaggregated by intervention
2.01.01 Provider- initiated testing and counselling
2.01.02 Opportunistic infection (OI) outpatient prophylaxis and treatment
2.01.03 Antiretroviral therapy
2.01.04 Nutritional support associated to ARV therapy
2.01.05 Specific HIV-related laboratory monitoring
2.01.06 Dental programmes for PLHIV
2.01.07 Psychological treatment and support services
2.01.08 Outpatient palliative care
2.01.09 Home-based care
2.01.10 Traditional medicine and informal care and treatment services
2.01.98 Outpatient care services not disaggregated by intervention
2.01.99 Outpatient Care services not elsewhere classified
2.02 In-patient care
2.02.01 Inpatient treatment of opportunistic infections (OI)
2.02.02 Inpatient palliative care
2.02.98 Inpatient care services not disaggregated by intervention
2.02.99 In-patient services not elsewhere classified
2.03 Patient transport and emergency rescue
2.98 Care and treatment services not disaggregated by intervention
3.02 OVC Basic health care
3.03 OVC Family/home support
3.04 OVC Community support
3.05 OVC Social services and Administrative costs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 173
0
0
0
0
0
0
0
3.99 OVC services not-elsewhere classified
0
0
4. Program Management and Administration Strengthening (sub-total)
0
0
4.01 Planning, coordination and programme management
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4.99 Program Management and Administration Strengthening not-elsewhere classified
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5. Incentives for Human resources (sub-total)
0
0
5.01 Monetary incentives for human resources
0
0
0
0
0
0
0
0
0
0
0
5.99 Incentives for Human Resources not elsewhere classified
0
0
0
0
0
0
0
6. Social Protection and Social Services excluding Orphans and Vulnerable Children (sub-total)
0
0
6.01 Social protection through monetary benefits
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6.99 Social protection services and social services not elsewhere classified
0
0
0
0
0
0
0
0
7. Enabling Environment (sub-total)
0
0
7.01 Advocacy
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7.99 Enabling Environment and Community Development not elsewhere classified
0
0
0
0
0
0
0
0
0
8. Research (sub-total)
0
0
8.01 Biomedical research
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3.06 OVC Institutional Care
3.98 OVC services not disaggregated by intervention
4.02 Administration and transaction costs associated with managing and disbursing funds
4.03 Monitoring and evaluation
4.04 Operations research
4.05 Serological-surveillance (Serosurveillance)
4.06 HIV drug-resistance surveillance
4.07 Drug supply systems
4.08 Information technology
4.09 Patient tracking
4.10 Upgrading and construction of infrastructure
4.11 Mandatory HIV testing (not VCT)
4.98 Program Management and Administration Strengthening not disaggregated by type
5.02 Formative education to build-up an HIV workforce
5.03 Training
5.98 Incentives for Human Resources not specified by kind
6.02 Social protection through in-kind benefits
6.03 Social protection through provision of social services
6.04 HIV-specific income generation projects
6.98 Social protection services and social services not disaggregated by type
7.02 Human rights programmes
7.03 AIDS-specific institutional development
7.04 AIDS-specific programmes focused on women
7.05 Programmes to reduce Gender Based Violence
7.98 Enabling Environment and Community Development not disaggregated by type
8.02 Clinical research
8.03 Epidemiological research
8.04 Social science research
8.05 Vaccine-related research
8.98 Research not disaggregated by type
8.99 Research not elsewhere classified
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 174
Annex C. List of Documents consulted
"Annual
Survey among
HarmAND
Reduction
Program Participants in 7 provinces." NAC,
V. TREATMENT,
CARE
SUPPORT
HCPI AusAID, 2011.
"Estimation of at-risk Adult Population." MoH, 2009.
HCPI, Ministry of Justice and Human Rights. "Program Monitoring ." October 2009.
"IBBS." MoH, 2011.
"IDHS." Central Bureau of Statistics, National Family Planning Coordinating Board,
MoH, 2007.
"Mathematic Model of HIV Epidemic in Indonesia." MoH, 2008-2014.
"Monitoring the inclusion of Violence against Women at the national level of the
AIDS response and the Impelementation of the UNAIDS agenda for women and
girls." Indonesia AIDS Coalition; IPPI; ARI, 2011.
"Program Monitoring." NAC, 2011.
"Program Monitoring in Universal Access Report." MoH, 2011.
"Rapid Study on HIV comprehensive knowledge in 5 cities in 5 provinces." CDC,
MoH, 2011.
"Regional Report Tuberculosis in the Southeast Asia Region Country Indonesia."
WHO, 2011.
"Report on Age Group Disaggregation of Survey and Research Data." MoH, NAC,
UNICEF, 2006-2007.
"Social Protection Assessment Based National Dialog in Indonesia." ILO, 2011.
"The Response to HIV and AIDS In Indonesia 2006 - 2011, Report on 5 Years
Implementation of Presidential Regulation No. 75/2006 on the National AIDS
Commission." NAC, 2011.
"The socio-economic impact of HIV at the individual and household levels in
Indonesia a seven province study." JOTHI; NAC; Bureau, Statistical Central; UNDP;
UNDAIS; ILO, 2009.
"Year end Program Report." Spiritia, 2011.
