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  • A boy is seen on a beach at sunset in Sorong, a city with the highest HIV/AIDS infection in West Papua.<br />
<br />
40 percent of all HIV/AIDS cases in Indonesia are found in Papua. 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 and they are living and dying in the midst of the fastest growing epidemic in Asia.  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. This epidemic, if unchecked, threatens their survival and jeopardizes the longevity of Indigenous Papuans' future generations.
    Against All Odds_40.JPG
  • A boy is seen on a beach at unset in Sorong, a city with the highest HIV/AIDS infection in West Papua.<br />
<br />
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.The people of Papua are living and dying in the midst of the fastest growing epidemic in Asia.  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. This epidemic, if unchecked, threatens their survival and jeopardizes the longevity of their future generations.
    AgainstAllOdds_Color_40.JPG
  • Mountainous terrain of Papua seen from above.<br />
<br />
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.The people of Papua are living and dying in the midst of the fastest growing epidemic in Asia.
    XD1A8320.jpg
  • L-R: Roni (26) and Mecky (18), each wearing an apron with a diagram of the male and female reproduction organs, participate in a sexual reproduction and HIV/AIDS educational training conducted by the Public Health Development Foundation (YPKM).<br />
<br />
In Papua young teenagers are already having sex but HIV/AIDS education are still lacking. GIDI Baptist Church invited teenagers from surrounding villages in Wamena for a weeklong crash course on sex education, family planning, condom, sexual transmitted diseases (STD), and HIV/AIDS. These young adults will return to their villages to serve as peer counselors and provide information and support. However, despite the program's effectiveness, YPKM is lacking funding to continue this important educational course.<br />
<br />
For many Papuan youths, their first sexual encounter can take place during their early teenage years.  Some are sexually active by the time they reach puberty.  Life Skills Education (LSE), a curriculum designed by UNICEF that provides education on human reproduction, pregnancy, sex, Sexual Transmitted Diseases, and HIV/AIDS is taught in many high schools throughout Papua.  However, this essential educational course is mainly available in schools located in cities but not in rural areas.  Moreover, LSE does not reach many indigenous Papuan youths because many of them are not able to attend high school.  In most cases teachers responsible for teaching this course lack sufficient training and essential materials, such as books with up-to-date information and visual aids, to adequately educate their students.  They often encourage their students to seek additional information on the Internet.  Also, detailed information on condoms is regularly excluded in lectures and reading materials because of the general perception that it will endorse pre-marital sex.  As a result, students carry incomplete information, misconceptions and misunderstandings into adulthood, which increases their vulnerability to the epidemic.
    AgainstAllOdds_Color_13.JPG
  • L-R: Roni (26) and Mecky (18), each wearing an apron with a diagram of the male and female reproduction organs, participate in a sexual reproduction and HIV/AIDS educational training conducted by the Public Health Development Foundation (YPKM).<br />
<br />
In Papua young teenagers are already having sex but HIV/AIDS education are still lacking. GIDI Baptist Church invited teenagers from surrounding villages in Wamena for a weeklong crash course on sex education, family planning, condom, sexual transmitted diseases (STD), and HIV/AIDS. These young adults will return to their villages to serve as peer counselors and provide information and support. However, despite the program's effectiveness, YPKM is lacking funding to continue this important educational course.<br />
<br />
For many Papuan youths, their first sexual encounter can take place during their early teenage years.  Some are sexually active by the time they reach puberty.  Life Skills Education (LSE), a curriculum designed by UNICEF that provides education on human reproduction, pregnancy, sex, Sexual Transmitted Diseases, and HIV/AIDS is taught in many high schools throughout Papua.  However, this essential educational course is mainly available in schools located in cities but not in rural areas.  Moreover, LSE does not reach many indigenous Papuan youths because many of them are not able to attend high school.  In most cases teachers responsible for teaching this course lack sufficient training and essential materials, such as books with up-to-date information and visual aids, to adequately educate their students.  They often encourage their students to seek additional information on the Internet.  Also, detailed information on condoms is regularly excluded in lectures and reading materials because of the general perception that it will endorse pre-marital sex.  As a result, students carry incomplete information, misconceptions and misunderstandings into adulthood, which increases their vulnerability to the epidemic.
    AgainstAllOdds_Final_13.JPG
  • Students listen to a lecture on HIV/AIDS at SMA Negeri 1, a government high school in Jayapura, capital of Papua. The course is taught by a teacher who only had 1 week of training and without books or visual help.<br />
<br />
For many Papuan youth, a first sexual encounter can take place during their early teenage years, and some are sexually active by the time they reach puberty in their mid-teens.  Life Skills Education (LSE), a curriculum that covers education on human reproduction, pregnancy, sex, STDs, and HIV/AIDS designed by UNICEF is taught in many high schools throughout Papua.  However, this essential educational course is only available in schools located in cities but not in rural areas.  Moreover, LSE doesn't reach many indigenous Papuan youth because many young Papuans are not able to attend high school.  Additionally, many teachers lack sufficient training and essential materials such as books with up-to-date information and visual aids to adequately educate their students.  Often, they encourage their students to seek additional information on the Internet.  Detailed information on condoms is regularly excluded in lectures and reading materials because of the general perception that it will endorse pre-marital sex.  Students carry incomplete information, misconceptions and misunderstandings into adulthood, which increase their vulnerability to the epidemic.
    AgainstAllOdds_Final_12.JPG
  • Family members watch helplessly as Mandisa (25) lose consciousness. No doctor was available to provide medical assistance.<br />
<br />
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 a lack of experienced health staff, family and friends must stay by her side the entire time.  Her condition suddenly deteriorated overnight and her body went into a state of shock and she lost consciousness.
