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Promoting UA to HIV prevention The Indonesian Experience

UNAIDS Sattelite on HIV Prevention IAS Mexico City, 4 August 2008 Nafsiah Mboi, Secretary National AIDS Commission, Indonesia. Promoting UA to HIV prevention The Indonesian Experience. Outline. I. The Indonesian Experience: - Some Challenges - Our Commitment

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Promoting UA to HIV prevention The Indonesian Experience

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  1. UNAIDS Sattelite on HIV Prevention IAS Mexico City, 4 August 2008 Nafsiah Mboi, Secretary National AIDS Commission, Indonesia Promoting UA to HIV preventionThe Indonesian Experience

  2. Outline I. The Indonesian Experience: - Some Challenges - Our Commitment II. Advocacy for Univ Access to HIV prev III . Some results: coverage, effectiveness, sustainability IV. Conclusion

  3. Some challenges • Indonesia: 237 million people, > 17,000 islands, 33 provinces, 548 districts, • Young pop.: 57 million age 15 – 24 years • Multiple epidemics: HIV & Inj drug use • Epid levels: Nat: low level (0,16%), 30 prov concentrated epid, 2 prov low level generalized epid (2,4%)

  4. 1.9 million Km2

  5. First step: est & mapping Different epidemic levels among regions Most provinces: Concentrated epidemic. Tanah Papua: Low level Generalized epidemic Prevalence of HIV (%) (Estimation of PLWHA per projected number of adult population) 5

  6. Our commitment To : Change the course of the epidemic throughout Indonesia – our aim: prevent HIV infection in 1 million Indonesian people by 2020  As a nation, reach int’l targets and standards as agreed in international agreements like – MDG, UNGASS, etc

  7. The Concept Most at Risk Key Populations PREVENTION Behaviour Change Interventions CARE SUPPORT AND TREATMENT PREVENTION VCT & Care, Support,Treatment POSITIVE PREVENTION Positive prevention HIV AIDS

  8. IIAdvocacy for Univ Access to HIV prevention

  9. Costed Nat Action Plan 2007 - 2010 “key targets” by 2010 : 80% of most at risk key populations, reached by comprehensive prevention programs Behaviour change in at least 60% of most at risk key populations all eligible PLWA receive ARV and humane care, support & treatment services Enabling environment:  civil society active participation  prevent & fight stigma & discrimination

  10. Mathematic Epidemiologic Model on Trends to Year 2020

  11. Economic & social “savings” Harm Reduction Target: IDUs reached 232,000 Pgm costs NSP Pgm US$ 9,500,000 MMT Pgm US$ 6,200,000 TOTAL US$ 15,700,000 Est. cost new HIV+ IDUs US$ 92,003,200 Est. financial savings US$ 76,303,200 People saved from infection 140,000

  12. Primary targets : key populations most at risk Proportions among new infections! Epidemiologic modeling 1999 - 2020 180,000 160,000 140,000 120,000 Partner of FSW-Client Female Sex Worker New infections 100,000 MSM IDUs 80,000 Client FSW 60,000 40,000 20,000 0 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019

  13. Significant proportion of the people engaged in high risk behaviors areyoung people (15 – 24 yrs) • 52% of IDUs • 45% of sex workers • 31% of men who have sex with men Source : BSS 2006

  14. IIISome achievements: coverage, effectiveness

  15. Behaviour Change Intervention for Key Populations (Dec 2007) Source: Routine Monitoring, NAC 08

  16. % Key pop access to HIV prev pgms, by age 100 80 47.3 < 25 43.2 60 41.0 44.7 40.1 39.6 38.9 >= 25 Percentage 36.8 35.8 40 All 20 0 Sex Workers MSM IDUs (IBBS MARPs, FHI and CDC MoH, 2007)

  17. Needle-Syringe Programs (NSP)

  18. Methadon Clinics

  19. % key pop reporting condom use most recent sex by age (IBBS MARPs, MOH & FHI, 2007)

  20. Indonesian Injecting Drug Users : % reporting use of sterile equipment at last use Male Female All Source : Indonesia. UNGASS country report 2007

  21. By March 2008, we had : 119 NSPs w basic health care for drug users, some w ARV (11 Hosp, 77 PHC, 24 NGO) 24 MMT in 9 hosp, 11 PHC, 4 prisons (+ bleach 13) 78 NGOs w specific harm reduction activities 274 PSG support groups for PLHIV in 31 prov and 86 cities/ distr. Many started by IDUs 15 prov Funding - GFATM, Ind Partnership Fund (DFID), AUSAID, USAID + Nat & Local Govt !

  22. IIISome achievements: sustainability

  23. NAC Secretariat Budget (all funding sources) 2005-2008 Nat. Budget I P F GFATM Gates/UNAIDS

  24. National Budget Allocation for HIV & AIDS in (US$) Source: Routine Monitoring, NAC 2008

  25. Provincial Budget Allocation for HIV & AIDS (Year 2004-2007, in 23 Provinces, in US$) Source: Routine Monitoring, NAC

  26. District Budget Allocation for HIV & AIDS (Year 2005-2007, in US$)

  27. Can we prevent the disaster in our beloved country RIcaused by the twin epidemics HIV & Injecting Drug Use? Yes, we Can!!

  28. See you in Bali Muchas Gracias Thank You Terima Kasih

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