Measuring Occupational Regulation AIDS in West Kalimantan Province
PROVINCIAL GOVERNMENT ( administration ) of West Kalimantan ( Kalbar ) into a region that spawned the 30th local regulations ( Regulation ) against AIDS in Indonesia . West Kalimantan province through Bylaw No. spawned regulations . 2 dated June 15, 2009 on the Prevention and Control of HIV and AIDS in the province of West Kalimantan . Already 30 local, provincial , district and municipal that have issued AIDS regulations.
Is the reduction and prevention of HIV / AIDS on offer in the local regulations work ?
As of March 2009 Kalbar ranked sixth nationally with 730 AIDS cases .
The idea of issuing regulations to support the AIDS response in Indonesia ' oriented ' to Thailand . Reported incidence of new HIV infections among adults in the land of the White Elephant began to decline through the ' mandatory 100 percent condom program ' . Came the idea to implement the same in Indonesia . Beginning in Nabire , West Papua , through Regulation No. 18 of 2003 which was ratified on January 31, 2003 . Areas other then the race was spawned regulations AIDS response .
One way of prevention are offered in local regulations AIDS is ' use a condom 100 percent ' . The program is in Thiland is the tail of a series of comprehensive prevention program . Unfortunately , AIDS bylaws actually plucks ' tail ' program in Thailand has become the 'head ' of the program.
Control mechanism'100 Per cent condom program ' can be applied in Thailand because there brothel and brothels . While in Indonesia, all localization has been closed . In fact , some regions makes regional anti- prostitution , anti- liquor , and anti- vice with strict law enforcement , such as raids on couples in inns and budget hotels . While the ' prostitution ' which became one of one of the triggers the spread of HIV is not only happening in the inns and budget hotels , but it can happen in hotels, houses , boarding houses , open fields , etc. .
Application of " 100 percent condom program ' in Indonesia can not be executed because there is no location or lokaliasi prostitution and brothels . One such tool is the program control routine checks against sex workers who work at the location or brothel and brothels . If there are sex workers who have an STI is detected then it proves there are customers who do not use condoms when having sex with sex workers . Business will be dealt with in stages until closing locations or home embroidery .
In West Kalimantan AIDS legislation on Article 15 , paragraph 1 stated : Prevention of HIV and AIDS aims to protect any person from being infected with HIV and do not infect others which include : ( b ) 100 % Condom Use Program at any risk sex . In chapter 1 verse 13 it says: Risky Sexual Behavior is behavior changing sexual partners without using a condom .
There is a huge misunderstanding in Indonesia because linking promiscuity with prostitution which is also referred to as ' free sex ' ( the term is ambiguous because it is a free translation of free sex is not known in the English vocabulary ) . In fact , multiple sexual partners can also occur within the bounds of legal marriage ( such as divorce ) , infidelity , ' cohabiting ' , marriage contracts , etc. .
Unfortunately , man ' masher ' usually do not change sexual partners because they have a subscription or a ' girlfriend ' among sex workers . Because not changing partners so they do not regard the risk . This is because there are so-called risky behavior just ' having sex with a partner who alternated ' . In fact, the risk of contracting HIV juba behavior can occur if unprotected sex within or outside marriage with someone who frequently changing partners , such as sex workers .
The question then is : How do I control the obligation to wear condoms in risky sex ?
Honey in the regulations no monitoring mechanism . Certainly not exist because there is no localization in West Kalimantan and home embroidery that ' official ' . Thus , an attempt to break the chain of HIV transmission in the community through the use of condoms ' this would not be the way .
When Indonesia is aggressively adopting condom program in Thailand would start happening counter-productive to the program . Many men ' johns ' who bring sex workers out of a brothel or home embroidery so that they are no longer bound by the obligation to wear a condom .
Detecting HIV
Article 15 paragraph 1 letter stated : Prevention of HIV and AIDS aims to protect any person from being infected with HIV and do not infect others which include : ( e) Prevention of mother-to- child transmission ( PMTCT / Prevention of Mother to Child Transmission transmittion ) .