    Against All Odds_41.JPG
  • Hilda weighs herself inside the office of a local NGO in Wamena.  She has gained 3kg (6.5 lbs) and she has started taking ARV only after staying in their temporary shelter for 2 weeks.<br />
<br />
Hilda walked five days from her village in Yahukimo to reach the town of Wamena. Hilda said she contracted HIV at the age of 11 after an older man raped her.  When she arrived in Wamena, she was already in the second stage of AIDS experiencing symptoms of diarrhea and losing more than 10% of her body weight.  Fortunately, an NGO field worker from YPKM discovered her at the local clinic and offered her a room in the back of their office.  The small room was initially used for storage but now functions as a temporary shelter for Hilda and another young girl.  At the shelter, Hilda receives constant care and nutritious food such as rice, vegetables, and fish. <br />
<br />
Adequate long-term 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 because it provides a place where patients can receive constant care and support.  For patients who have to travel to cities to get treatment, a hospice provides a convenient temporary shelter.  At times, a hospice also offers a sanctuary for those with HIV/AIDS who are rejected or face discrimination due to their status.  <br />
<br />
One of the biggest obstacles to recovery and rehabilitation for 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 or consume wholesome foods.  Papuans who are HIV-positive find it extremely difficult to work or tend their crops.  Consequently, indigenous Papuans do not receive sufficient vitamins, proteins and nutrients from their diet.  When they fall sick Papuans recover at a much slower pace and most find it extremely challenging to stay healthy.
    AgainstAllOdds_Color_30.JPG
  • Dewi's lifeless body is carried onto the cremation pyre by her uncle.   <br />
<br />
Dewi (20) was a young wife who died from AIDS after contracting HIV from her husband.  Dewi kept her HIV status a secret from her family.  Dewi's family, who were unaware of her real illness, used a traditional healing method of cutting parts of 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, has 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.<br />
<br />
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 condom to avoid drawing suspicion.  As a result, the HIV virus is often passed between spouses.
    AgainstAllOdds_Color_01.JPG
  • 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.<br />
In Papua, all indigenous Papuans have access to health insurance, called Jamkesmas or Jaminan Kesehatan Masyarakat Miskin, provided at no cost by the provincial government. However, 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, and medicines to treat opportunistic infection and antiretroviral therapies.
    Against All Odds_30.JPG
  • The statue of General McArthur at Imbi Park, a popular place to buy sex in Jayapura.
    HIV/AIDS_Papua56.jpg
  • A young mother with HIV is seen wearing a necklace with a picture of Jesus Christ and a sweater that reads, “I love Papua.”
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  • Terry is seen inside the Emergency Room of Wamena’s hospital.  Terry (25) had stopped taking his ARV medication because he lived too far from the health center that provided refills and follow-up care.<br />
<br />
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.   <br />
<br />
<br />
Many health facilities that provide services and support for HIV/AIDS are located mainly in cities, far away from the majority of indigenous Papuans who live in rural villages.  Due to Papua's arduous terrain, these health centers are often reachable only by planes or sport utility vehicles.  However, the high costs of fuel and expensive fare for transportation means that native Papuans living outside urban settings have limited access to essential care and treatment.<br />
<br />
In Jayawijaya, a mountainous region in central Papua, the average cost for a round trip on public transportation to a neighboring town could cost as much as one's daily earning.  Gas can 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 cannot 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.  In many cases, they arrive at the medical center in critical condition with little hope of surviving.
    _MG_6666.jpg
  • Terry’s mother looks after her son who is in the late stages of AIDS (Stage 4) inside the Emergency Room.  Terry (25) had stopped taking his ARV medication because he lived too far from the health center that provided refills and follow-up care.<br />
<br />
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.   <br />
<br />
<br />
Many health facilities that provide services and support for HIV/AIDS are located mainly in cities, far away from the majority of indigenous Papuans who live in rural villages.  Due to Papua's arduous terrain, these health centers are often reachable only by planes or sport utility vehicles.  However, the high costs of fuel and expensive fare for transportation means that native Papuans living outside urban settings have limited access to essential care and treatment.<br />
<br />
In Jayawijaya, a mountainous region in central Papua, the average cost for a round trip on public transportation to a neighboring town could cost as much as one's daily earning.  Gas can 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 cannot 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.  In many cases, they arrive at the medical center in critical condition with little hope of surviving.
    _MG_6630.jpg
  • A freshly killed pig that David purchased for $300 to conduct the adat ritual. <br />
<br />
One of the most common practices in the highlands to diagnose and cure HIV is by conducting a traditional ritual termed adat.  This involves killing a pig and examining its blood, heart, lungs, and kidney.  After cutting the pig open and inspecting its internal organs, the practitioners of adat remove what they interpret as parasites or cancerous parts that they believe caused the sickness.  Cleaning the pig's flesh by washing it with water would also "cure" the person's illness.  Performing the adat ritual is expensive since a pig can cost hundreds of dollars.  The treatment does not work despite the strong cultural belief behind it.  In the end, after killing numerous pigs and spending a fortune, many people give up hope.  By the time they finally decide to go to the hospital, their condition is too critical with little chance for survival.<br />
<br />
Due to a lack of HIV/AIDS education, limited access to health services, and strong pre-existing cultural beliefs about illness, many Papuans who are desperate for a cure turn to alternative medicines and traditional methods of healing.  Sometimes it involves cutting different parts of the body to drain "dirty" blood believed to cause the sickness.  Fruit potions such as the renowned red fruit potion (buah merah) are also extremely popular for its perceived healing capability.  In some cases, those who are already taking ARV medication abandon it to take expensive alternative medications such as Herbal Life vitamin supplements because they are promised an immediate cure.
