ANALISIS
HIV/AIDS Situation
in Indonesia
(1994)
Imran Lubis
Health Research and Development Board Communicable Diseases Research Centre,
Department of Health of RI, Jakarta
INTRODUCTION
The Republic of Indonesia, situated between the Asian and
Australian continents, is an archipelago consisting of 13.000
islands., The unevenly distributed population lives in about
6,000 islands, particularly in five big islands namely : Sumatra,
Java, Kalimantan, Sulawesi and Irian Jaya. The total population
in 1993 is about 187 million, with more than 60% living in Java
islands which is only 6% of the total land area. The proportion
of rural and urban population is 35/65, literacy rate is 84.1%,
birth rate is 27.9, death rate 8.9 per 1,000 population, and per
capita income is US $ 650. As the fourth biggest nation in the
world, Indonesia consists of about 300 ethnic groups with their
own languages, but nationally the Indonesian language (which
is basically similar to Malayan language) is used. Adminis-
tratively, the republic consists of 27 provinces, covering 302
Regencies/Districts and about 6,000 subdistricts (the lowest
official/governmental level of administration),
The first AIDS case reported in Indonesia was a Dutch
tourist from Bali in April 5, 1987. ADB (Asian Development
Bank) predicted that the number of HIV/AIDS in Indonesia in
the year of 2000 would be 5.000 AIDS and 50.000 HIV(÷). The
direct and indirect cost of those AIDS cases would be as high
as US $ 81.000.000.
HWO predicted that by the year 2000, 30% of the total
HIV/AIDS cases in the world (30-40 millions) will be from
ASEAN countries, including Indonesia.
RULESAND REGULATIONS REGARDING TO HIV/AIDS
After AIDS was first reported in 1987, the Ministry of
Health took an immediate response by legislating a Decree No.
339/IV/1988 about the National AIDS Control Committee to
control further spread. The objectives of this Committee during
the First Term Plan (FTP) were to establish infrastructural
facilities such as laboratories, training of workers in labora-
tory aspects and case management of AIDS. MTP (Mid Term
Plan in 1991-1996) objectives are : consolidation, extension
and expansion of AIDS control activities, screening of blood
donors, development of surveillance system, improvement of
laboratory facilities and strengthening of STD control programs.
From 1988 to 1993, many government officials still did not
care much about the impending epidemic of HIV/AIDS in
Indonesia. Sometimes argument arise in the ground that Indo-
nesia is unlike other countries. The Indonesian socioculture
and religious disciplines would be able to prevent the spread
of the fatal disease. Other communicable diseases which is still
prominent especially among children and pregnant women is
still considered in higher priority in health program rather than
HIV/AIDS. HP//AIDS prevention campaign was not allowed
through mass media, street billboard, many leaflet designed
for limited target group were considered pornographic, condom
promotion is very limited.
However, realizing that HP//AIDS is a disease of many
factors, exponentially increased overtime, and predicted to have
an impact on economic and nation development programs, in
1994 there was a strong political agreement on control of HIV/
AIDS. Presidential Decree No. 36, 1994 on the Commission on
AIDS Control were declared which would involve many ini-
nistries and would work to control HIV/AIDS through multi-
Presented at the International Course on AIDS Control in Asia, Japanese
Foundation for AIDS Prevention, Tokyo, 12 February-25 March 1995.
Cermin Dunia Kedokteran No. 117, 1997 17
sectoral approach under the Ministry of Coordination on People
Prosperity.
The basic principles of this decree are as follows :
a) AIDS Control Program should be based on the existent
laws and regulations and should follow the principles of AIDS
Control Program by the United Nations.
b) To increase AIDS Awareness in the community and to
increase prevention and control of AIDS activities through
multi sectoral, coordination, integrated and comprehensive
approach.
Person with HIV or AIDS should be reported to the govern-
ment based on The Ministry of Health Instruction No. 72/1988
on AIDS Case Compulsory Report, which stated:
a) All health personnel who know and/or find someone with
AIDS must report to the nearest health facilities as soon as
possible with respect to individual confidentiality.
b) Health facilities which found an AIDS case must report with
confidentiality and according to the assigned procedures to the
Director General of CDC&EH, Ministry of Health.
