Can You Keep a Secret? Pretences of Confidentiality in HIV/AIDS Counseling and Treatment in Eastern Indonesia

Abstract

A critical feature of contemporary interventions of HIV is the provision of voluntary counseling and testing. Protecting the confidentiality of the client is a lynchpin of successful counseling. This article explores the teaching and implementation of the concept of confidentiality in highlands Papua, Eastern Indonesia. Results of participant observation and in-depth interviews with clinic staff in 2009 and 2010 show that confidentiality is an ideal poorly taught and systematically violated in practice. Identifying, labeling, and regulating HIV-positive persons appears more important than enacting the humanitarian and moral imperative of protecting client rights. Confidentiality becomes the means to enact dividing practices and to create categories of persons—those who choose to adhere to therapies and those who do not. The implications of this pattern are discussed with reference to wider humanitarian initiatives.

Key Words:

• confidentiality
• counseling
• humanitarianism
• Indonesia
• Papua

ACKNOWLEDGMENTS

The research project “Women, Stigma, and AIDS in Highlands Papua” was funded by the Social Sciences and Humanities Research Council of Canada. I am grateful to Jack Morin of UNCEN for sponsoring and supporting this project in all of its phases; to Gerdha Numbery, Ibrahim Peyon, and Andreas Goo for contributing their outstanding research skills to this project; and to Richard Eves, Lisa Mitchell, and Jenny Munro for providing constructive feedback on earlier versions of this article.

Notes

In 2003, the Indonesian province of Papua was divided into two provinces, Papua and West Papua. This article discusses the new province of Papua.

Indigenous anthropologists from Universitas Cenderawasih (UNCEN) collaborated with the lead author and a graduate student from the University of Victoria to conduct participant observation and in-depth interviews with 31 HIV-positive persons and 19 health care staff.

National production of ARTs is done by Kimia Farma, a company contracted by the Ministry of Health. First-line medications produced in-country are Zidovudine, Nevirapine, and Lamivudine.

Based on a seven percent estimate of 8750 infected persons out of a total adult population of 125,000 in Jayawijaya district.

These include the standard booklet for case manager courses (Dinas Kesehatan and FHI 2007) and training workshops (Departemen Kesehatan RI 2006; Departemen Kesehatan RI 2004; Departemen Kesehatan RI 2003).

These include good food, health care, good quality of life, ARTs, giving and getting love, money, housing, clothes, support groups, medical information, condoms, support to stay on therapy, home care, spiritual assistance, knowledge of mother to child transmission, support from family, and support for family.

I also observed many VCT staff adhere to protocol. One worker hid the results of a blood test while talking to me. Another case manager was scrupulous in how she talked about her cases. And the case worker who had been asked to bring in a list of her clients for a workshop refused to do so.

Redfield (2008) suggested this phrase is a truism among humanitarian workers.

Additional information

Notes on contributors

Leslie Butt

LESLIE BUTT is Associate Professor in the Department of Pacific and Asian Studies at the University of Victoria, British Columbia, Canada. She is co-editor with Richard Eves of Making Sense of AIDS: Culture, Power, and Sexuality in Melanesia (2008), and has published widely on health, sexuality, and HIV/AIDS in Papua, Indonesia.