• The provinces of Papua and West Papua, formerly known as Irian Jaya, are located in easternmost Indonesia. They are home to only one percent of Indonesia's 230 million people; however, almost 40 percent of all HIV/AIDS cases in the country are located there. In the two provinces' (which I call "Papua," as is the norm in the region), HIV/AIDS infection rates are the highest in the country, 15 times higher than the national average. The people of Papua are living and dying in the midst of the fastest growing epidemic in Asia.

    Each year in Papua the number of recorded cases of HIV increases by almost 50 percent. Current estimates suggest at least 3 percent of the adults in the province are HIV-positive. In an epidemic where the virus is transmitted mostly through heterosexual relationships, men and women, children, husbands and wives, and in some cases entire communities are under attack.

    Although they say that HIV/AIDS does not discriminate, in Papua the epidemic follows along the fault lines of race: about three-quarters of those infected are indigenous Papuans. Due to economic disparity and a lack of political power, indigenous Papuans are more susceptible to poverty, malnutrition, unemployment, and illiteracy than the Indonesian migrants who have relocated to the province. Already at a disadvantage, indigenous Papuans lack access to the information and education necessary to make informed decisions to reduce vulnerability to HIV. They also have limited access to preventive services, adequate health support, and treatment. Consequently, no other ethnic group in Papua bears as high a risk of transmission, stigmatization, marginalized well-being, and mortality related to HIV/AIDS as do indigenous Papuans.

    Against All Odds uses images and text to explore some of the reasons why indigenous Papuans are contracting HIV, including limited economic opportunities, lack of HIV/AIDS education and awareness, insufficient access to health services, inadequate support, discrimination, and stigma. One of the project's goals is to put face to this regional crisis by showing how they try and come to terms with their situation. Ultimately, it aims to raise awareness about Papua and improve access to care for indigenous Papuans facing or living with HIV/AIDS.

  • Dewi (20) is a young wife who died from AIDS after contracting HIV from her husband. Dewi kept her status a secret from her family. Dewi's family, who were unaware of her real illness, used a traditional healing method of cutting her body to let out "dirty" blood in an attempt to cure her. Dewi's body was displayed in her finest clothes as family members and neighbors mourned her death inside her parents' honai. A local NGO, called Caring Hands, donated money to buy woods for her cremation since Dewi's family was too poor to have her buried. Outside, men cut woods into smaller pieces and stacked them to prepare for her cremation. A pastor led the ceremony and prayed before Dewi's body was place on top of the funeral pyre. Due to shame and fear of discrimination or punishment, it is common for husbands who are HIV-positive to keep their status from their wives or vice versa. Even after testing positive for HIV, many still disregard using condoms to avoid drawing suspicion. As a result, the HIV virus is often passed between spouses.

  • Becky (24) hands off her newborn baby, Gabriel, to her twin sister Dessy. Becky and Dessy are both HIV positive. However, neither of them took ARV even when they were pregnant. Gabriel often gets sick. Dessy's daughter died last year at age 2 and Becky's daughter Emma (1) recently died from a sudden illness. None of these children has been tested for HIV because the test cannot be administered before the age of two, but their frequent illnesses suggests that they were infected. In Papua there are more records of housewives infected with HIV than sex workers. In most cases, housewives contracted HIV from their husbands. As a result, many pregnant women who are unaware of their infection may pass HIV onto their infants. Fortunately, HIV testing on pregnant women is a mandatory practice conducted during prenatal care. Nevertheless, the transmission of HIV from mother to child still occurs, especially since many women have limited access to a clinic during their pregnancy.

  • Children and parents from the Husoak village outside of Wamena watch an educational movie on HIV/AIDS. Perhaps one of the most effective ways to promote awareness and educate the public on HIV/AIDS is by playing informative movies in open forums. In Wamena, YUKEMDI, a local NGO run by indigenous Papuans, plays an educational movie in rural communities featuring native Papuans and using local dialects. The movie is both entertaining and informative, and attracts hundreds of villagers to the showings. After watching the movie, villagers receive additional information, and are encouraged to ask questions which promote communication and open discussions. However, these screenings are not conducted as often as they should be despite their effectiveness and demands from village elders. YUKEMDI is unable to reach and provide HIV/AIDS education to villages in rural areas because they do not get enough government support to cover the costs of fuel, transportation and equipment for screenings in remote communities. Better methods of education and more effective delivery of information on HIV/AIDS need to be implemented in Papua in order to effectively raise awareness and prevent misunderstandings. Ultimately, accurate and reliable information is one essential way to educate and empower the public to make informed decisions and reduce vulnerability to infection.