Another regulation which is commonly broken, even by
medical professionals, and newspaper journalists, is the concern
on the privacy of a person with HIV and AIDS is Law no. 10
1966 on Medical Confidentiality. This law clarify that medical
confidentiality mean that anything learned by health personnel
while performing their professional job should be kept confi-
dential. Health worker, medical students, student conducting
medical examination or treatment and other persons appointed
by the Ministry of Health are subject to this regulation.
Several times, newspapers exposed the initial name, iden-
tification of sex, place and name of village, etc. of a person
with HIV/AIDS that resulted on stigmatization and isolation.
HIV SEROSURVEY DATA
Serosurvey was started in 1987, on migrant workers before
they left for Arab Countries. Since then surveillance of various
groups in Indonesia has been conducted in provinces with high
incidence of HIV/AIDS (Table 1). The total amount of
specimen collected for serosurvey until June 1994 were
1.916.158, 228 out of them were HIV positives.
The highest positive rate was among referral cases - 1%
(123/1 .333) followed by high risk groups such as commercial
sex worker (CSW)-0.04% (47/104.880) and the lowest are from
low risk groups such as blood donors - 0.0004% (8/1.808.870).
Thai sailors working near West Irian has the prevalence of 4%
(48/1.075).
HIV/AIDS CASES IN INDONESIA
The first AIDS case reported in Indonesia was a Dutch
tourist from Bali in April 5, 1987. Until December 1994 the
number of HIV/AIDS cases reported to the Department of Health
has increased to 275; 67 of them were AIDS cases (Figure 1).
The number of HIV/AIDS cases in Indonesia has reached
the second phase of epidemic, the early exponential increase,
which started in 1993. By using AIDS model, in the medium
transmission scenario, the cumulative number of HIV/AIDS
Table 1. Prevalence of HIV in Various Groups in IndonesIa 1987 1994
(June)
Reported
by
CDC
HIV Positive
Year
Target Population No. Specimen
Elisa W.
Blot
Pre
valence
HIV +
1987
Low risk group
Migrant Worker
46.682
41
1
0.0020
1987-1991 Blood
Donor
177.072 16
0
0
1992 Blood
Donor
359.449
281
3
0.0008
1993 Blood
Donor
555.712
444
2
0.0004
1994 (Mar)
Blood Donor
669.951
397
2 0.0003
1.808.870
1.179
8
1988
High risk
Cross Sectional
7.912
1
1
0 013
1989 Cross
Sectional 14.045
2
1
0.007
Sentinel
4.114
0
0
0
1990 Cross
Sectional
3.296
0
0 0
Sentinel
2.105
0
0
0
1991 Cross
Sectional 22.377
5
3
0.013
1992 Cross
Sectional 22.134
140
14
0.063
1993 Cross
Sectional 20.741
200
20
0.096
1994 (Jun)
Sentinel
8.056
8
8
0.099
104.880
356
47
1987-1993
Referral
1.333 125 123
1993
Thai Sailor
1.075 63 48 4.5
Total
1.916.158
1.723
228
Source: Dir.Jen CDC & EH
Figure 1. Number of HIV/AIDS cases in Indonesia each year, 1997 - 1994
(Dec)
Source : CDC&EH
infections in Indonesia in 1995 is estimated at 175,000 and a
prevalence of 0,085%. Without adequate interventions, the
cumulative number in 2000 will reach 600,000 (prevalence
Cermin Dunia Kedokteran No. 117, 1997
18
0,29%) and in 2005 will become 1,400,000 (prevalence 0,62%).
Distribution of HIV/AIDS cases according to sex in Indo-
nesia were shown in Figure 2. In 1987-1992 most HIV/AIDS
cases were male. But this picture has been changing since 1993
where female AIDS cases were found 7% among the total AIDS
cases and 28% female HIV cases were found among the total
HIV cases.