    _MG_4598.jpg
  • David’s family members examine the pig’s internal organs to search for the cause of his illness during the adat ritual. <br />
<br />
One of the most common practices in the highlands to diagnose and cure HIV is by conducting a traditional ritual termed adat.  This involves killing a pig and examining its blood, heart, lungs, and kidney.  After cutting the pig open and inspecting its internal organs, the practitioners of adat remove what they interpret as parasites or cancerous parts that they believe caused the sickness.  Cleaning the pig's flesh by washing it with water would also "cure" the person's illness.  Performing the adat ritual is expensive since a pig can cost hundreds of dollars.  The treatment does not work despite the strong cultural belief behind it.  In the end, after killing numerous pigs and spending a fortune, many people give up hope.  By the time they finally decide to go to the hospital, their condition is too critical with little chance for survival.<br />
<br />
Due to a lack of HIV/AIDS education, limited access to health services, and strong pre-existing cultural beliefs about illness, many Papuans who are desperate for a cure turn to alternative medicines and traditional methods of healing.  Sometimes it involves cutting different parts of the body to drain "dirty" blood believed to cause the sickness.  Fruit potions such as the renowned red fruit potion (buah merah) are also extremely popular for its perceived healing capability.  In some cases, those who are already taking ARV medication abandon it to take expensive alternative medications such as Herbal Life vitamin supplements because they are promised an immediate cure.
    _MG_4718.jpg
  • Mama Yuli socializes with her friends after the Sunday sermon. <br />
<br />
In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds). With ARV she is now healthy to work and support her family.<br />
<br />
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 started providing ARV therapies in 2003. In that year only 7 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% of those with HIV/AIDS are undergoing ARV therapy.<br />
<br />
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 provide misleading information and perception such as "there is no medicine for HIV/AIDS."<br />
<br />
As a general practice health personnel often evaluate patients for their adherence in taking their medication and keeping up with appointments before allowing them to undergo ARV therapy. Indigenous Papuans tend to fall short of this assessment and fail to return for their check-up because many of them live too far from the health centers.  At times, they do not fully understand the benefits of ARV medication and the importance of taking them properly due to poor counseling from the health staff.  Also, many of them are unable to keep their appointments or take medication regularly because they still keep their status a secret from their immediate family members or spouse.
    _MG_8303.jpg
  • Young men drying after bathing in Wouma river in Wamena.<br />
<br />
Scenery (establishing shots)
    AAO_Scans2_250.JPG
  • Young Papuans play soccer in an empty field near the airport in Wamena.
    AAO_Scans2_343.jpg
  • Women from Pugima, a village in the Baliem Valley, are seen walking home.  Only vehicles with 4-wheel drive could navigate through the difficult terrain.<br />
<br />
Rough terrain, lack of transportation means, and the high cost of fuel and transportation are some of the biggest obstacles for people with HIV/AIDS to overcome in order to reach health facilities to get necessary care and medication.  Most Voluntary Counseling and Testing (VCT) clinics and ARV medication are available only in cities that are hundreds of miles away from villages.
    AAO_Scans2_106.JPG
  • Yukemdi hands out educational pamphlets on HIV/AIDS and condoms to Papuan men 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 dialects. The pamphlet also does not 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.<br />
<br />
Awareness of HIV/AIDS is very low among indigenous Papuans because educational materials remains inadequate and information is delivered inefficiently.  For example, billboards related to HIV/AIDS in Jayapura rarely mention condoms as an effective way to reduce or prevent infection nor do they provide locations to the nearest Voluntary Counseling and Testing center (VCT).  Therefore, despite their strategic placement in crowded markets and busy streets, billboards are not as effective in promoting awareness and providing reliable information.  Other HIV/AIDS educational materials used in Papua such as pamphlets are often ineffective in reaching indigenous Papuans because their content frequently uses images of non-Papuans, which Papuans do not relate to.  Furthermore, many indigenous Papuans have limited literacy and these booklets mainly use Bahasa Indonesia rather than the local dialects.<br />
<br />
Better methods of education and more effective ways of delivering information on HIV/AIDS need to be implemented in Papua in order to effectively raise awareness and provide accurate and reliable information.  This is an essential step to educate and empower the public to make informed decisions and reduce their vulnerability to HIV infection.
    AgainstAllOdds_MG_2241.JPG
  • Nurse Febe checks the tonsil of an HIV-positive patient at Kalvary Klinil during a health examination.<br />
<br />
Opened in 2006, Klinik Kalvary has been providing quality care to mostly indigenous Papuans in Wamena and they've helped hundreds of patients in the past.  They focus on diseases such as 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).  Many indigenous Papuans prefer to go to here than the overcrowded government public health clinic due to its quality care and attentive staffs. Nevertheless, the clinic rarely receives government funding and relies mostly on foreign donors to continue opening its doors to provide medical care to those in need.
    Against All Odds_28.JPG
  • Hospital staffs and family members carry Eddy's body to be transported back to his village.  <br />
<br />
Eddie (30) was a schoolteacher in Jayapura.  Despite his education and access to health facilities in the city, Eddie did not seek medical treatment when he was diagnosed with HIV because he was afraid that his friends and family members would find out.  Instead, Eddie returned to his village when his health declined.  He stayed in his parents' honai but kept his illness a secret and did not seek clinical treatment.  The virus progressed into the later stages of AIDS.  When Eddie's condition became life threatening, his family finally brought him to the hospital and he arrived in critical condition.  His CD4 or white blood cell count was 1, when a typical count is 700.  Family members gathered everyday at his bedside, waiting and praying.  Despite doctors' attempt to stabilize his condition Eddie passed away in less than a week.  Eddie's body was brought back to his village. Family members, friends, and neighbors mourned his death.  The following day, Eddie was buried and hundreds of people, including colleagues and students, attended his funeral.<br />
<br />
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 term often used to label a person living with HIV/AIDS.  This label has a negative connotation since HIV/AIDS is frequently associated with dishonor and death and it is often viewed as a curse or retribution for sins or deviant behaviors such as alcoholism, promiscuity, and extra marital sex.  Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS.  Consequently, fear of abuse, persecution, and ostracism from family members and the wider community has made secrecy the primary concern for ODHA rather than seeking treatment.