The question is : What is the mechanism to detect HIV among pregnant women ? In this regulation there is no way offered . This article would be useful if there is a mechanism for detecting HIV among pregnant women . Malaysia , for example , apply to the routine screening of pregnant women .
In the seventh part of the transmission chain termination addressed to people who already know her HIV - positive . For example , a chapter 20 verse mentioned : Every person who knew he was infected with HIV and AIDS are obligated to protect their sexual partners to take steps to prevent the use of condoms . The problem is more than 90 percent of the people who are already infected with HIV do not realize it because there are no signs , symptoms or characteristics typical of AIDS on the physical before reaching the age of AIDS ( statistically between 5-15 years after contracting HIV ) . At this time span the spread of HIV occurs unnoticed by the people who are already HIV - positive .
Again mentioned in Article 23 : Every person who shall make sex risky effective prevention by using condoms . If associated with chapter 1 verse 13 it is not clear to whom this article is addressed. This article will work if reads : Any person having sex , in or out of wedlock in the West Kalimantan region or outside of West Kalimantan , with alternating pairs or with someone who frequently changing partners are required to wear a condom .
One effective way to break the chain of horizontal spread of HIV among the population is to detect cases of HIV in the community by adding a clause which reads : Every person who has ever had sex , in or out of wedlock in the West Kalimantan region or in areas of Kalimantan , with alternating pairs or with someone who often have multiple sexual partners use condoms are not required to undergo voluntary HIV testing .
People who have been infected with HIV in the community that have not been detected will be the chain of HIV horizontally , al . through unprotected sex , without them knowing it . HIV cases in the community can be seen from detection in VCT clinics or hospitals and blood donor screening in PMI .
Compared with local regulations existing regulation AIDS Kalbar step further . However , this regulation can also encourage stigmatitasi ( bad labeling ) and discrimination
( differential treatment ) in people with HIV due to enter ' faith and piety ' as part of a policy of prevention and treatment of HIV and AIDS ( article 37 paragraph i ) . It impresses people who are infected with HIV ' is not faithful and devoted no ' .
This regulation also degrading human dignity by mentioning prostitutes as sex workers . Sex workers are not working as prostitutes ( themselves ) . Sex workers who came to man . So , who transmitted HIV to sex worker is male locals or migrants in everyday life there are as husbands , widowers , single or teen . Man this is precisely the chain of spread of HIV in the community . Again, without them knowing it .
To that required continuous extension with accurate Counseling Education and Information ( CEI )materials to enable people to understand the ways of transmission and prevention of HIV so that they can weigh their behavior .
In the end the expected behavior of the population at risk of contracting HIV realized that undergo voluntary HIV testing .
( * The author is a contributor to Voice We specialized health news in Jakarta ) ***
The idea of issuing regulations to support the AIDS response in Indonesia ' oriented ' to Thailand . Reported incidence of new HIV infections among adults in the land of the White Elephant began to decline through the ' mandatory 100 percent condom program ' . Came the idea to implement the same in Indonesia . Beginning in Nabire , West Papua , through Regulation No. 18 of 2003 which was ratified on January 31, 2003 . Areas other then the race was spawned regulations AIDS response .
One way of prevention are offered in local regulations AIDS is ' use a condom 100 percent ' . The program is in Thiland is the tail of a series of comprehensive prevention program . Unfortunately , AIDS bylaws actually plucks ' tail ' program in Thailand has become the 'head ' of the program.
Control mechanism'100 Per cent condom program ' can be applied in Thailand because there brothel and brothels . While in Indonesia, all localization has been closed . In fact , some regions makes regional anti- prostitution , anti- liquor , and anti- vice with strict law enforcement , such as raids on couples in inns and budget hotels . While the ' prostitution ' which became one of one of the triggers the spread of HIV is not only happening in the inns and budget hotels , but it can happen in hotels, houses , boarding houses , open fields , etc. .