Figure 2. Sex distribution of HIV andAIDS cases in Indonesia, 1987.1994
(Dec)
Source: CDC & EH
Nationality of HIV/AIDS cases in Indonesia were shown in
Figure 3. In the beginning, HIV/AIDS cases were mostly among
foreigners visiting Indonesia as tourists or expatriates. The
cumulative number in 1994 shows that the percentage of AIDS
cases with Indonesian nationality were higher than in HIV cases
(70% compared to 57%). But the total number of HIV cases
with Indonesian nationality were still much higher. There has
been a transition of HIV/AIDS cases from foreigner to Indo-
nesian as more cases of Indonesian nationality reported each
year.
The mode of transmission are (Figure 4): for HIV cases :
69% heterosexual, 13% homosexual/bisexual; and for AIDS
cases : 18% heterosexual, 62% homosexual/bisexual, 5%
others and 15% unknown.
Heterosexual was the predominant transmission mode in
Indonesia for HIV (recent infection) and homosexual/bisexual
was the predominant transmission mode for AIDS (late infec-
tion).
The AIDS cases are mostly in productive age group of 30-
39 years old and for HIV are in 20-29 years old (Figure 5). The
youngest age group for HIV are 15-19 years old and the oldest
are more than 60 years old. Apparently there is no children
detected as HIV positive.
Figure 3. Nationality of HIV and AIDS cases in Indonesia, 1987.1994 (Dec)
Source: CDC & EH
Figure 4. HIV/AIDS risk factors distribution in Indonesia 1987.1994 (Dec)
First AIDS cases were reported from Bali Province in
1987, since then, spread to 15 provinces in the island of Java,
Sumatera, Kalimantan, Irian Jaya, Bali, NTB and Maluku
(Figure 6). The increase of HIV/AIDS cases is mainly in Java.
The number of AIDS cases and death by provinces is shown
in Figure 7. DKI Jakarta (the capital city of Indonesia), Bali
Cermin Dunia Kedokteran No. 117, 1997 19
Figure 5. Age group distribution of HIV/AIDS cases in Indonesia, 1987/
1994
(Dec)
Source: CDC&EH
Figure 6. Number of HIV/AIDS cases by provinces in Indonesia, 1987/
1994
(Dec)
Provinces
Source: CDC&EH
(the number one tourist resort) and Jabar and Surabaya (the
second largest city) have the highest number of AIDS and deaths.
OPPORTUNISTIC INFECTIONS
Opportunistic infections detected among hospitalized AIDS
cases were tuberculosis, pneumocystis carinii pneumonia,
Figure 7. Number of AIDS cases and death and prov. in Indonesia, 1987/
1994
(Dec)
Provinces
Source: CDC&EH
candidiasis, cytomegalovirus retinitis, cryptococcus meningitis,
cerebral toxoplasmosis, herpes zoster and bacterial sepsis.
Wasting syndrome, dementia, and neurological symptoms are
frequently encountered.
TUBERCULOSIS
According to World Bank Study in Indonesia, tuberculosis
infection and tuberculosis disease continue to be a widespread
problems. More than 50% of Indonesians are infected with TB.
The Annual Risk of Infection (ARI) of tuberculosis is at
2.5%. Knowing that there will be an increasing number of
adults who will become HIV(+), the situation might increase
the risk for premature death due to TB and for transmitting TB
to others.
The countrywide prevalence of smear positive pulmonary
TB cases were as follows :
No. of Smear Positive Pulmonary
TB Cases
Year
21,549
34,733
60,933
52,331
73,655
23,673
Sept.
1989
1990
1991
1992
1993
1994
Cermin Dunia Kedokteran No. 117, 1997
20
REFERENCES
1. Kosen S, Linnan M. Projection of HIV/AIDS in Indonesia (1990-2005).
Presented at the 7th Congress of the World Federation of Public Health
Association, Bali, December 4-8. 1994.
2. Lubis I. AIDS and Employment in Indonesia. ILO Study Report 1994.
3. HIV-Related Tuberculosis in Urban Indonesia, Estimates from World Bank,
1993.
