Social, cultural and political factors in the design of HIV programmes with Papuan highland communities

Abstract

The Indonesian province of Papua faces a growing HIV epidemic, particularly amongst remote highland Papuans, such as the Western Dani. The specific, challenging political and sociocultural context of Papuan highland communities greatly influences the transmission of HIV. Different initiatives have struggled to meet the sexual and reproductive health needs of Papuan communities and of minority ethnic communities and the challenges they pose. The prolonged cultural tensions between Papuan and Indonesian communities are a major barrier to effective dialogue between the Indonesian state and its minority ethnic communities, the absence of which only exacerbates the epidemic. Tackling HIV in Papua requires responses that are both culturally and politically sensitive, in direct challenge to existing development paradigms.

La province indonésienne de Papouasie fait face à une épidémie croissante de VIH, en particulier parmi les Papous des hautes terres lointaines, comme les Dani de l'Ouest. Le contexte socio-culturel et politique complexe, spécifique aux communautés des hautes terres, est un facteur important de transmission du VIH. Différentes initiatives tentent de répondre aux besoins en santé sexuelle et reproductive des communautés papoues et des minorités ethniques, et aux défis posés par ceux-ci. Les tensions culturelles toujours présentes entre les communautés papoues et indonésiennes constituent un obstacle majeur à un dialogue effectif entre l'État indonésien et les minorités ethniques dans le pays, sans lequel l'épidémie du VIH s'aggrave. S'attaquer au VIH en Papouasie exige des réponses qui tiennent compte aussi bien des cultures que de la politique, ce qui constitue une remise en question directe des paradigmes de développement existants.

La provincia indonesia de Papúa atraviesa una creciente epidemia del virus del sida, en concreto entre los papúes de tierras altas remotas, tales como Dani Occidental. El complejo contexto polı´tico sociocultural especı´fico de las comunidades de tierras altas de Papúa influye en gran medida en la transmisión del VIH. Las diferentes iniciativas han tenido dificultades a la hora de responder a las necesidades sanitarias en materia sexual y reproductiva de las comunidades de Papúa y las comunidades de minorúas étnicas y hallar respuestas a los desafúos que plantean estas necesidades. Las prolongadas tensiones culturales entre las comunidades de Papúa e Indonesia representan un obstáculo importante para un diálogo eficaz entre el estado indonesio y sus comunidades de minorúas étnicas, una carencia que no hace más que agravar la epidemia. Para solucionar el problema del VIH en Papúa son necesarias respuestas que tengan en cuenta los diferentes factores culturales y polı´ticos, en directo desafı´o a los actuales paradigmas del desarrollo.

Keywords:

• HIV prevention
• Papua
• minority ethnic communities
• Dani

Acknowledgements

The authors would like to thank Médecins du Monde and STOP AIDS NOW! for their support and collaboration in preparing this paper. While the ideas presented are those of the authors alone, the facilitation of both organisations in accessing field information was of vital importance. The authors would like to thank MdM and UNEP/GRID-Arendal Maps and Graphic Library for the authorisation to use their visual materials in this article. The authors particularly would like also to thank Patricia Gaillard-Olokose (MdM), Niklas Luhmann (MdM) and Nienke Westerhof (STOP AIDS NOW!) for their input and, above all, Pauline Oosterhoff and Joanna White for their attention and support.

Notes

^1. At the same time, many Indonesians define themselves as the antithesis of Papuans.

^2. The names of local Papuans attached to quotes in this article are fictitious in order to preserve anonymity.

^3. A concentrated epidemic is one in which HIV prevalence is above 5% in any sub-population at higher risk of infection, such as sex workers, drug users etc.

^4. ‘Free sex’ or ‘sex bebas’ in Bahasa Indonesia is the expression for sexual intercourse outside marriage.

^5. The sexual and reproductive health project described here was part of the Gender Development Project (GDP) of STOP AIDS NOW! The GDP integrates promotion of gender equality and women's rights in HIV work.