  • Seen through a one-way mirror, sex workers wait to be chosen by a customer inside a popular brothel, Bar Kharisma, in Jayapura capital of Papua In Papua, sex is a profitable industry. The influx of non-Papuan migrants into the region brings sanctioned prostitution usually run by the military. Brothels hire mostly non-Papuan sex workers, and are often disguised as clubs, karaoke bars, and massage parlors. These are formal establishments employing 4,000-plus sex workers who earn more than their Papuan counterparts working on the street or in dilapidated buildings. Above and beyond the financial discrepancy (brothel workers make ten times what street workers do), the biggest discrepancy between Indonesian brothel workers and Papuan street workers is disproportionate access to health care and HIV support. Most HIV and Sexually Transmitted Diseases (STDs) intervention programs are geared towards sex workers in brothels. In Jayapura, the capital of Papua, there are over 30 brothels, and non-Papuan sex workers in these establishments undergo monitored testing and receive regular counseling for STDs every month, and for HIV every 3 months. As a result, they are much better informed about HIV/AIDS and have better access to preventive services and care than indigenous Papuan sex workers.

  • Ophira (18) has been HIV-positive for 1 year. She is recovering from her injuries after getting drunk and falling off her motorcycle. Despite her condition, Ophira doesn't take her ARV medication regularly and she rarely comes to the clinic for her check-ups because she is afraid others would find out about her status. ODHA (Orang Dengan HIV/AIDS) is the Indonesian term used to label a person living with HIV/AIDS. This label has negative implications since HIV/AIDS is often associated with and viewed as a curse or retribution for personal misconduct and deviant behaviors such as sinful acts, alcoholism, promiscuity, "free sex"(seks bebas), and extra marital sex. Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS. Many who test positive for HIV do not seek essential care because they are afraid of stigma and discrimination. Consequently, fear of abuse, persecution and ostracism from family members and the wider community has made secrecy the primary concern for ODHA, rather than getting treatment.

  • People are seen bathing and washing clothes are Wouma River in Wamena, Jayawijaya district, a mountainous region in Papua. It is estimated that at least 3% of 2.5 million inhabitants in Papua is already infected with HIV/AIDS. However, the prevalence rate for HIV among indigenous Papuans is estimated at 7% and they account for 75% of the total number of recorded infection. Currently, Wamena has 1,894 recorded HIV/AIDS cases and the number continues to rise.

  • Children playing jump rope after Sunday School in the mountainous region of Papua. HIV/AIDS is spreading at an alarming rate impacting the general population including children, men and women, husbands and wives, young and old, families and communities.

  • Passengers wait to depart and embark at the sea port in Jayapura, capital of Papua, which is the main entry point for goods and migrants entering and exiting the region. The province of Papua is large, and has abundant natural resources such as copper, gold, and timber. However, most indigenous Papuans live on less than $1 a day. The incidence of poverty in Papua is the highest in the country, doubling the national average. Papua was acquired by Indonesia in 1969 in a disputed vote rejected by most Papuans. For the past four decades, indigenous Papuans have sought independence A transmigration policy implemented by the federal government relocated almost a million non-Papuan migrants from surrounding provinces as a part of "Indonesianization." process. These migrants, along with another million that moved voluntary, dominate most of the trade and business in the region, thereby controlling authority by dictating commerce in Papua. Goods such as rice, medication and gas that are imported into Papua are sold at exorbitant prices, making the cost of living the highest in Indonesia. Coupled with unequal access to education and training, opportunities for indigenous Papuans to advance economically are limited. The consequence is economic inequality--wealthy migrants and poor indigenous Papuans--and a marginalized indigenous population where poverty, unemployment, malnourishment, illness, illiteracy, and discrimination are the norm.

  • Crowd gathers at a night market in Sorong, West Papua. Non-Papuans now outnumber ethnic Papuans. The province of Papua is large, and has abundant natural resources such as copper, gold, and timber. However, most indigenous Papuans live on less than $1 a day. The incidence of poverty in Papua is the highest in the country, doubling the national average. Papua was acquired by Indonesia in 1969 in a disputed vote rejected by most Papuans. For the past four decades, indigenous Papuans have sought independence A transmigration policy implemented by the federal government relocated almost a million non-Papuan migrants from surrounding provinces as a part of "Indonesianization." process. These migrants, along with another million that moved voluntary, dominate most of the trade and business in the region, thereby controlling authority by dictating commerce in Papua. Goods such as rice, medication and gas that are imported into Papua are sold at exorbitant prices, making the cost of living the highest in Indonesia. Coupled with unequal access to education and training, opportunities for indigenous Papuans to advance economically are limited. The consequence is economic inequality--wealthy migrants and poor indigenous Papuans--and a marginalized indigenous population where poverty, unemployment, malnourishment, illness, illiteracy, and discrimination are the norm.