    AgainstAllOdds_Color_38.JPG
  • Eddie's mother and aunt mourn his lifeless body just moments after he died from AIDS.<br />
<br />
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.<br />
<br />
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 term often used to label a person living with HIV/AIDS.  This label has a negative connotation since HIV/AIDS is frequently associated with dishonor and death and it is often viewed as a curse or retribution for sins or deviant behaviors such as alcoholism, promiscuity, and extra marital sex.  Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS.  Consequently, fear of abuse, persecution, and ostracism from family members and the wider community has made secrecy the primary concern for ODHA rather than seeking treatment.
    AgainstAllOdds_Color_37.JPG
  • Patients are seen through a small window queuing to register at the public health clinic in Wamena.<br />
<br />
Wamena currently has 1,894-recorded HIV/AIDS cases, and the number continues to rise.  The main public health clinic in Wamena is swamped with over 200 patients a day seeking various forms of health treatment.  Those who want to get tested for HIV 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 patients and addressing their questions.  The lab responsible for processing the HIV test must also conduct lengthy tests for various illnesses including malaria and tuberculosis.  The overwhelming burden on both the staff and the facility reduces the quality of care.  Despite an increasing desire from the public to get tested for HIV, the clinic limits HIV testing to only 10 patients per day.  The director of the clinic believes that the cap is necessary to maintain quality control and ensure accurate test results.  Nevertheless, sometimes as many as 25 patients visit the clinic to get tested for HIV.  When they are turned away, many patients are discouraged to return.
    AgainstAllOdds_Color_29.JPG
  • Gary takes a shower as he prepares to go to school. <br />
<br />
Gary is 11 years old and he is HIV-positive.  Gary lost both of his parents to AIDS and he has been taking ARV regularly since the age of four.  Currently, Gary lives with his grandmother and younger cousin.  To support her grandchildren, Gary's grandmother sells betel nut in front of the house earning $2-3 per day.  Due to her meager income Gary's grandmother is unable to buy wholesome and nutritious food and vitamins to help maintain his health and growth.  Last year the Department of Social Services had to suddenly stop providing milk for Gary.  Fortunately, Sorong Sehati, a local community group in Sorong financed by 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 the clinic for check-ups and ARV refills.  At one point, Gary experienced discrimination at school when his teacher forced him to sit in the back to isolate him from the other students.  Sorong Sehati intervened by providing HIV/AIDS education to the schools' faculty including Gary's teacher.  Now Gary sits in the front of the class and he hopes to be a doctor one day so he can help people like him.
    AgainstAllOdds_Color_19.JPG
  • Becky's newborn son, Gabriel, is cradled to sleep. Becky is HIV-positive but she did not take ARV during her pregnancy. Gabriel often gets sick and his frequent illnesses suggest that he is infected. <br />
<br />
In Papua there is a higher recorded number of housewives infected with HIV than sex workers.  In most cases, housewives contracted HIV from their husbands.  Pregnant wives who are unaware that they are infected with HIV often pass the virus onto their infants.  Fortunately, HIV testing on pregnant women is a mandatory practice conducted during pre-natal care.  Nevertheless, the transmission of HIV from mother to child still occurs, especially since many women still have limited access to health services and pre-natal care.
    AgainstAllOdds_Color_26.JPG
  • Unconscious, a tear rolls off Mandisa's face as she lay on the hospital bed at the brink of death. <br />
<br />
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 a lack of experienced health staff, family and friends must stay by her side the entire time.  Her condition suddenly deteriorated overnight and her body went into a state of shock and she lost consciousness.<br />
<br />
In Papua, all indigenous Papuans have access to health insurance, called Jamkesmas or Jaminan Kesehatan Masyarakat Miskin, provided at no cost by the provincial government. However, 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 Voluntary Counseling and Testing (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, and medicines to treat opportunistic infection and antiretroviral therapies.  In some cases, health care workers fail to monitor and maintain the availability of necessary supplies and medicines to avoid shortages.
    AgainstAllOdds_Color_21.JPG
  • 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 dialects.<br />
<br />
Awareness of HIV/AIDS is very low among indigenous Papuans because educational materials remains inadequate and information is delivered inefficiently.  For example, billboards related to HIV/AIDS in Jayapura rarely mention condoms as an effective way to reduce or prevent infection nor do they provide locations to the nearest Voluntary Counseling and Testing center (VCT).  Therefore, despite their strategic placement in crowded markets and busy streets, billboards are not as effective in promoting awareness and providing reliable information.  Other HIV/AIDS educational materials used in Papua such as pamphlets are often ineffective in reaching indigenous Papuans because their content frequently uses images of non-Papuans, which Papuans do not relate to.  Furthermore, many indigenous Papuans have limited literacy and these booklets mainly use Bahasa Indonesia rather than the local dialects.<br />
<br />
Better methods of education and more effective ways of delivering information on HIV/AIDS need to be implemented in Papua in order to effectively raise awareness and provide accurate and reliable information.  This is an essential step to educate and empower the public to make informed decisions and reduce their vulnerability to HIV infection.
    AgainstAllOdds_Color_14.JPG
  • A portrait of  Mecky (18) wearing an apron with a diagram of woman's reproduction organ...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.
