TEMPO.CO, Jakarta - According to Prasada Rao, ignorance has been the biggest barrier in dealing with the decades-old HIV/AIDS epidemic. This is why he speaks openly about the disease, freely discussing such topics as sex and sex education, which most Asians see as taboo, so that the social stigma attached to its victims can be erased, a first step in the prevention and treatment of the disease.
Rao truly believes that an open discussion of the subject would be the best protection against the disease, yet the biggest challenge in addressing this global epidemic. "For Asians, sex is taboo. It's in your bedroom, not on the road. So there's always that challenge," he told Tempo.
Not surprisingly, when he was appointed director-general for the Indian government's National AIDS Control Organization, the prevalence rate of HIV/AIDS in India dropped from 42 to 3.5 percent. His strategy was straightforward: Get the people to talk about the disease openly, encourage them to conduct HIV tests and urge hospitals to provide HIV/AIDS testing units.
His success led Rao to be appointed as the UN AIDS Asia Pacific regional director in 2004, based in Bangkok, Thailand. From his experience in countries like India and Thailand, he concluded that, "Dispersing the red-light district is misguided and must be prevented." In 2012, UN Secretary-General Ban Ki-Moon named him Special Envoy for AIDS in Asia Pacific.
Meanwhile in Indonesia, it is estimated that of 600,000 people infected by HIV/AIDS this year, only 20 percent of the cases have been reported, a fact which caught Rao's attention. "You have all the right approaches for healthcare program in Indonesia, but there are a few issues that need to be sorted out for it to be successful," he said. Rao was in Jakarta two weeks ago to discuss ways to address the HIV/AIDS problem which, according to the Sustainable Development Goals, must be eliminated by 2030. While in Indonesia, he delivered a keynote speech at the 5th National AIDS Conference in Makassar, South Sulawesi. In between meetings, he shared his views with Tempo journalists Hermien Y. Kleden and Cheta Nilawaty. Excerpts:
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How critical is the HIV/AIDS problem that we need to make it a priority in our national agenda?
Look at the example of forest fires. Today, it's a priority for Indonesia. Because five years back it was not, today you have a situation where the forests are burning, you have an environmental problem, people are dying. It's the same with HIV/AIDS, if you don't put it as a priority today, five years down the line you will be forced to put it on top of the priority.
So we must act early?
To avoid that kind of situation, we must act early. Don't wait until things get out of hand. For example, today you have 600,000 infections. If you wait for five years, you will have 1 million infections. And if that's the case, you're losing the battle.
Are you saying we haven't done enough to tackle the problem?
To be fair, I would say Indonesia health programs (on HIV/AIDS) have all the essential elements. In prevention, they focus on transgenders, they have treatment programs, they also have awareness programs. All the essential elements are in position. The only thing is, it's not happening to scale at the level it should be done.
What do you mean?
First of all, you must test them. Many of them don't know they have AIDS. You need to open testing centers so they can come and get tested. This scales up of the treatment program to at least by 80-90 percent. If this takes place, then they don't transmit (the disease) to others. So automatically, the new infection rate will come down. The three most important things they must do is prevention; the second is treatment; and the third is (care for the) children. Many mothers give birth to HIV-positive children, yet they're not being treated. Today there are some excellent drugs available.
There are data that show that in almost 99 percent of cases , the mother delivers a healthy baby.
But for that, you must identify the positive mothers and let them come to hospitals and health centers, test them and if they're positive, put them on treatment. So that the child is delivered without an HIV condition.
What can we learn from India's experience in dealing with the epidemic?
When we started in 1997, we didn't have a clue as to what to do, to be very frank. Nobody told us what to do. There was no information, there was no strategy, so that's how we started. But then, we looked at the epidemic and then the characteristics of the epidemic. We found there were the vulnerable groups: the sex workers, homosexuals and transgenders. They were the ones we found with a high level of infection. So we thought we must definitely have a prevention program.
What did it consist of?
We tried to devise what the prevention program should be. We called it targeted interventions. It was held on three types of characteristics. One is giving them the knowledge on a one-to-one basis, not posters. Second is giving condoms, so they wear condoms for sex. Third is we also needed an enabling environment around them.
What do you mean?
For example, if we do something and the police come and take them away, then we're gone. Then all the good work we do would be washed away. So we must also educate the police.
You said closing brothels was a crazy idea, why is that?
If you close brothels, you wouldn't be stopping the sex trade. They will just move somewhere else. And they would be doing the same business without any control, any monitoring, any available test services. One of my recommendations would be: please stop the closing the brothels.
We have done that here. Do you think sex workers can be rehabilitated and make a living outside the sex trade?
You're destroying the AIDS program there. It will only increase the problem. It has been tried elsewhere and it has failed miserably. And having seen that, I don't know why Indonesia is doing it.
It's because some people believe that spending money on the victims would not stop the problem.
Yes, that's always the people's fast reaction. But they don't know. I told them the infection will not stop. They'll pass on to the general population. For example, in the sex trade, who are the clients? They're our own people. Somebody's husband, somebody's brother, somebody's father.
Yes, many of them are from the general population.
They all come back and infect the wife. She doesn't even know the husband went somewhere else. That's how it passes on to the general population. So unless you protect the sex workers, you're not protecting yourself and your children. I think that's the message that needs to go out.
The challenge in tackling HIV/AIDS is the issue of morality. How do you deal with it?
We can't be moralistic when it comes to this. We must look at the facts. How he got (HIV) and from where he got it is not for us to judge. What is important is whether he's positive or not. If he is, he should be given treatment. Don't ask him how many women he slept with. Don't ask that kind of question. Then you get on a moral high ground. Everyone has his own weak points. So, who should be the moral authority? Even the highest religious leaders have all sorts of stories about them.
What about the argument that promoting condoms is promoting free sex?
What we do is done with good intentions. We are trying to prevent people from getting infected with HIV. Today there's no cure, there's no vaccine. How can we protect everyone from HIV? The only 100 percent effective prevention for HIV is condom. So we need to promote that. In fact what we told the community: if you keep changing your partner every other day, you have a higher propensity to be infected. You should stick to one partner, even man to man. (*)