  • "Tembok," a place that is dark and overlooking the ocean is a popular spot get drunk and to buy and sell sex in Sorong. For many young Papuan women in urban and developing areas, poverty and economic pressures have forced the exchange of sex for goods, cash, or food as an accepted mean for survival. Unlike non-Papuan sex workers, Papuan prostitutes often seek clients in public venues and have sex outside, by the side of the road, or in urban dwellings. Operating outside formal establishments, the exact numbers of Papuan sex workers are unknown but are estimated to be at least double the number of non-Papuans. Despite their high numbers, most Papuan sex workers rarely have access to information, preventive services and support for HIV/AIDS and STDs. Intervention programs targeting Papuan sex workers have not been a priority. With limited access to information and support, Papuan sex workers are less informed, have lower rates of condom usage (5% compared to non-Papuans with a 70% rate of condom usage), and are more likely to get infected with STDs and HIV than their non-Papuan counterparts in regulated brothels.

  • Papuan street prostitutes, Betty (25) and Natasha (16) share a cigarette as they wait for potential clients. For many young Papuan women in urban and developing areas, poverty and economic pressures have forced the exchange of sex for goods, cash, or food as an accepted mean for survival. Unlike non-Papuan sex workers, Papuan prostitutes often seek clients in public venues and have sex outside, by the side of the road, or in urban dwellings. Operating outside formal establishments, the exact numbers of Papuan sex workers are unknown but are estimated to be at least double the number of non-Papuans. Despite their high numbers, most Papuan sex workers rarely have access to information, preventive services and support for HIV/AIDS and STDs. Intervention programs targeting Papuan sex workers have not been a priority. With limited access to information and support, Papuan sex workers are less informed, have lower rates of condom usage (5% compared to non-Papuans with a 70% rate of condom usage), and are more likely to get infected with STDs and HIV than their non-Papuan counterparts in regulated brothels.

  • Yayasan Harapan Ibu (Mother's Hope Foundation), a local NGO in Jayapura, demonstrates the use of condom at public places to help prevent the spread of HIV virus. In Papua, it is assumed almost all transmission of HIV occurs through sexual encounters. Thus, the consistent use of condoms is understood as one of the most effective ways to reduce or prevent infection. Nevertheless, condoms are seen as taboo. Condom usage is a taboo an often opposed or disregarded by religious and community leaders, and rarely discussed in public. Moreover, health staff endorses abstinence more often than condoms as a method of reducing or preventing infection. As a result, the use of condoms is low and condoms are frequently associated with sin, misconduct, and shame. Most people are embarrassed to buy condoms even when they are available. However, it is still very difficult to obtain a condom in most locations. Because of low condom education and awareness, many people in Papua don't know how to use condoms or where to go to obtain them. Most importantly they don't understand the benefit of condom usage in reducing or preventing STDs and HIV infection.

  • L-R: Roni (26) and Mecky (18), each wearing an apron with a diagram of the male and female reproduction organs, participates in a sexual reproduction and HIV/AIDS educational training conducted by the Public Health Development Foundation (YPKM), a local NGO in Wamena. In Papua young teenagers are already having sex but education is still lacking. GIDI Baptist Church invited teenagers from surrounding villages in Wamena for a week-long crash course on sex education, family planning, condom, sexual transmitted diseases (STD), and HIV/AIDS. These young adults will return to their villages and serve as peer counselors providing information support. However, despite the program's effectiveness, YPKM is lacking funding to continue this important educational course.

  • A field worker from Yukemdi, a local NGO in Wamena, educates the public on Sexual Transmitted Diseases (STD) and HIV/AIDS at a local market using the local dialect. Awareness of HIV/AIDS is very low among indigenous Papuans because education about HIV remains inadequate and information is delivered inefficiently. HIV/AIDS educational materials used in Papua such as pamphlets and booklets are inefficient in reaching indigenous Papuans because their content frequently uses images of non-Papuans, which Papuans are unable to relate to. Furthermore, many indigenous Papuans have limited literacy and leaflets usually use Bahasa Indonesia rather than local dialects. Better methods of education and more effective delivery of information on HIV/AIDS need to be implemented in Papua in order to effectively raise awareness and prevent misunderstandings. Ultimately, accurate and reliable information is one essential way to educate and empower the public to make informed decisions and reduce vulnerability to infection.