4. Abednego HM, Gunawan S. Ancaman AIDS dewasa mid Indonesia. Semi-
nar Asian Business Responds to AIDS, Jakarta, 21 April 1994.
Tabel 2. Persentase kader ISPA yang mengatakan apakah anak men-
derita ISPA boleh diberi obat batuk (n = 20)
Ringan Berat
Frekuensi
pemberian
I II I II
Ya, selalu
Kadang-kadang
Tidak boleh
80
15
5
100
0
0
30
10
60
100
0
0
Jumlah 100
100
100
100
Tabel 2. Persentase kader ISPA yang mengatakan apakah anak men-
derita ISPA boleh diberi obat batuk (n = 20)
Ringan Berat
Frekuensi
pemberian
I II I II
Ya, selalu
Kadang-kadang
Tidak boleh
80
15
5
100
0
0
30
10
60
100
0
0
Jumlah 100
100
100
100
Keterangan : I : sebelum pelatihan
II
: sesudah
pelatihan
Mohon maaf atas kekurangan-kekurangan tersebut.
KOREKSI DAN TAMBAHAN
Dalam artikel Keefektifan Paduan Obat Ganda Bifasik Anti Tuberkulosis Di-
ial dan Atas Dasar Kegiatan Pemulihan
ar kegiatan antimikrobial paduan obat oleh
Anggraeni Inggrid Handojo, yang dimuat dalam Cermin
edokteran no. 1
7 terdapat beberapa kekurangan/kekeliruan, yang kami
sebagai berikut:
1. hal.
is 6 dar awah:
ang digunakan asal kasus TB yang terkait tidak pernah memperoleh obat
TB sebe
ya. Per
gan kurun waktu..... dst.
2. hal. 18 kolom 1 alinea 4:
ri segi kegiatan antim
khemoterapi anti TB bertujuan untuk mem-
peroleh dahak negatif (sputum negativity) dan yang lebih penting, memperoleh
ersi da
putum conversion). Kenegatifan dahak adalah ... dst.
3. hal. 22:
Tabel 9. Kegiatan
uhan
4. hal. 23 kolom
:
n RMP mempunyai NKB sebesar 1
5. hal. 23 kolom 1, bab Diskusi, baris ke 19:
mempunyai NKB sebesar 11/2
6. hal. 23 kolom 2, antara baris ke 7 dan ke 8:
Golongan AB terdiri dari 3 subgolongan, yaitu:
7. hal. 24 kolom 1, alinea 3, baris ke 12:
bahwa pada penggunaan paduan obat HR/5-8H
2
R
2
oleh kasus TB yang belum
pernah memperoleh obat anti TB, pemeriksaan . . . dst.
8. hal. 24 kolom 1, alinea 4, baRIs ke 6:
.....dan golongan keseluruhan kasus yang memperoleh paduan obat HS/11H
2
S
2
9. hal. 24 kolom 1, alinea 5, baRIs ke 3:
bulan (HS/11H
2
S
2
) (Tabel 9). . . dst.
RALAT
Dalam artikel Peranan Kader dalam Menunjang Program ISPA di Jawa Barat
oleh Enny Muchlastriningsih yang dimuat dalam Cermin Dunia Kedokteran no. 115,
1997 halaman 5255, terdapat tabel yang (mungkin) kurang jelas.
Untuk itu, kami terbitkan kembali tabel-tabel tersebut dalam bentuk sebagai
nilai Atas Dasar Kegiatan Anti Mikrob
Imunitas Protektif. 2. penilaian atas das
RA Handojo, Sandi Agung,
Dunia K
perbaiki
15, 199
17 bar
obat y
i b
anti
lumn
panjan
Da
ikrobial.
konv
hak (s
antimikrobial. Golongan keselur
1, bab Diskusi, baris ke 14
ar 2 karena INH maupu
punyai NKB sebes
dan. . . dst.
berikut:
Cermin Dunia Kedokteran No. 117, 1997 21