Jakarta Globe, Basten Gokkon on 12:03 am Dec 01, 2014
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| Public health activists are attempting to persuade inmates living with HIV and AIDS to accept antiretroviral treatment through psychological counseling despite previously refusing. Meanwhile, Governor Basuki made bold pronouncements about HIV-positive inmates’ coverage under the national health insurance scheme, . administered by BPJS, that strain credulity. (AFP Photo/Manpreet Romana) |
Jakarta.
Inmates at Salemba Penitentiary learned on Saturday morning that they may soon
benefit from a service sorely needed by so many throughout Indonesia, yet
actually available to vanishingly few: psychological counseling for people
living with HIV and AIDS.
Inmates
learned of the news during their observance of World AIDS Day, which was
organized in cooperation with the Jakarta chapter of the National AIDS
Commission (KPA) and the Justice and Human Rights Ministry’s Jakarta Office.
The Jakarta
Globe visited the counseling center and saw three group sessions led by six
psychologists from the Indonesian Psychological Association’s Jakarta branch
(Himpsi Jaya).
“We’re here
because the National AIDS Commission in Jakarta asked us about two months ago
to help the inmates who are living with HIV and AIDS,” psychologist Seri Liani
Ketaren said. “This is our first time ever helping inmates who are living with
HIV and AIDS.”
Voluntary
refusal: a psychopathology?
Rohanna
Manggala, who heads the National AIDS Commission in Jakarta, said her office
sought to involve psychologists in their prison program after finding cases in
which inmates who tested positive for the virus, which attacks the immune
system, declined to partake in voluntary antiretroviral (ARV) therapy because
of what her organization sees as a psychological issue. “It’s got to be really
difficult for them.
They must
be very depressed for having been imprisoned and then tested positive for HIV,”
Rohanna said. “That’s why they decline to join the therapy: Because they tend
to think that there’s no hope any more, anyway.”
Rohanna
said that such thinking would only further harm inmates’ health and could
eventually lead to premature death.
Seri said
she spoke with 14 inmates at the prison in Salemba who had tested positive for
HIV but refused ARV therapy, because, as she tells it, “they feel ashamed to
disclose their HIV-positive status.”
“Some of
them also said that they had ‘poor knowledge about the treatment,’ ” she added,
in what may be presumed was a clinically stilted ventriloquation of the
prisoners’ actual words. Warden Abdul Karim said 105 of Salemba prison’s 1,812
total inmates have tested HIV-positive.
The
prison’s capacity is just 587. “When they are admitted to the prison, they will
be screened for HIV, they can’t say no to that,” Abdul said. “However, inmates
who tested positive for HIV have the right to decline treatment.”
According
to the UN World Health Organization’s guidelines on HIV infection and AIDS in
prisons: “Compulsory testing of prisoners for HIV is unethical and ineffective,
and should be prohibited.”
The Jakarta
Globe was unable to speak with inmates who declined to undergo ARV treatment,
but we spoke with Indra Agustiawan, a 24-year-old inmate living with HIV who
has been on ARV treatment since April.
Indra told
the Jakarta Globe that the fear of stigma by other inmates, particularly cell
mates, was the biggest reason why some of his friends declined to partake in
ARV therapy. “[Those who decline to be treated] are afraid of people insulting
them and not accepting them,” Indra told the Jakarta Globe.
“But that’s
not the truth. That’s not what happens here.” “Ever since I came out [as
seropositive], my friends, including those who are negative, have fully
supported me,” he said.
“They even
sometimes remind to take my medicine when it’s time. We’re only people living
with HIV and AIDS. We don’t spread our disease,” Indra said.
Changing
minds
The group
counseling session ranged from education about ARV treatment to a sharing
session by inmates on ARV treatment who encouraged their peers to join them.
“We’ve
trained the six psychologists from Himpsi about ARV treatment and other
things,” Rohanna said. “Himpsi tried to encourage the inmates to think
positively about ARV treatment,” Seri said. “We tell them that having HIV is
not a death sentence, and what you need is treatment to stay healthy.”