  • Yukemdi, a local NGO, hands out educational pamphlets on HIV/AIDS and condoms at Pasar Baru, the biggest market in Wamena. However, the text is written in Bahasa Indonesia and many people there are illiterate and speak mainly the local dialect. The pamphlet also doesn't feature Papuan people on its cover. Nevertheless, Yukemdi included their office telephone number and address in the back each pamphlet for anyone who wants to contact them directly for immediate assistance. Almost all cases of HIV virus are transmitted through sexual intercourse (99%) and the use of condom is perhaps the most efficient way to prevent infection. However, many men never seen or used a condom before and those who use condoms do not use it consistently (less than 30% could identify a condom and only 8% have used it.) Condom promotion is low and obtaining condoms outside of urban area is also difficult.

  • Mary leans on her friend's shoulder waiting for her test results at a Voluntary Counseling and Testing clinic (VCT). For many young Papuan women in urban and developing areas, poverty and economic pressures have forced the exchange of sex for goods, cash, or food as an accepted mean for survival. Unlike non-Papuan sex workers, Papuan prostitutes often seek clients in public venues and have sex outside, by the side of the road, or in urban dwellings. Operating outside formal establishments, the exact numbers of Papuan sex workers are unknown but are estimated to be at least double the number of non-Papuans. Despite their high numbers, most Papuan sex workers rarely have access to information, preventive services and support for HIV/AIDS and STDs. Intervention programs targeting Papuan sex workers have not been a priority. With limited access to information and support, Papuan sex workers are less informed, have lower rates of condom usage (5% compared to non-Papuans with a 70% rate of condom usage), and are more likely to get infected with STDs and HIV than their non-Papuan counterparts in regulated brothels.

  • Mama Yuli comforts her granddaughter Anace (8). They are very close. In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. Her youngest son also died from an illness when he was only 2 years old. In her worst condition, Mama Yuli was just skin and bones weighing only 22kg (48lbs). With ARV she is now healthy to work and support her family. If taken properly and regularly, ARV has been proven to prolong the survival rate of people living with HIV/AIDS and enables them to live a productive life. The Indonesian government only started providing ARV therapies in 2003. In that year only seven packages of ARV were purchased for all of Papua. Each package cost approximately $5000. Today in Indonesia this vital medication can be obtained at no cost only in Papua but only 12% are undergoing Antiretroviral therapy. Despite these advances, ARV is mostly available only in cities. Collaboration between health facilities in urban centers and staffs in rural areas to make ARV more accessible for patients living in the countryside is still lacking as well as the endorsement of ARV as a legitimate medicine for HIV/AIDS. Sometimes health staff and even educational materials still uphold misleading information and perception such as "there is no medicine for HIV/AIDS." As a general practice, health personnel often evaluate patients to see if they adhere to medication schedules and if they keep follow-up appointments before they will allow them to go on ARVs. Indigenous Papuans tend to fall short of this assessment because they often live too far from health centers to return for mandatory check-ups, and at times they don't fully understand the benefits of ARV medication and the importance of taking them properly and regularly due to lack of information and poor counseling. Moreover, many of them are unable to keep appointments and take medication regularly because their status is still kept a secret from their immediate family.

  • Mama Yuli holds two ARV pills in her hands on the 8th year anniversary of undergoing Anti Retroviral Treatment (ART). In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. Her youngest son also died from an illness when he was only 2 years old. In her worst condition, Mama Yuli was just skin and bones weighing only 22kg (48lbs). With ARV she is now healthy to work and support her family. If taken properly and regularly, ARV has been proven to prolong the survival rate of people living with HIV/AIDS and enables them to live a productive life. The Indonesian government only started providing ARV therapies in 2003. In that year only seven packages of ARV were purchased for all of Papua. Each package cost approximately $5000. Today in Indonesia this vital medication can be obtained at no cost only in Papua but only 12% are undergoing Antiretroviral therapy. Despite these advances, ARV is mostly available only in cities. Collaboration between health facilities in urban centers and staffs in rural areas to make ARV more accessible for patients living in the countryside is still lacking as well as the endorsement of ARV as a legitimate medicine for HIV/AIDS. Sometimes health staff and even educational materials still uphold misleading information and perception such as "there is no medicine for HIV/AIDS." As a general practice, health personnel often evaluate patients to see if they adhere to medication schedules and if they keep follow-up appointments before they will allow them to go on ARVs. Indigenous Papuans tend to fall short of this assessment because they often live too far from health centers to return for mandatory check-ups, and at times they don't fully understand the benefits of ARV medication and the importance of taking them properly and regularly due to lack of information and poor counseling. Moreover, many of them are unable to keep appointments and take medication regularly because their status is still kept a secret from their immediate family.