"Year end Report on Situation of HIV and AIDS in Indonesia." MoH, 2005 and 2011.
"Yearly Report CATAHU." National Commission on Elimination of Violence against
Women, 2011.
List of Documents consulted in Chapter 4, Best Practices:
"Data reported to HCPI." Ministry of Law and Human Rights, October 2009.
Dolan K, Rutter S, Wodak AD. "Prison-based syringe exchange programmes: a
review of international research and development." Addiction, 2003, 153-8.
H. Stőver, C. Weilandt et al. "Final report on prevention, treatment, and harm
reduction services in prisons, on reintegration services on release from prison and
methods to monitor/analyze drug use among prisoners." Directorate General for
Health and Consumers, European Commission, April 2008.
Page
175
"HIV and AIDS in places of detention. A toolkit for policymakers, program
managers, prison officers and health care providers in prison settings." UNODC,
New York, 2008.
"HIV and Syphilis Prevalence and Risk Behaviour Study among Prisoners in Prisons
and Detention Centres in Indonesia." Ministry of Law and Human Rights, 2010.
"HIV Transmission and Prevention in Prisons." HIV InSIte Knowledge Base,
University of California San Francisco, April 2006.
HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings – A Framework for
an Effective National Response. WHO, Joint United Nations Program on HIV/AIDS,
New York, 2006.
Hughes RA, Huby M. "Life in prison: perspectives of drug injectors: Deviant
Behaviour." 2000, 451-79.
Nelles J, Fuhrer A, Hirsbrunner H, Harding T. Provision of syringes: the cutting edge of
harm reduction in prison, BMJ, 1998, 270-3.
"Report on Research on the Narcotic Problem in Prisons." 2004.
Shewan D, Gemmell M, Davies JB. Behavioral Change Amongst Drug Injectors in
Scottish Prisons. Soc Sci Med, 1994, 1585-86.
"Status Paper on Prisons, Drugs and Harm Reduction." WHO Europe, 2005.
Page
176
Annex D. Member of Extended Monitoring and Evaluation Working Group
V. TREATMENT, CARE AND SUPPORT
Contacts
Name of Institution
Contacts
Name of Institution
Naning
Nugrahaeni
Ministry of Health
Lely Wahyuiar
UNAIDS
Enang Rochjana
Ministry of Social Affairs
Sri Pandam
WHO
dr. Sudi Astono
Ministry of Man Power and
Transmigration
Daniel Marguari
Spiritia (NGO in
Indonesia working with
PLHIV)
Erwin Anjasmara
Ministry of Man Power and
Transmigration
Mujtahid
Nahdatul Ulama (Faithbased Organization)
Harto
Ministry of Law and
Human Rights
Ari Wibowo
Nahdatul Ulama (Faithbased Organization)
Subi Sudarto
Ministry of Education
Husein Habsyi
Yayasan Pelita Ilmu
Ghufron Solihin
Indonesian Armed Forces
Cahyo Heri
National Family
Planning Association
Suminto
National Population and
Family Planning Board
Sumedi Ryan
Care for AIDS Forum –
Jakarta province branch
dr. Lilis Wijaya
Indonesia Red Cross
Ratna
HIV Cooperation
Program for Indonesia
(AusAID)
Robby Nur Aditya
Indonesia Red Cross
(Directorate of Blood
Transfusion)
Suzanne Blog
HIV Cooperation
Program for Indonesia
(AusAID)
Nurcholis Madjid
Family Health International
(SUM2)
Kemal Siregar
NAC
Heru Suparno
University of Indonesia
Roberta Taher
NAC
Sabarinah
Prasetyo
University of Indonesia
Yanti Susanti
NAC
Page
177
Annex E. Member of the NAC Executing Team
Coordinating Minister for People’s
National Population and Family
Welfare
Planning Board
Ministry of Health
Ministry of Foreign Affairs
Ministry of Home Affairs
Ministry of Religion Affairs
Ministry of Law and Human Rights
Ministry of Youth and Sports
Ministry of Social Affairs
National Development Planning Board
Ministry of Culture and Tourism
Ministry of Education
Ministry of Man Power and
Ministry of Information and
Transmigration
Communication
Ministry of Women’s Empowerment and
The National Development Planning
Child Protection
Agency
Ministry of Transportation
Ministry of Technology and Research
Secretariat of the Ministry of the
Indonesian National AIDS Commission
Republic of Indonesia
Secretariat
Ministry of Finance
Ministry of Public Works
Ministry of Defense
Armed Forces
Indonesian National Police
National Narcotics Agency
Agency for the Assessment and
Indonesian Chamber of Commerce and
Application of Technology
Industry
Indonesian Doctors Association
Indonesia Business Coalition on AIDS
Indonesian Public Health Association
Indonesia Red Cross
Page
178
IPPI: Indonesia Association of Positive
GWL-Ina: Indonesia Association of Gay,
HIV Women
Transgender and MSM
PKNI: Indonesia Association of Drug
OPSI: Indonesia Association of Sex
User Victims
Workers
JOTHI: Indonesian PLHIV Network
Spiritia
V. TREATMENT, CARE AND SUPPORT
Page
179
Page
180
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