    AgainstAllOdds_Color_13.JPG
  • Passengers wait to depart and embark at the seaport in Jayapura, the capital of Papua, which is the main entry point for goods and migrants entering and exiting the region.<br />
<br />
Papua is a vast province 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; double that of the national average.  Papua was acquired by Indonesia in 1969 in a disputed vote rejected by most Papuans.  For the past four decades Papuans have sought independence.  A transmigration policy implemented by the federal government relocated almost a million non-Papuan migrants from surrounding provinces as part of the "Indonesianization" process.  These migrants, along with another million voluntary migrants, dominate most of the region's trade and business, thereby controlling authority and dictating commerce in Papua.  Imported goods such as rice, medication, and gas are brought into Papua and 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 Papuans--and a marginalized indigenous population where poverty, unemployment, malnourishment, illness, illiteracy, and discrimination are the norm.
    AgainstAllOdds_Color_08.JPG
  • Ophira (18) has been HIV-positive for one year. She is recovering from her injuries after getting drunk and falling off her motorcycle. Despite her condition, Ophira does not take her ARV medication regularly and she rarely comes to the clinic for her check-up because she is afraid others would find out about her status.<br />
<br />
ODHA (Orang Dengan HIV/AIDS) is the term often used to label a person living with HIV/AIDS.  This label has a negative connotation since HIV/AIDS is frequently associated with dishonor and death and it is often viewed as a curse or retribution for sins or deviant behaviors such as alcoholism, promiscuity, and extra marital sex.  Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS.  Consequently, fear of abuse, persecution, and ostracism from family members and the wider community has made secrecy the primary concern for ODHA rather than seeking treatment.
    AgainstAllOdds_Color_05.JPG
  • 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. At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds). With ARV she is now healthy to work and support her family.<br />
<br />
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 started providing ARV therapies in 2003. In that year only 7 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% of those with HIV/AIDS are undergoing ARV therapy.<br />
<br />
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 provide misleading information and perception such as "there is no medicine for HIV/AIDS."<br />
<br />
As a general practice health personnel often evaluate patients for their adherence in taking their medication and keeping up with appointments before allowing them to undergo ARV therapy. Indigenous Papuans tend to fall short of this assessment and fail to return for their check-up because many of them live too far from the health centers.  At times, they do not fully understand the benefits of ARV medication and the importance of taking them properly due to poor counseling from the health staff.  Also, many of them are unable to keep their appointments or take medication regularly because they still keep their status a secret from their immediate family members or spouse.
    Against All Odds_17.JPG
  • Pastor Leo prays for an HIV-positive patient with Tuberculosis at Klinik Kalvari. The pastor sole responsibility is to provide spiritual support for every patient before they leave the clinic.<br />
<br />
Opened in 2006, Klinik Kalvari has been providing quality care to mostly indigenous Papuans in Wamena and they've helped hundreds of patients in the past.  They focus on diseases such as 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).  Many indigenous Papuans prefer to go to here than the overcrowded government public health clinic due to its quality care and attentive staffs. Nevertheless, the clinic rarely receives government funding and relies mostly on foreign donors to continue opening its doors to provide medical care to those in need.
    AgainstAllOdds_Final_34.JPG
  • Doctor Zanty, one of only 3 doctors at main hospital, checks the condition of Eddie who is in critical condition from AIDS.<br />
<br />
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 his HIV because he was afraid of friends and family finding 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.<br />
<br />
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.
    AgainstAllOdds_Final_35.JPG
  • A family member finds a "worm" clinging to the wall of the pig's lungs that they believed to be the cause of HIV.<br />
<br />
One of the most common practices in the highlands to diagnose and cure HIV is by conducting a traditional ritual termed adat.  This involves killing a pig and examining its blood, heart, lungs, and kidney.  After cutting the pig open and inspecting its internal organs, the practitioners of adat remove what they interpret as parasites or cancerous parts that they believe caused the sickness.  Cleaning the pig's flesh by washing it with water would also "cure" the person's illness.  Performing the adat ritual is expensive since a pig can cost hundreds of dollars.  The treatment does not work despite the strong cultural belief behind it.  In the end, after killing numerous pigs and spending a fortune, many people give up hope.  By the time they finally decide to go to the hospital, their condition is too critical with little chance for survival.<br />
<br />
Due to a lack of HIV/AIDS education, limited access to health services, and strong pre-existing cultural beliefs about illness, many Papuans who are desperate for a cure turn to alternative medicines and traditional methods of healing.  Sometimes it involves cutting different parts of the body to drain "dirty" blood believed to cause the sickness.  Fruit potions such as the renowned red fruit potion (buah merah) are also extremely popular for its perceived healing capability.  In some cases, those who are already taking ARV medication abandon it to take expensive alternative medications such as Herbal Life vitamin supplements because they are promised an immediate cure.
    Against All Odds_23.JPG
  • A fresh-killed pig is washed with water and placed on top of a fire pit to burn off its hair.  After 3 days in the hospital, David who is in the late stages of AIDS insisted on checking himself out to perform "adat," one of the common traditional methods of healing to cure HIV/AIDS.<br />
<br />
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.  <br />
<br />
One of the common practices in the highlands to try 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 take the sick person to a hospital, the patient's condition is critical and they soon die.
    AgainstAllOdds_Final_27.JPG
  • Dewi's lifeless body is carried onto the cremation pyre by her uncle.   <br />
<br />
Dewi (20) was a young wife who died from AIDS after contracting HIV from her husband.  Dewi kept her HIV status a secret from her family.  Dewi's family, who were unaware of her real illness, used a traditional healing method of cutting parts of 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, has 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.<br />
<br />
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 condom to avoid drawing suspicion.  As a result, the HIV virus is often passed between spouses.