  • Gary takes a shower as he prepare to go to school. At age 11, Gary is HIV positive and he had lost both of his parents to AIDS. Gary has been taking ARV regularly since age 4 and he lives with his grandmother and younger cousin. His grandmother sells "pinang" or betel nut in front of the house earning an average $2-3 per day. Due to her meager income, Gary's grandmother is unable to buy wholesome and nutritious food and vitamins for Gary to help maintain his health and growth. The Department of Social Services used to provide milk for Gary but the assistance suddenly stopped last year. Fortunately, Sorong Sehati a local community group in Sorong financed by a local NGO Yayasan San Agustino (YSA) came to the rescue and regularly provides Gary with bread, milk, and monetary assistance to pay for his schooling and transportation to a clinic for check-ups and ARV refills. At school Gary sits in front of the class and wants to be a doctor when he grows up so he can help people like him who are sick.

  • Lana (18) and her mother sit in silence after nurses insert an I.V. line. Lana is in Stadium 3 of AIDS and she was brought into the Emergency room when her condition worsened. She was not taking Antiretroviral medication. Many people that arrive in hospitals are already in the late stages of AIDS. They arrive at the medical center in critical condition with little hope of surviving.

  • Unconscious, a tear rolls off Mandisa's face as she lay on the hospital bed at the brink of death. Mandisa (25) who is in the late stage of AIDS clings to her life. After being sick for many months, Mandisa's family finally brought her to the hospital to get medical treatment. Due to lack of experienced health staffs, family and friends must stay by her side the entire time. Her condition got worst over night and her body went into a state of shock and she lost consciousness.

  • A man wearing traditional Papuan attire from Asolo Gaima, a village 40km from Wamena, is getting tested for Sexual Transmitted Disease (STD) at the main public clinic. Sexual Transmitted Diseases increase the transmission of the HIV virus. In Papua, education HIV/AIDS and STD as well as condom promotion is significantly low.

  • A family member finds a "worm" clinging to the wall of the pig's lungs that they believed to be the origin of an illness such as HIV. One of the common practices in the highlands to diagnose and cure HIV is by conducting a traditional diagnostic ritual termed adat. This involves killing a pig and examining its blood, heart, lungs, and kidney. The intention of this practice is to discover the causes of the disease. After cutting the pig open and inspecting the pig's internal organs, the practitioners of adat remove what they interpret as parasites or cancerous parts that they believe caused the sickness. Cleaning the pig flesh by washing it with water would also "cure" the person's illness. Making adat diagnoses and cures are expensive since a pig can cost hundreds of dollars. The treatment does not work despite the strong cultural belief system that is behind it. In the end, after killing numerous pigs and spending a fortune, many people give up hope, and when they finally decide to go to the hospital, the patient's condition is critical and they don't survive. Due to a lack of education about HIV, limited access to health services, and strong preexisting cultural beliefs about illness, many people who are desperate for a cure turn to traditional methods of healing. This involves cutting different parts of the body to drain "dirty" blood believed to cause sickness. Fruit potions such as the renowned red fruit potion (buah merah) are extremely popular. Holy water and prayers, and expensive Herbal Life vitamin supplements can also replace clinical treatments and ARV. Sometimes people who are already taking ARV abandon it to take expensive alternative medications because they are promised an immediate cure.

  • Public health clinic in Wamena, a developing town in the mountainous region of Papua. Currently, Wamena has 1,894-recorded HIV/AIDS cases and the number continues to rise. The main public health clinic in Wamena is busy, with over 200 patients a day seeking various forms of treatment. People who want to take an HIV test must line up in the morning and register with everyone else. The cramped HIV testing and counseling room is packed with several clients at a time, leaving no room for privacy and confidentiality. Counselors are unable to spend much time educating clients and addressing their questions. The inadequate lab that is responsible for HIV tests must also conduct tests for various other illnesses including malaria and tuberculosis. Thus, the overwhelming burden on both staff and facility reduces the quality of care. Despite an increasing desire from the public to get tested for HIV, the clinic limits testing to only 10 clients per day. The director of the clinic argues that the cap is necessary to maintain quality control and ensure accurate test results. Nevertheless, as many as 25 patients visit the clinic to get tested for HIV every day. Turned away, many of them are discouraged and do not return.

