Fighting HIV/AIDS in High-Risk Areas

Harjana Nanang Suryadi is the sexually transmitted infections coordinator of the Rimba Melintang public health center in Riau.

KOMPAS/SYAHNAN RANGKUTI

Harjana Nanang Suryadi with his wife Dewi Marisa Sari.

He looks like the average man, like millions of others. With his crew cut, he exudes self-assurance and grit in facing many kinds of people. His name is Harjana Nanang Suryadi, a health officer who often goes undercover to monitor HIV/AIDS high-risk areas (HRA).

Harjana Nanang Suryadi, or Nanang as his family and friends call him, is the sexually transmitted infections (STIs) coordinator of the Rimba Melintang public health center in Rokan Hilir regency, Riau, some 200 kilometers north of the capital of Pekanbaru. His main job is to reduce the risk of HIV/AIDS transmission.

In fulfilling his duties, the 40-year-old father of three must often dive into the world of prostitution. On Monday evening (27/11), Kompas accompanied him in visiting a number of HRA along Jl. Lintas Timur, Sumatra’s eastern highway. He called these areas “hotspots”.

That evening, he visited several small shops and cafes with many trucks parked outside. These establishments are known to offer female sex workers. Most of these places have wooden walls and roofs made of sheet-metal, asbestos or palm leaves.

Inside these huts are “execution rooms”, the local term for a place for a sex worker’s place of business, which are 8-12 square meters. There are no bathrooms inside. Nor are there any expensive, soft beds, only a thin foldable mattress placed directly on the floor. The rooms are generally filthy, dimly lit and stuffy.

“There are up to 113 hotspots in Rokan Hilir, spread across 15 districts on the roadside, near residential homes and along the coast. In the past five years, up to 200 local people have gotten HIV/AIDS. In our region, 24 people lived with HIV/AIDS and nine of them died,” said Nanang.

After the night’s monitoring, Nanang and his team, which includes his wife Dewi Marisa Sari, hold routine daily trainings on a healthy sexual behavior. He also routinely arranges blood tests for people at risk for HIV/AIDS infection, and distributes condoms at predetermined locations. Throughout these activities, Nanang maintains a firm composure, even though he often faces local thugs who guard these spots.

The Riau health agency’s data shows that Rokan Hilir had seven new HIV cases as of October 2017. One of these was diagnosed at the Rimba Melintang public health center. However, Nanang said that the patient was referred there from a neighboring health center.

New recruits

What activities do Nanang and his team undertake to combat HIV?

All public health centers in the country are tasked with monitoring HIV/AIDS. However, not all centers have an active HIV/AIDS team. The healthcare officers at most of these centers often wait passively for patients to come in. Afterwards, they wait for the next patients to visit. If no patients visit, no disease management is carried out.

At the Rimba Melintang public health center, things are decidedly different. Nanang’s team actively visits and monitors the local “hotspots”. If they encounter people living with HIV/AIDS, they provide direct counseling. If patients do not return after their first treatment, the officers visit them at home.

“We do not wait. We establish networks, especially with patients’ families or colleagues to support our work. They help us monitor the patients’ progress and remind them to take their medicines, as well as other activities,” said Nanang.

Before, he said, it was difficult to monitor sex workers with HIV/AIDS. After being treated once or twice, they usually disappeared and moved to new locations. “Now, we hold counseling for our sex worker patients. We approach their handlers. If the sex workers move away, we give them a reference letter for the health center in their new location,” Nanang said.

In order to foster close relationships among his patients, Nanang and his team establish groups. In collaboration with senior volunteer Warsinah, 50, they gathered 20 people living with HIV/AIDS and other STIs in Mukti Jaya village, along with their families. Some patients had contracted HIV/AIDS from their spouses.

The group often holds sharing sessions at which members remind each other not to give up hope, and to continue their treatments. The group also learns how to create handcrafts for sale, including bags, wallets, brooches and other accessories. The group has gained popularity in Rokan Hilir over the past three years.

“The members’ income isn’t steady. However, when we receive many orders, they can take home between Rp 3 million (US$222) and Rp 4 million a month,” Warsinah said.

Nanang also initiated a Peer Support Group (KDS) for lesbian, gay, bisexual and transgender (LGBT) patients. These patients tend to keep to themselves most of the time, and are only open to suggestions from the trusted seniors in their group.

Undergraduate thesis

Why was Nanang drawn to HIV/AIDS programs?

This is closely linked to the undergraduate thesis he completed in 2006 at the Health Sciences College in Jambi. He researched the effectiveness of government programs in relation to localized HIV/AIDS management.

“There was a gap. The National AIDS Commission data recorded success, but things were different in the field. Many sex workers with HIV that I interviewed had never received any counseling or treatment,” Nanang said.

In 2013, Nanang finally dove into HIV/AIDS management after he was appointed as the STIs coordinator. The health center then developed into a specialized HIV/AIDS clinic.

What is the difference between the Rimba Melintang public health center and others in managing HIV/AIDS? According to Nanang, Rimba Melintang has doctors and healthcare workers who are well prepared, quick to respond, skillful and proactive. The health center is also fully equipped for treating HIV and has complete test kits.

However, stopping the transmission of HIV will not depend only by the hard work of health officers like Nanang. The high circulation of money in unmonitored hotspots, cafes and dimly lit shops remains the main cause of the spread of HIV/AIDS.