The
counseling session, Seri said, also informed inmates about possible side
effects from taking ARV medication, which include nausea, headache and
itchiness, lasting up to three months. “But, we tell them that once their body
tunes in with the medicines, the side effects will be gone,” Seri said.
Psychologists
also told inmates that ARV treatment’s benefits include the chance of having a
family without needing to worry about infecting their partner or children, as
long as they adhere to treatment. Indra said he decided to adhere to ARV
therapy because he “wanted to be healthy” so that he “could help his family”
once he’s out of prison sometime next year.
“We then
tell them, ‘You have a disease, the medicines are free and you have doctors to
help you. Why not do treatment?’ ” Seri said. Saturday’s counseling session
reportedly worked out well, especially for the inmates, according to Seri.
“[The 14
inmates] agreed to join ARV treatment,” she said. The central government, she
added, should involve psychologists in handling HIV and AIDS-related issues
within prisons across Indonesia.
Needle-sharing
by intravenous drug users, a more common practice among inmates before the
adoption of harm-reduction as a national strategy in 2007, was previously
accounted for the majority of new AIDS cases. (Sexual transmission has since
surpassed intravenous drug use as the leading means of transmission in
Indonesia.) Still, the effects on the prison population remain a grave concern
for many: An estimated 25 percent of Jakarta’s prisoners are HIV-positive, but
do not know their status, according to a presentation by former United Nations
Joint Programme for HIV and AIDS country coordinator for Indonesia, Nancy Fee.
“As of now,
the ARV therapy has been conducted by doctors provided by the Justice and Human
Rights Ministry,” Seri said. “But I think psychologists should also be involved
in their mental health.”
BPJS
promised, but what will it deliver?
Jakarta
Governor Basuki “Ahok” Tjahaja Purnama announced during Saturday’s 2014 World
AIDS Day ceremony that the Health Care and Social Security Agency (BPJS), would
administer health care for all inmates, including those living with HIV and
AIDS, next year.
Basuki’s
announcement appears to contradict BPJS and Ministry of Health officials’
long-repeated policy that the national health insurance scheme will not cover
HIV or other infections contracted through intravenous drug use, citing moral
hazard.
According
to the current division of responsibility between BPJS and the Health Ministry,
ARV treatment is the sole responsibility of the ministry’s existing infectious
disease programs.
“Starting
Jan. 1, we will issue a decree that BPJS will cover all treatment costs [for
prisoners living with HIV and AIDS],” Basuki said. “If there isn’t any
component in the BPJS program for that, then the Jakarta office will cover the
costs.”
Since
Governor Basuki holds no official authority to make such a decree on BPJS’s
behalf and there is not, in fact, a BPJS component to cover all treatment costs
for prisoners, it is fair to assume Basuki’s administration will be left
holding the bag.
“All
inmates here in the prisons are citizens of Jakarta and we’re preparing a
letter to BPJS allowing the inmates to be covered by their program just by
submitting a letter from the head of the prison,” Basuki said.
The
capital’s six detention centers have a combined official capacity of 5,810
inmates. According to January-November 2014 data from Mardjoeki, who heads the
Justice and Human Rights Ministry’s Jakarta office, these six detention centers
currently hold 15,536 inmates, 744 of whom have tested positive for HIV.
During the
same period, 115 Jakartans died from
AIDS-related illnesses. “Death from [AIDS-related illness] still takes the
second place after tuberculosis,” Mardjoeki added.
It should
be noted that Mardjoeki has no background in public health and his ministry is
not responsible for HIV and AIDS surveillance, which is the province of the
Health Ministry’s research arm.
Mardjoeki
added that HIV transmission in Jakarta’s prisons has narrowed to nearly zero
because the inmates condemn any homosexual activities and have ceased using
drugs intravenously.
The Jakarta
Globe was unable to independently verify any of Mardjoeki’s claims at press
time; however, background discussions with health officials have suggested
post-2007 acceptance of harm reduction measures have had an impact on the rate
of increase in new AIDS cases in prisons.
“Prison
conditions are often ideal breeding grounds for onward transmission of HIV
infection. Tensions abound, including sexual tensions. Release from these
tensions, and from the boredom of prison life, is often found in the
consumption of drugs or in sex,” according to a UNAIDS report.
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