  • Becky's newborn son, Gabriel, is cradled to sleep. Becky is HIV-positive but she didn't take ARV during her pregnancy. Gabriel often gets sick and his frequent illnesses suggests that he is infected. In Papua there are more records of housewives infected with HIV than sex workers. In most cases, housewives contracted HIV from their husbands. As a result, many pregnant women who are unaware of their infection may pass HIV onto their infants. Fortunately, HIV testing on pregnant women is a mandatory practice conducted during prenatal care. Nevertheless, the transmission of HIV from mother to child still occurs, especially since many women have limited access to a clinic during their pregnancy.

  • Terry traveled hundreds of miles from his village in Lani Jaya to reach the main hospital in Wamena. His family paid over $100 to charter a vehicle for transportation. Already in the late stages of AIDS (Stage 4), Terry was carried onto a stretcher because he was too weak to walk. He had stopped taking his ARV medication because he lived too far from the health center that provided refills and follow-up care. Many health facilities that provide services and supports such as VCT clinics and antiretroviral medication (ARC) are mainly located in cities, far away from the majority of indigenous Papuans who live in rural villages. Due to PapuaÕs arduous terrain, these medical facilities are often only reachable by plane or sport utility vehicles. The high costs of fuel and expensive fare for transportation, means native Papuans living outside urban settings have limited access to essential care and treatment. In Jayawijaya, a mountainous region in Papua, the average cost for a round trip to a neighboring town on public transportation is as much as a person could earn in a day. Gas could cost up to $20 per gallon and one might have to travel a full day or more just to reach the nearest health center. As a result, those who are too sick to make the long journey or canÕt afford to pay for transportation end up without treatment. And those who are fortunate enough to get to a clinic or hospital often wait too long before making the trip. They arrive at the medical center in critical condition with little hope of surviving.

  • Nurse Febe checks the tonsil of an HIV-positive patient at Kalvary Klinil during a health examination. Opened in 2006, Klinik Kalvary has been providing quality care to mostly indigenous Papuans in Wamena. Their main focuses are tuberculosis, HIV/AIDS, and Sexual Transmitted Disease (STD). The clinic offers free Voluntary Counseling and Testing (VCT) for HIV/AIDS and ART (Anti- Retroviral Therapy) and they've helped hundreds of patients in the past. Many indigenous Papuans prefer to go to here than the overcrowded government public health clinic due to its quality care and attentive staffs. Despite its contribution, the clinic rarely receives government funding relies mostly on foreign donors to continue opening its doors and providing medical care to those in need.

  • Hilda weighs herself inside a local NGO in Wamena. She had gained 3kg (6.5lbs) after only staying in their temporary shelter for 2 weeks. Hilda walked 5 days from her village in Yahukimo to reach the town of Wamena. Hilda said she contracted HIV at the age of 11 when an older man raped her. When Hilda arrived in Wamena, she was already in the 2nd stage of HIV/AIDS, experiencing symptoms such as diarrhea and losing more than 10% of her body weight. Fortunately, an NGO field worker discovered her at the local clinic and offered a temporary shelter in the back of their office. The small room used to be a storage room but it now functions as a sanctuary for Hilda and another young girl. Adequate hospice support for people living with HIV/AIDS is lacking in both cities and rural regions of Papua. A hospice is essential in HIV/AIDS recovery by providing a place where a patient can receive constant care and long-term support. At times, a hospice also offers a sanctuary for those who are rejected or who face discrimination due to their status. For clients from rural areas who travel to cities to get treatment, a hospice provides a convenient temporary shelter. At the shelter, Hilda received constant care and nutritious food such as rice, vegetables, and fish. One of the biggest obstacles to recovery and rehabilitation among indigenous Papuans living with HIV/AIDS is the lack of adequate nutrition. Due to poverty and because many Papuans have moved away from a subsistence garden culture, many cannot afford to purchase wholesome and nutritious food. Papuans who are HIV-positive find it hard to work or tend their crops, and are incapable of earning enough money. Ultimately, because they don't receive sufficient vitamins, proteins and nutrients from their diet, many indigenous Papuans recover slowly when they are sick and find it difficult to keep their immune system and overall health strong.

  • Patients are seen through a small window queuing to register at the public health clinic in Wamena. Currently, Wamena has 1,894-recorded HIV/AIDS cases and the number continues to rise. The main public health clinic in Wamena is busy, with over 200 patients a day seeking various forms of treatment. People who want to take an HIV test must line up in the morning and register with everyone else. The cramped HIV testing and counseling room is packed with several clients at a time, leaving no room for privacy and confidentiality. Counselors are unable to spend much time educating clients and addressing their questions. The inadequate lab that is responsible for HIV tests must also conduct tests for various other illnesses including malaria and tuberculosis. Thus, the overwhelming burden on both staff and facility reduces the quality of care. Despite an increasing desire from the public to get tested for HIV, the clinic limits testing to only 10 clients per day. The director of the clinic argues that the cap is necessary to maintain quality control and ensure accurate test results. Nevertheless, as many as 25 patients visit the clinic to get tested for HIV every day. Turned away, many of them are discouraged and do not return.