    Against All Odds_01.JPG
  • Dewi's body was displayed in her finest clothes as family members and neighbors mourned her death inside her parents' traditional hut.<br />
<br />
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.  Before her death, Dewi's family used a traditional healing method of cutting her body to let "dirty" blood out in order to cure her illness.  Outside, men cut wood into small pieces and stacked them to prepare for her cremation.  A local NGO called Caring Hands donated money for cremation, since Dewi's family was too poor to have her buried.  A pastor led the ceremony and prayed before Dewi's body was place on top of the funeral pyre. <br />
<br />
It is common for husbands to keep their status from their wives or vice versa due to shame and fear of discrimination or punishment.  Even after testing positive for HIV, many still disregard using condoms to avoid drawing suspicion.  As a result, HIV is often passed on to their spouse.
    AgainstAllOdds_Final_23.JPG
  • Dessy's (24) diary entry of her daughter's death, Yhoana, who died from a sudden illness at the age of 2.  Dessy is HIV positive but she did not take ARV medications during her pregnancy nor gave birth via Cesarean Section to reduce the probability of passing on the virus to her child. Currently, Dessy is in poor health because she is still not taking ARV. Dessy's twin sister is also HIV- positive.<br />
<br />
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 often pass the virus to 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.
    Against All Odds_32.JPG
  • Blood inside a syringe seen at a Voluntary Counseling and Testing clinic. The test result was positive.
    Against All Odds_15.JPG
  • Children playing jump rope after Sunday School in the mountainous region of Papua<br />
<br />
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.
    Against All Odds_07.JPG
  • Mama P. (43) carrying 60kg (132lbs) of crops.  She is a single mother and she sells the crops from her garden at a local market to support her 3 children.   <br />
<br />
Mama P. is HIV-positive and she has been taking ARV medication regularly for the last 3 years.  However, Mama P. still keeps her status from her children.  As far as Mama P' children knows, their mother is sick from a common illness but they still remind her to take medication and help get refills. Family support is important but due to fear of discrimination many people living with HIV/AIDS keep their status a secret.  Mama P. receives support from Jayapura Support Group (JSG) who monitors her health and provides rice, cooking oil, milk, and vegetables as well as counseling.
    ODHA_24.JPG
  • A portrait of Wesley; a loving brother and son, a caring and giving advocate. <br />
<br />
After learning about HIV/AIDS Wesley shares his experience through public testimony. He also formed Noken, a support group that provides counseling and encouragement to individuals living with HIV in his community.
    ODHA_20.JPG
  • A portrait of Meri; a loving sister and daughter, an independent and beautiful woman.
    ODHA_17.JPG
  • Yalena (20) has been HIV-positive for over 2 years and she is undergoing Antiretroviral Therapy (ART) for almost a year.
    ODHA_16.JPG
  • Danita (21) with her mother.  Danita has been positive for one year but she is not undergoing Antiretroviral Therapy (ART).  Her child died due a sudden illness.
    ODHA_15.JPG
  • Becky and Dessy (24) are twins and they are both HIV-positive.  However, neither of them had ever taken ARV even when they were pregnant.  Dessy’s daughter, Yhoana, died last year from a sudden sickness and Dessy’s health has declined significantly.  Becky recently gave birth to a baby boy she named Gabriel, and he often gets sick.  Becky’s one-and-a-half year old daughter, Emma, also gets sick frequently and she has spent many days in the hospital.  Emma died suddenly before she turned two years old.  None of their children have been tested for HIV because the test cannot be administered before the age of two.  However, their frequent illnesses suggest that Becky’s and Dessy’s children might have contracted the HIV virus from their mothers. Both Becky and Dessy died recently from their condition.  Becky's parents now look over her son Gabriel.
    ODHA_06.JPG
  • Rika receives her medication from a local clinic.
    HIV/AIDS_Papua79.jpg
  • Rika, age 17, is the third wife and contracted HIV from her husband. Her parents rejected her at first but now shows support. At one point she weighed 35kg (77lbs). But as her health improves after receiving and taking medication regularly from a nearby clinic she is stronger and now weighs 52kg (114lbs).
    HIV/AIDS_Papua74.jpg
  • A local clinic in Wamena that provides support and assistance to people infected with HIV/AIDS.
    HIV/AIDS_Papua73.jpg
  • Market scene in Wamena.
    HIV/AIDS_Papua67.jpg
  • The body of a patient with AIDS covered with boils.
    HIV/AIDS_Papua66.jpg
  • Rejected by his family because he has AIDS, Daud (23) finds refuge at a local hospice in Jayapura.
    HIV/AIDS_Papua64.jpg
  • A nurse checks on Brothel Workers of Tanjung Elmo in Jayapura.
    HIV/AIDS_Papua61.jpg
  • Barbie (14), waits for her turn for a blood test at a clinic in Jayapura.
    HIV/AIDS_Papua59.jpg
  • Michael (17) turns his face away during his first time getting tested for HIV at a local clinic in Jayapura. There is high probability for Michael to contract the virus since girlfriend is HIV positive and they don't use protection.
    HIV/AIDS_Papua57.jpg
  • An empty bottle of liquor and used cardboard. Street sex workers and their clients often have sex in public because it's cheaper than renting out a hotel room.
    HIV/AIDS_Papua55.jpg
  • Mama Fin works for local NGO, Yayasan Harapan Ibu (YHI) or Mother's Hope (right) visits a young woman with AIDS living under a bridge in the city of Jayapura (middle).
    HIV/AIDS_Papua50.jpg
  • A brothel worker shows pictures of her son.