Application of " 100 percent condom program ' in Indonesia can not be executed because there is no location or lokaliasi prostitution and brothels . One such tool is the program control routine checks against sex workers who work at the location or brothel and brothels . If there are sex workers who have an STI is detected then it proves there are customers who do not use condoms when having sex with sex workers . Business will be dealt with in stages until closing locations or home embroidery .
In West Kalimantan AIDS legislation on Article 15 , paragraph 1 stated : Prevention of HIV and AIDS aims to protect any person from being infected with HIV and do not infect others which include : ( b ) 100 % Condom Use Program at any risk sex . In chapter 1 verse 13 it says: Risky Sexual Behavior is behavior changing sexual partners without using a condom .
There is a huge misunderstanding in Indonesia because linking promiscuity with prostitution which is also referred to as ' free sex ' ( the term is ambiguous because it is a free translation of free sex is not known in the English vocabulary ) . In fact , multiple sexual partners can also occur within the bounds of legal marriage ( such as divorce ) , infidelity , ' cohabiting ' , marriage contracts , etc. .
Unfortunately , man ' masher ' usually do not change sexual partners because they have a subscription or a ' girlfriend ' among sex workers . Because not changing partners so they do not regard the risk . This is because there are so-called risky behavior just ' having sex with a partner who alternated ' . In fact, the risk of contracting HIV juba behavior can occur if unprotected sex within or outside marriage with someone who frequently changing partners , such as sex workers .
The question then is : How do I control the obligation to wear condoms in risky sex ?
Honey in the regulations no monitoring mechanism . Certainly not exist because there is no localization in West Kalimantan and home embroidery that ' official ' . Thus , an attempt to break the chain of HIV transmission in the community through the use of condoms ' this would not be the way .
When Indonesia is aggressively adopting condom program in Thailand would start happening counter-productive to the program . Many men ' johns ' who bring sex workers out of a brothel or home embroidery so that they are no longer bound by the obligation to wear a condom .
Detecting HIV
Article 15 paragraph 1 letter stated : Prevention of HIV and AIDS aims to protect any person from being infected with HIV and do not infect others which include : ( e) Prevention of mother-to- child transmission ( PMTCT / Prevention of Mother to Child Transmission transmittion ) .
The question is : What is the mechanism to detect HIV among pregnant women ? In this regulation there is no way offered . This article would be useful if there is a mechanism for detecting HIV among pregnant women . Malaysia , for example , apply to the routine screening of pregnant women .
In the seventh part of the transmission chain termination addressed to people who already know her HIV - positive . For example , a chapter 20 verse mentioned : Every person who knew he was infected with HIV and AIDS are obligated to protect their sexual partners to take steps to prevent the use of condoms . The problem is more than 90 percent of the people who are already infected with HIV do not realize it because there are no signs , symptoms or characteristics typical of AIDS on the physical before reaching the age of AIDS ( statistically between 5-15 years after contracting HIV ) . At this time span the spread of HIV occurs unnoticed by the people who are already HIV - positive .
Again mentioned in Article 23 : Every person who shall make sex risky effective prevention by using condoms . If associated with chapter 1 verse 13 it is not clear to whom this article is addressed. This article will work if reads : Any person having sex , in or out of wedlock in the West Kalimantan region or outside of West Kalimantan , with alternating pairs or with someone who frequently changing partners are required to wear a condom .
One effective way to break the chain of horizontal spread of HIV among the population is to detect cases of HIV in the community by adding a clause which reads : Every person who has ever had sex , in or out of wedlock in the West Kalimantan region or in areas of Kalimantan , with alternating pairs or with someone who often have multiple sexual partners use condoms are not required to undergo voluntary HIV testing .
People who have been infected with HIV in the community that have not been detected will be the chain of HIV horizontally , al . through unprotected sex , without them knowing it . HIV cases in the community can be seen from detection in VCT clinics or hospitals and blood donor screening in PMI .
