The Asian Voice

Covid-19 is not the only pandemic that needs to end: Jakarta Post contributors

The writers say vulnerable communities and existing public health threats cannot be forgotten to achieve Indonesia's vision to be a pioneer in global health.

People queue to get a booster shot vaccine for the Covid-19 coronavirus in Bekasi, Indonesia on Feb 5, 2022. PHOTO: AFP

JAKARTA (THE JAKARTA POST/ASIA NEWS NETWORK) - In the past two years, there has not been a day going by without us thinking about our health and well-being.

Health has been the topic of conversation among families, friends, colleagues, as well as topic of headlines all over global and national media outlets. Indeed, two years into the Covid-19 pandemic, the world's attention is more than ever focused on healthcare.

The same can be said for the government of Indonesia, whose commitment to health can be seen from the strong pandemic response to the prioritisation of global health infrastructure in the Group of 20 (G-20) presidency. Despite facing massive hurdles since the first cases of Covid-19 in March 2020, Indonesia has now seen a largely successful pandemic response, with consistent declining rates of infections, hospitalisations, and deaths.

At the same time, President Joko "Jokowi" Widodo continues to express his aspiration and drive for Indonesia to be a vaccine production hub in the region. The success of the Covid-19 response and the vision of Indonesia leading in pandemic preparedness is highly commendable. But it still leaves much to be desired, especially as most of the attention revolves around the Covid-19 pandemic.

AIDS is not over, but it can be. With the government's dedicated attention and commitment to healthcare and pandemic preparedness, we must not forget the public health threats that still exist, like AIDS and Tuberculosis (TB).

With less than a decade to 2030, when both epidemics are targeted to end, we see that far too many preventable deaths still occur due to these diseases. In Indonesia alone, 24,000 people lost their lives in 2020 because of AIDS-related illnesses, despite AIDS being preventable with antiretroviral treatment.

This is a consequence of the low treatment coverage of only 26 per cent of people living with HIV on treatment in Indonesia, which is one of the lowest rates in the world, only higher than South Sudan (23 per cent), Madagascar (14 per cent), Pakistan (12 per cent) and Afghanistan (9 per cent), according to UNAIDS 2020 estimates.

Globally, HIV disproportionately affects populations who are often marginalised, criminalised and subjects of stigma and discrimination, namely men who have sex with men, transgender women, sex workers and people who use drugs. A similar situation is often experienced by many women living with HIV and children living with HIV.

Harmful gender and social norms as well as legal barriers greatly hamper the HIV response, as highly affected communities fear accessing services. Studies have shown that people living with HIV who perceive high levels of HIV-related stigma are 2.4 times more likely to delay enrolment in care until they are very ill.

Despite the challenges, we have the tools to end the epidemic in the Global AIDS Strategy 2021-2026. The Global AIDS Strategy gives the world the main priority areas and actions to end AIDS, namely ensuring equitable access to services for everyone, especially those at risk; breaking down social and legal barriers to HIV, such as the decriminalisation of key populations; and ensuring a fully-funded and sustainable HIV response.

The strategy also stresses the need to end inequalities that still drive the epidemic and distance us from universal health coverage. The principle of universal health coverage is guided by the notion that high quality, accessible and affordable healthcare should not be a privilege of the few, but of all.

Indonesia has proven its ability to uphold this principle in the Covid-19 response. Covid-19 vaccines, for example, have been equally distributed and administered to Indonesians across the country, without discrimination.

Moreover, even most people living with HIV, who have a higher risk of severe or fatal Covid-19 infection, have been able to access Covid-19 vaccines as other populations have, according to a survey conducted by the Jaringan Indonesia Positif.

Outside of Covid-19, however, universal health coverage is not yet a reality. Key populations at risk of HIV are being left behind in universal health coverage according to a recently published review by UNAIDS Asia Pacific which focused on six countries in the region-Cambodia, India, Indonesia, the Philippines, Thailand and Vietnam. Barriers to enrolment, such as lack of awareness of eligibility and unmet administrative requirements and decriminalisation, prevent some people living with HIV and key populations from benefiting from health insurance in Indonesia.

The national insurance scheme of Indonesia, similar to neighbouring countries, doesn't comprehensively cover HIV prevention services, leaving community-based organisations to play the significant role in filling in these gaps for people without financial protection.

Unlike Covid-19 vaccinations, preventing HIV is not made a priority. The absence of HIV prevention as national priority has led to rates of new HIV infections that are not declining at a rapid enough speed. In 2020, 28 thousand new HIV infections were estimated in Indonesia, 46 per cent of which occurred among young people between 15-24 years of age.

Inaction to the AIDS epidemic has come at a high price. Indonesia's bold actions and commitments against Covid-19 cannot stop there. In 2021, Indonesia as a UN member state adopted the Political Declaration to End AIDS, committing itself to meet the global targets and to tackle inequalities that drive the epidemic.

The global targets are indeed being adopted at the national level, rooted in the government's upcoming Multisectoral Strategic Action Plan on HIV. As the world commemorates World Health Day on April 7, we send an urgent reminder that Covid-19 is not the only pandemic that needs to end. For Indonesia's vision to be a pioneer in global health to be realised, vulnerable communities and existing public health threats cannot be forgotten.

So, when we think of health, let us not only think of Covid-19. Bring attention back to HIV and AIDS, and we can successfully end inequalities, end AIDS and end pandemics for a healthier tomorrow.

  • Krittayawan Boonto is UNAIDS country director Indonesia. Tjandra Yoga Aditama is post-graduate director at YARSI University and professor of pulmonology and respiratory medicine at University of Indonesia. Meirinda Sebayang is chair of Jaringan Indonesia Positif National Secretariat. The Jakarta Post is a member of The Straits Times media partner Asia News Network, an alliance of 23 news media organisations.

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