    HIV/AIDS_Papua48.jpg
  • Yayasan Harapan Ibu (Mother's Hope), a local NGO, visits local brothels regularly to encourage condom usage to sex workers. However, most sex workers don't enforce condom usage with their clients especially when they offer more money.
    HIV/AIDS_Papua45.jpg
  • A VIP room at Bar Kharisma that also functions as a brothel.
    HIV/AIDS_Papua44.jpg
  • The hallway of Bar Kharisma and entrances to VIP rooms.
    HIV/AIDS_Papua42.jpg
  • Yayasan Harapan Ibu (Mother's Hope), a local NGO, demonstrates the use of condom at public places to help prevent the spread of HIV virus.
    HIV/AIDS_Papua40.jpg
  • Yayasan Harapan Ibu (Mother's Hope), a local NGO, demonstrates the use of condom at public places to help prevent the spread of HIV virus.
    HIV/AIDS_Papua39.jpg
  • Linde, age 10, a victim of rape, waits for her blood result at a local hospital.
    HIV/AIDS_Papua35.jpg
  • Motorcycle taxi drivers have the highest risk of contracting HIV since all of them are men and most young, mobile, and has money. Family Health International (FHI) is an NGO that conducts mobile clinic and give blood test to taxi drivers on the spot throughout the city.
    HIV/AIDS_Papua34.jpg
  • Nomina, age 20, has AIDS finds refuge at a hospice in Jayapura.
    HIV/AIDS_Papua30.jpg
  • A TV screen inside a popular "Karaoke" bar that also functions as a brothel.
    HIV/AIDS_Papua28.jpg
  • In the middle of the cold and wet night, Betrix (25), Marsela (14), Barbie (14), and Natalia (16) walks the empty street looking for potential clients.
    HIV/AIDS_Papua18.jpg
  • Betrix (25), Marsela (14), Barbie (14), and Natalia (16) finds refuge from the rain under the tent of a street food vendor.
    HIV/AIDS_Papua17.jpg
  • Barbie (15) and Marsela (14) are already infected with HIV and sells their bodies for means of survival in the city of Jayapura.
    HIV/AIDS_Papua14.jpg
  • Barbie (14), an HIV infected street sex worker finds refuge inside the home of Mama Fin, a local NGO worker of Yayasan Harapan Ibu (YHI) or Mother's Hope.
    HIV/AIDS_Papua09.jpg
  • Mama Fin, a worker for Yayasan Harapan Ibu (YHI) or Mother's Hope, provides shelter and education to sex street workers.
    HIV/AIDS_Papua08.jpg
  • Sex street workers Natalia (16) and Arken (17).
    HIV/AIDS_Papua06.jpg
  • The cracked floor of an abandoned hospice in Oksibil, a developing city in the mountainous region of Papua.  The 6-bedroom hospice was built in 2009 but not a single patient has ever stayed there mainly due to fear of discrimination.
    _MG_1450.jpg
  • Dewi's lifeless body is carried onto the cremation pyre by her uncle.<br />
<br />
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.  Before her death, Dewi's family used a traditional healing method of cutting her body to let "dirty" blood out in order to cure her illness.  Outside, men cut wood into small pieces and stacked them to prepare for her cremation.  A local NGO called Caring Hands donated money for cremation, since Dewi's family was too poor to have her buried.  A pastor led the ceremony and prayed before Dewi's body was place on top of the funeral pyre. <br />
<br />
It is common for husbands to keep their status from their wives or vice versa due to shame and fear of discrimination or punishment.  Even after testing positive for HIV, many still disregard using condoms to avoid drawing suspicion.  As a result, HIV is often passed on to their spouse.
    _MG_5237.jpg
  • Children and parents from the Husoak village outside of Wamena watch an educational movie on HIV/AIDS.  The film uses the local dialects and also entertaining and informative attracting hundreds of villagers to the showings.
    _MG_3104.jpg
  • Becky (24) and her daughter, Emma, are seen inside their home.  Becky is HIV-positive but she did not take ARV during her pregnancy.  Emma died from a sudden illness before the age of two.<br />
<br />
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 often pass the virus to 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.
    _MG_8575.jpg
  • One of the first ARV medications provided by the government in 2003.  Only 7 packages were purchased then for all of Papua costing 375,000,000 IDR ($40,000).  ARV is now available at no cost in Papua but only 10-12% of people with HIV/AIDS are taking them.
    _MG_9432.jpg
  • Eddie’s family members carry his body back to his village from the hospital.  <br />
<br />
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.<br />
<br />
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 term often used to label a person living with HIV/AIDS.  This label has a negative connotation since HIV/AIDS is frequently associated with dishonor and death and it is often viewed as a curse or retribution for sins or deviant behaviors such as alcoholism, promiscuity, and extra marital sex.  Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS.  Consequently, fear of abuse, persecution, and ostracism from family members and the wider community has made secrecy the primary concern for ODHA rather than seeking treatment.
    _MG_7829.jpg
  • Back in his village, Eddie’s family members and friends mourn his death.   <br />
<br />
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.<br />
<br />
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 term often used to label a person living with HIV/AIDS.  This label has a negative connotation since HIV/AIDS is frequently associated with dishonor and death and it is often viewed as a curse or retribution for sins or deviant behaviors such as alcoholism, promiscuity, and extra marital sex.  Thus, shame, guilt and death go hand in hand with how Papuans see HIV/AIDS.  Consequently, fear of abuse, persecution, and ostracism from family members and the wider community has made secrecy the primary concern for ODHA rather than seeking treatment.