Compared with local regulations existing regulation AIDS Kalbar step further . However , this regulation can also encourage stigmatitasi ( bad labeling ) and discrimination
( differential treatment ) in people with HIV due to enter ' faith and piety ' as part of a policy of prevention and treatment of HIV and AIDS ( article 37 paragraph i ) . It impresses people who are infected with HIV ' is not faithful and devoted no ' .
This regulation also degrading human dignity by mentioning prostitutes as sex workers . Sex workers are not working as prostitutes ( themselves ) . Sex workers who came to man . So , who transmitted HIV to sex worker is male locals or migrants in everyday life there are as husbands , widowers , single or teen . Man this is precisely the chain of spread of HIV in the community . Again, without them knowing it .
To that required continuous extension with accurate Counseling Education and Information ( CEI )materials to enable people to understand the ways of transmission and prevention of HIV so that they can weigh their behavior .
In the end the expected behavior of the population at risk of contracting HIV realized that undergo voluntary HIV testing .
( * The author is a contributor to Voice We specialized health news in Jakarta ) ***
Menakar Kerja Perda AIDS Provinsi Kalimantan Barat
PEMERINTAH PROVINSI (Pemprov) Kalimantan Barat (Kalbar) menjadi daerah ke-30 yang menelurkan peraturan daerah (Perda) penanggulangan AIDS di Indonesia. Pemprov Kalbar menelurkan perda melalui Perda No. 2 tanggal 15 Juni 2009 tentang Pencegahan dan Penanggulangan HIV dan AIDS di Provinsi Kalimantan Barat. Sudah 30 daerah, provinsi, kabupaten dan kota yang sudah menerbitkan perda AIDS. Apakah penanggulangan dan pencegahan HIV/AIDS yang ditawarkan di perda-perda itu (bisa) bekerja? Sampai Maret 2009 Kalbar menempati peringkat keenam secara nasional dengan 730 kasus AIDS.
Gagasan menerbitkan perda untuk mendukung penanggulangan AIDS di Indonesia ‘berkiblat’ ke Thailand. Dikabarkan insiden infeksi HIV baru di kalangan dewasa di Negeri Gajah Putih itu mulai menurun melalui ‘program wajib kondom 100 persen’. Muncul pemikiran untuk menerapkan hal yang sama di Indonesia. Dimulai di Kabupaten Nabire, Papua Barat, melalui Perda No 18 tahun 2003 yang disahkan tanggal 31 Januari 2003. Daerah-daerah lain pun kemudian berlomba menelurkan perda penanggulangan AIDS.
Salah satu cara pencegahan yang ditawarkan dalam perda-perda AIDS adalah ‘penggunaan kondom 100 persen’. Program ini di Thiland merupakan ekor dari serangkaian program penanggulangan yang komprehensif. Celakanya, perda-perda AIDS justru mencomot ‘ekor’ program Thailand menjadi ‘kepala’ program.
Mekanisme Kontrol
Program ‘100 persen kondom’ bisa diterapkan di Thailand karena ada lokalisasi pelacuran dan rumah bordir. Sedangkan di Indonesia semua lokalisasi sudah ditutup. Bahkan, beberapa daerah membuat perda anti pelacuran, anti minuman keras, dan anti maksiat dengan penegakan hukum yang ketat, seperti razia terhadap pasangan-pasangan di losmen dan hotel melati. Sedangkan ‘praktek pelacuran’ yang menjadi salah salah satu pemicu penyebaran HIV tidak hanya terjadi di losmen dan hotel melati, tapi bisa saja terjadi di hotel berbintang, rumah, tempat kos, lapangan terbuka, dll.