  • The lab's counter at the public health clinic in Wamena. There are only 3 lab technicians working in the lab who are overwhelmed with the responsibility to test for various illnesses including sexual transmitted diseases, Tuberculosis, HIV, etc. In Papua, all indigenous Papuans have access to health insurance given by the provincial government, known as Jamkesmas or Jaminan Kesehatan Masyarakat Miskin that provides health care at no cost. However, lack of access to basic services, inadequate facilities, limited availability of medical equipment and medicines, and inexperienced health staff have made it difficult for indigenous Papuans to get tested for HIV/AIDS and receive quality assistance, counseling, and long-term care. Many health staff in Papua still lacks medical training to run and manage VCT clinics. In other places, even when health personnel have sufficient training, their clinics are often overcrowded and inadequate, lacking proper equipment such as testing reagents, centrifuge, HIV rapid tests, CD4 machines, antiretroviral therapies, and medicines to treat opportunistic infection.

  • Public Health Development Foundation (YPKM), a local NGO in Wamena, helps bring David who is in the late stages of AIDS to the hospital for immediate medical assistance. Along the way, he walked past a grave of a baby who died a month earlier from a sudden illness after contracting the HIV virus from the mother. David has been HIV-positive for almost 4 years. His wife is also HIV-positive and they are both taking ARV. However, David didn't take medication properly and his health declined. Living in a rural area of Lani Jaya, David's village lacks an adequate health facility, and he traveled hundreds of miles to Wamena to receive care. Staying in a relative's honai, David's condition worsened. Finally, YPKM, an NGO promoting the health of Papuans, chartered a vehicle to take David to the emergency room. Frail and in poor health, David barely made it to the hospital. His white blood cell count was dismal at 24, instead of a normal 700.

  • Dessy's (24) diary entry of her daughter's death, Yhoana. Dessy is HIV positive and she didn't take ARV medications during her pregnancy nor gave birth via Cesarean Section to reduce the probability of passing on the virus to the fetus. Yhoana died due to illness at the age of 2. Currently, Dessy is in poor health because she is still not taking medication. Her twin sister is also HIV positive. In Papua there are more records of housewives infected with HIV than sex workers. In most cases, housewives contracted HIV from their husbands. As a result, many pregnant women who are unaware of their infection may pass HIV onto their infants. Fortunately, HIV testing on pregnant women is a mandatory practice conducted during prenatal care. Nevertheless, the transmission of HIV from mother to child still occurs, especially since many women have limited access to a clinic during their pregnancy.

  • Family members watch helplessly as Mandisa (25) lose consciousness. No doctor was available to provide medical assistance. Mandisa (25) who is in the late stage of AIDS clings to her life. After being sick for many months, Mandisa's family finally brought her to the hospital to get medical treatment. Due to lack of experienced health staffs, family and friends must stay by her side the entire time. Her condition got worst over night and her body went into a state of shock and she lost consciousness.

  • Pastor Leo prays for an HIV-postive patient with Tuberculosis at Klinik Kalvary. The pastor sole responsibility is to provide spiritual support for every patient before they leave the clinic. Opened in 2006, Klinik Kalvary has been providing quality care to mostly indigenous Papuans in Wamena. Their main focuses are tuberculosis, HIV/AIDS, and Sexual Transmitted Disease (STD). The clinic offers free Voluntary Counseling and Testing (VCT) for HIV/AIDS and ART (Anti- Retroviral Therapy) and they've helped hundreds of patients in the past. Many indigenous Papuans prefer to go to here than the overcrowded government public health clinic due to its quality care and attentive staffs. Despite its contribution, the clinic rarely receives government funding relies mostly on foreign donors to continue opening its doors and providing medical care to those in need.

  • Family members hopelessly gather around Mandisa, as she lay unconscious at the brink on death. Doctors did all they could to save her. Mandisa (25) who is in the late stage of AIDS clings to her life. After being sick for many months, Mandisa's family finally brought her to the hospital to get medical treatment. Due to lack of experienced health staffs, family and friends must stay by her side the entire time. Her condition got worst over night and her body went into a state of shock and she lost consciousness.

