Wamena, Indonesia (AFP) Nov 30, 2008
Gaunt and covered in sores, 20-year-old Christina Mabele is a rarity in the ballooning AIDS crisis that has hit the remote Papua region in eastern Indonesia: she knows why she is sick.
Sitting in a hospice in this highlands town, which much of the time is only accessible to the outside world by plane, Mabele might get treatment in time.
But her friend Juliana Halo did not.
"She was a friend of mine, we sat together in school, but yesterday she died. She was the same age as me," Mabele said.
Papua, a vast territory of tropical jungles and jagged mountain peaks on the western edge of New Guinea island, has seen an explosion in HIV/AIDS cases among a population that is the poorest in Indonesia.
Its infection rate, estimated at 2.4 out of every 100 people, is one of the highest outside Africa. And it is set to rise.
Foreign journalists are usually barred from visiting Papua, which has been under Indonesian control since the 1960s and is home to a low-level independence insurgency.
AFP was granted access under escort by an officer of Indonesia's state intelligence agency.
While HIV/AIDS rates in the rest of Indonesia are low, a combination of poverty, distance, lack of education and plenty of sex is driving infections in Papua, according to the government AIDS commission.
The disease is hitting hardest in remote regions like the Baliem Valley, which was untouched by the outside world until after World War II and where many men go naked except for long, pointed gourds over their penises.
Amos Alua, a worker with the Yukemdi independent organisation that tries to educate highlanders about the disease, indicates the scale of the problem by sweeping his hand toward the jungled peaks that rise around the valley.
In those vast mountains, accessible only by light planes or days of walking on tracks that rise precipitously from the valley floor, people are dying but do not know why, Alua said.
"Behind the mountains, they still don't know about HIV/AIDS. They're infected but they don't know it," he said.
What makes Papua's HIV/AIDS problem so bad, in short, is sex, according to health experts. Injecting drug use, which is a major source of transmission elsewhere, is not a serious factor here.
Despite widespread poverty, the sex industry is booming in towns across Papua as money rolls in from natural resources under a new system of "special autonomy" with Indonesia, said Jack Morin, the head of population research at Papua's Cendrawasih University.
A sizeable minority of Papuan men are travelling vast distances -- often by foot -- for work or to go to markets, having sex with prostitutes in towns, and then bringing infections back to their villages, Morin said.
This is then compounded by high-risk sex in the villages. Papuans know little of condoms and in many places tradition -- and in other places encroaching modernity -- mean a significant minority are having unprotected sex with multiple partners.
"A number of tribes believe that if semen is thrown away outside of the vagina it can wreck plants, their gardens won't be fertile, people can get sick, or it can be used for black magic," he said.
A recent conference of non-governmental organisations, government and international donors in the provincial capital Jayapura showed the world is waking up to the crisis, with tens of millions of dollars set to roll in for treatment and prevention.
Governor Barnabas Suebu has also thrown his support behind some questionable plans, such as a scheme to microchip some HIV/AIDS victims and, he told AFP, encouraging the infected to drink pandanus palm fruit juice.
Some local leaders are prickly about Papuans being stigmatised as immoral or primitive, said Helena Picarina, who heads the Papua HIV/AIDS programme of Family Health International non-governmental organisation.
"It's a very sensitive issue. If you talk about it, some of them, church people and politicians, will reject it and say it's not our behaviour'," she said.
Education also remains desperately inadequate. Baliem villagers are largely unaware of the virus or attribute its spread to flies, or sharing food or cigarette butts.
Parti, a 40-year-old prostitute from far-off Java island who has sex with men behind a tumbledown roadside shack selling soft drinks, said she knew condoms stopped HIV but often let men go ahead without them.
"If we take a look at their appearance, see if they're clean, we can tell if they're infected," she said, adding that she takes antibiotics as a precaution.
With thousands of Indonesian soldiers and a history of human rights abuses towards indigenous Papuans, mistrust of the government also poisons much of the HIV/AIDS fight.
Some prominent Papuan leaders have denounced HIV/AIDS as a "genocide" plot by the government, pointing to the growing number of migrants from other parts of Indonesia who already outnumber Papuans in major coastal cities.
They also point to prostitutes such as Parti, who come to Papua in their hundreds in search of higher wages, as deliberate weapons in this alleged conspiracy.
The belief is pervasive. During a visit to Wamena's hospital, a Papuan man lingered until AFP's intelligence minder was out of earshot before furtively saying: "This is happening on purpose".
Joram Yogobi, an indigenous Papuan who heads the Yukemdi NGO in Wamena, said such conspiracy theories get in the way of efforts to promote condoms and other preventative measures, by shifting the blame on to a resented government.
"What we say is: Whether genocide is real or not, we're already dying'," he said.
Indonesian AIDS commission head Nafsiah Mboi said the government hopes its efforts to tackle HIV/AIDS will dispel the Papuans' fears.
"Every single Papuan is valuable to this nation and that is why we are supporting them," she said.
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