Penerapan ‘program 100 persen kondom’ di Indonesia tidak bisa dijalankan karena tidak ada lokasi atau lokaliasi pelacuran dan rumah bordir. Salah satu alat kontrol program ini adalah pemeriksaan rutin terhadap pekerja seks yang bekerja di lokasi atau lokalisasi pelacuran dan rumah bordir. Jika ada pekerja seks yang terdeteksi mengidap IMS maka itu membuktikan ada pelanggan yang tidak memakai kondom ketika melakukan hubungan seks dengan pekerja seks. Pengelola akan ditindak secara bertahap sampai penutupan lokasi atau rumah bordir.
Dalam Perda AIDS Kalbar pada pasal 15 ayat 1 disebutkan: Pencegahan HIV dan AIDS bertujuan untuk melindungi setiap orang agar tidak tertular HIV dan tidak menularkan kepada orang lain yang meliputi: (b) Program Pemakaian Kondom 100% pada setiap hubungan seks berisiko. Dalam pasal 1 ayat 13 disebutkan: Perilaku Seksual Beresiko adalah perilaku berganti-ganti pasangan seksual tanpa menggunakan kondom.
Ada salah paham yang besar di Indonesia karena mengaitkan berganti-ganti pasangan dengan pelacuran yang juga disebut sebagai ’seks bebas’ (istilah ini rancu karena merupakan terjemahan bebas dari free sex yang tidak dikenal dalam kosa kata Bahasa Inggris). Padahal, berganti-ganti pasangan pun bisa terjadi di dalam ikatan pernikahan yang sah (seperti kawin-cerai), perselingkuhan, ‘kumpul kebo’, kawin kontrak, dll.
Celakanya, lelaki ‘hidung belang’ biasanya tidak ganti-ganti pasangan karena mereka mempunyai langganan atau ‘pacar’ di kalangan pekerja seks. Karena tidak berganti-ganti pasangan maka mereka mengangap tidak berisiko. Ini terjadi karena selama ini yang disebut perilaku berisiko hanya ‘melakukan hubungan seks dengan pasangan yang berganti-ganti’. Padahal, perilaku berisiko tertular HIV juba bisa terjadi jika melakukan hubungan seks tanpa kondom di dalam atau di luar nikah dengan seseorang yang sering berganti-ganti pasangan, seperti pekerja seks.
Pertanyaannya kemudian adalah: Bagaimana mengontrol kewajiban memakai kondom pada hubungan seks berisiko? Sayang dalam perda tidak ada mekanisme pengawasannya. Tentu saja tidak ada karena di Kalbar tidak ada lokalisasi dan rumah bordir yang ‘resmi’. Maka, upaya untuk memutus mata rantai penyebaran HIV di masyarakat melalui program pemakaian kondom’ ini pun tidak akan jalan.
Ketika Indonesia gencar mengadopsi program kondom ini di Thailand justru mulai terjadi kontra produktif terhadap program ini. Banyak lelaki ‘hidung belang’ yang membawa pekerja seks ke luar dari lokalisasi pelacuran atau rumah bordir sehingga mereka tidak lagi terikat dengan kewajiban memakai kondom.
Mendeteksi HIV
Pasal 15 ayat 1 huruf disebutkan: Pencegahan HIV dan AIDS bertujuan untuk melindungi setiap orang agar tidak tertular HIV dan tidak menularkan kepada orang lain yang meliputi: (e) Pelayanan Pencegahan Penularan dari ibu ke anak (PMTCT/Prevention Mother Transmittion to Child Transmission).
Pertanyaannya adalah: Bagaimana mekanisme mendeteksi HIV di kalangan ibu-ibu hamil? Dalam perda ini tidak ada cara yang ditawarkan. Pasal ini akan berguna jika ada mekanisme untuk mendeteksi HIV di kalangan ibu-ibu hamil. Malaysia, misalnya, menerapkan skrining rutin terhadap terhadap perempuan hamil.