  • Family members mourn the death of Eddie who just minutes ago died from AIDS. Eddie (30) was a schoolteacher in Jayapura. Despite his education and access to health facilities in the city, Eddie didn't seek medical treatment for HIV because he was afraid that his friends and family would find out about his status. Eddie returned to his village in Wamena when his health declined, and his immediate family cared for him. He stayed in a traditional hut (honai) and avoided clinical treatment. The virus progressed into the later stages of AIDS. When Eddie's condition became critical, his family finally brought him to the hospital and he arrived on the brink of death. His CD4 or white blood cell count was 1, when a normal person would have at least 700. Family members gathered everyday at his bedside, waiting for the inevitable. Despite doctors' attempt to stabilize his condition Eddie passed away within less than a week. Stigma significantly reduces the quality of life and increases the likelihood of suffering and mortality for indigenous Papuans living with HIV/AIDS. ODHA (Orang Dengan HIV/AIDS) is the Indonesian term used to label a person living with HIV/AIDS. This label has negative connotations since HIV/AIDS is often associated with, and viewed as a curse or retribution for personal misconduct and deviant behaviors such as sinful acts, alcoholism, promiscuity, "free sex" (seks bebas), and extra marital sex. Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS. Many who test positive for HIV do not seek essential care because they are afraid of stigma and discrimination. Consequently, fear of abuse, persecution and ostracism from family members and the wider community has made secrecy the primary concern for ODHA, rather than getting treatment.

  • Hospital staffs and family members carry the body of Eddie who died from AIDS. Eddie (30) was a schoolteacher in Jayapura. Despite his education and access to health facilities in the city, Eddie didn't seek medical treatment for HIV because he was afraid that his friends and family would find out about his status. Eddie returned to his village in Wamena when his health declined, and his immediate family cared for him. He stayed in a traditional hut (honai) and avoided clinical treatment. The virus progressed into the later stages of AIDS. When Eddie's condition became critical, his family finally brought him to the hospital and he arrived on the brink of death. His CD4 or white blood cell count was 1, when a normal person would have at least 700. Family members gathered everyday at his bedside, waiting for the inevitable. Despite doctors' attempt to stabilize his condition Eddie passed away within less than a week. Stigma significantly reduces the quality of life and increases the likelihood of suffering and mortality for indigenous Papuans living with HIV/AIDS. ODHA (Orang Dengan HIV/AIDS) is the Indonesian term used to label a person living with HIV/AIDS. This label has negative connotations since HIV/AIDS is often associated with, and viewed as a curse or retribution for personal misconduct and deviant behaviors such as sinful acts, alcoholism, promiscuity, "free sex" (seks bebas), and extra marital sex. Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS. Many who test positive for HIV do not seek essential care because they are afraid of stigma and discrimination. Consequently, fear of abuse, persecution and ostracism from family members and the wider community has made secrecy the primary concern for ODHA, rather than getting treatment.

  • Eddie's casket is lowered into the ground. Hundreds of people including family members, friends, neighbors, colleagues, and students attended his funeral. Eddie (30) was a schoolteacher in Jayapura. Despite his education and access to health facilities in the city, Eddie didn't seek medical treatment for HIV because he was afraid that his friends and family would find out about his status. Eddie returned to his village in Wamena when his health declined, and his immediate family cared for him. He stayed in a traditional hut (honai) and avoided clinical treatment. The virus progressed into the later stages of AIDS. When Eddie's condition became critical, his family finally brought him to the hospital and he arrived on the brink of death. His CD4 or white blood cell count was 1, when a normal person would have at least 700. Family members gathered everyday at his bedside, waiting for the inevitable. Despite doctors' attempt to stabilize his condition Eddie passed away within less than a week. Stigma significantly reduces the quality of life and increases the likelihood of suffering and mortality for indigenous Papuans living with HIV/AIDS. ODHA (Orang Dengan HIV/AIDS) is the Indonesian term used to label a person living with HIV/AIDS. This label has negative connotations since HIV/AIDS is often associated with, and viewed as a curse or retribution for personal misconduct and deviant behaviors such as sinful acts, alcoholism, promiscuity, "free sex" (seks bebas), and extra marital sex. Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS. Many who test positive for HIV do not seek essential care because they are afraid of stigma and discrimination. Consequently, fear of abuse, persecution and ostracism from family members and the wider community has made secrecy the primary concern for ODHA, rather than getting treatment.

  • A boy is seen on a beach at unset in Sorong, a city with the highest HIV/AIDS infection in West Papua. This epidemic, if unchecked, threatens their survival and jeopardizes the longevity of their future generations.

Info of 40 Thumbs