Pada bagian ketujuh tentang pemutusan mata rantai penularan ditujukan kepada orang yang sudah mengetahui dirinya HIV-positif. Misalnya, pasal 20 ayat a disebutkan: Setiap orang yang telah mengetahui dirinya terinfeksi HIV dan AIDS wajib melindungi pasangan seksualnya dengan melakukan upaya pencegahan dengan menggunakan kondom. Persoalannya adalah lebih dari 90 persen orang-orang yang sudah tertular HIV tidak menyadarinya karena tidak ada tanda, gejala atau ciri-ciri yang khas AIDS pada fisiknya sebelum mencapai masa AIDS (secara statistik antara 5-15 tahun setelah tertular HIV). Pada rentang waktu ini terjadi penyebaran HIV tanpa disadari oleh orang-orang yang sudah HIV-positif.
Lagi-lagi pada pasal 23 disebutkan: Setiap orang yang melakukan hubungan seks beresiko wajib melakukan upaya pencegahan yang efektif dengan cara menggunakan kondom. Kalau dikaitkan dengan pasal 1 ayat 13 maka tidak jelas kepada siapa pasal ini ditujukan. Pasal ini akan bekerja jika berbunyi: Setiap orang yang melakukan hubungan seks, di dalam atau di luar nikah di wilayah Kalimantan Barat atau di luar Kalimantan Barat, dengan pasangan yang berganti-ganti atau dengan seseorang yang sering berganti-ganti pasangan wajib memakai kondom.
Salah satu cara yang efektif memutus mata rantai penyebaran HIV secara horizontal antara penduduk adalah dengan mendeteksi kasus-kasus HIV di masyarakat dengan menambahkan pasal yang berbunyi: Setiap orang yang sudah pernah melakukan hubungan seks, di dalam atau di luar nikah di wilayah Kalimantan Barat atau di luar Kalimantan Barat, dengan pasangan yang berganti-ganti atau dengan seseorang yang sering berganti-ganti pasangan tidak memakai kondom diwajibkan menjalani tes HIV secara sukarela.
Orang-orang yang sudah tertular HIV di masyarakat yang belum terdeteksi akan menjadi mata rantai penyebaran HIV secara horizontal, al. melalui hubungan seks tanpa kondom, tanpa mereka sadari. Kasus HIV di masyarakat dapat dilihat dari deteksi di klinik VCT atau rumah sakit dan skrining darah donor di PMI.
Dibandingkan dengan perda-perda yang sudah ada Perda AIDS Kalbar selangkah lebih maju. Tapi, perda ini juga bisa mendorong stigmatitasi (pemberian cap buruk) dan diskriminasi (pembedaan perlakuan) terhadap Odha karena memasukkan ‘iman dan taqwa’ sebagai bagian dari kebijakan pencegahan dan penanggulangan HIV dan AIDS (pasal 37 ayat i). Ini mengesankan orang-orang yang tertular HIV ‘tidak beriman dan tidak bertaqwa’.
Perda ini juga merendahkan harkat dan martabat manusia dengan menyebutkan pelacur atau pekerja seks sebagai penjaja seks. Pekerja seks tidak menjajakan seks (diri). Yang mendatangi pekerja seks justru laki-laki. Maka, yang menularkan HIV kepada pekeja seks adalah laki-laki penduduk lokal atau pendatang yang dalam kehidupan sehari-hari ada yang sebagai suami, duda, lajang atau remaja. Laki-laki inilah yang justru menjadi mata rantai penyebaran HIV di masyarakat. Lagi-lagi tanpa mereka sadari.
Untuk itulah diperlukan penyuluhan yang terus-menerus dengan materi KIE- Konseling Edukasi dan Informasi - yang akurat agar penduduk memahami cara-cara penularan dan pencegahan HIV sehingga mereka bisa menimbang-nimbang perilakunya.
Pada akhirnya diharapkan penduduk yang menyadari perilakunya berisiko tertular HIV agar menjalani tes HIV secara sukarela.
Note : This paper was published as an article in the Daily Opinion " Swara We " , Manado , August 20, 2009 ( http://www.swarakita-manado.com/index.php/berita-utama/16375-hivaids ) .[ AIDS Watch Indonesia / Syaiful W. Harahap ] ***
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