    _MG_7920.jpg
  • Mama P. walks to the market carrying 50kg (110 lbs) of crops.<br />
<br />
Mama P. is HIV-positive and she has been taking ARV medication regularly for the last 3 years.  However, Mama P. still keeps her status from her children.  As far as Mama P' children knows, their mother is sick from a common illness but they still remind her to take medication and help get refills. Family support is important but due to fear of discrimination many people living with HIV/AIDS keep their status a secret.  Mama P. receives support from Jayapura Support Group (JSG) who monitors her health and provides rice, cooking oil, milk, and vegetables as well as counseling.
    _MG_0128.jpg
  • Mama Yuli walks to church to attend the Sunday sermon.<br />
<br />
In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds). With ARV she is now healthy to work and support her family.<br />
<br />
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 started providing ARV therapies in 2003. In that year only 7 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% of those with HIV/AIDS are undergoing ARV therapy.<br />
<br />
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 provide misleading information and perception such as "there is no medicine for HIV/AIDS."<br />
<br />
As a general practice health personnel often evaluate patients for their adherence in taking their medication and keeping up with appointments before allowing them to undergo ARV therapy. Indigenous Papuans tend to fall short of this assessment and fail to return for their check-up because many of them live too far from the health centers.  At times, they do not fully understand the benefits of ARV medication and the importance of taking them properly due to poor counseling from the health staff.  Also, many of them are unable to keep their appointments or take medication regularly because they still keep their status a secret from their immediate family members or spouse.
    _MG_8266.jpg
  • Mama Yuli takes her ARV pills at eight o’clock every morning for the last eight years.<br />
<br />
In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds). With ARV she is now healthy to work and support her family.<br />
<br />
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 started providing ARV therapies in 2003. In that year only 7 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% of those with HIV/AIDS are undergoing ARV therapy.<br />
<br />
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 provide misleading information and perception such as "there is no medicine for HIV/AIDS."<br />
<br />
As a general practice health personnel often evaluate patients for their adherence in taking their medication and keeping up with appointments before allowing them to undergo ARV therapy. Indigenous Papuans tend to fall short of this assessment and fail to return for their check-up because many of them live too far from the health centers.  At times, they do not fully understand the benefits of ARV medication and the importance of taking them properly due to poor counseling from the health staff.  Also, many of them are unable to keep their appointments or take medication regularly because they still keep their status a secret from their immediate family members or spouse.
    _MG_8208.jpg
  • Portrait Series.<br />
<br />
A family portrait of Mama Yuli (48) with her daughters Aldofina (22) and Sela (12) and granddaughter, Anace (8).  <br />
<br />
Mama Yuli was infected with HIV from her husband who later died. At one point she weighed only 30kg (66lbs) but she is now healthy to work and support her family. Although ARV is free in Papua, less than 12% of those infected with HIV/AIDS are undergoing Anti-Retroviral Therapy (ART). Mama Yuli opened her status by making testimony to the public in order to encourage others living with HIV/AIDS to take their medication regularly and prove to them that they could still provide for their family and live a productive life.
    MamaYuli_1.JPG
  • Young men doing drills during a soccer practice.<br />
<br />
Scenery (establishing shots)
    AAO_Scans2_215.JPG
  • Garbage dump in Wamena near "Sunda Lekama," a popular place for gambling, drinking, and sex<br />
<br />
Scenery (establishing shots)
    AAO_Scans2_132.JPG
  • Students rest on the way home walking from school in the mountainous region of Papua, Oksibil.  Here education on HIV/AIDS is not available.  LSE or Life Skilled Education is taught in high school. This curriculum designed by Unicef covers education on human reproduction, pregnancy sex, STD, and HIV/AIDS. However, the curriculum is lacking essential materials and only taught in a handful of schools in Papua.
    AAO_Scans2_128.jpg
  • Children drying after bathing in the Wouma river.<br />
<br />
Scenery (establishing shots)
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  • Portrait Series.<br />
<br />
A portrait of Mina (11) who is infected with the HIV virus after an older man raped her.  Mina found a sanctuary and support at the temporary shelter of Public Health Development Foundation (YPKM).
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  • A teenager walking home in Wamena.<br />
<br />
Rough terrain, lack of transportation means, and the high cost of fuel and transportation are some of the biggest obstacles for people with HIV/AIDS to overcome in order to reach health facilities to get necessary care and medication.  Most Voluntary Counseling and Testing (VCT) clinics and ARV medication are available only in cities that are hundreds of miles away from villages.
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  • L-R: Roni (26) and Mecky (18), each wearing an apron with a diagram of the male and female reproduction organs, participate in a sexual reproduction and HIV/AIDS educational training conducted by the Public Health Development Foundation (YPKM), a Wamena based NGO.
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  • Pastor Leo prays for an HIV-positive patient with Tuberculosis at Klinik Kalvari. The pastor sole responsibility is to provide spiritual support for every patient before they leave the clinic.<br />
<br />
Opened in 2006, Klinik Kalvari has been providing quality care to mostly indigenous Papuans in Wamena and they've helped hundreds of patients in the past.  They focus on diseases such as 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).  Many indigenous Papuans prefer to go to here than the overcrowded government public health clinic due to its quality care and attentive staffs. Nevertheless, the clinic rarely receives government funding and relies mostly on foreign donors to continue opening its doors to provide medical care to those in need.
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  • Lana (18), who is in the late stages of AIDS, sits in the Emergency Room in silence after nurses insert an I.V. line to help stabilize her condition...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.
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  • Public Health Development Foundation (YPKM), a local NGO in Wamena, helps bring David who is in the late stages of AIDS to the Emergency Room 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.<br />
<br />
David has been HIV-positive for almost 4 years.  His wife is also HIV-positive and they are both taking ARV medication.  However, David did not take his medication properly and his health has declined significantly.  Living in a rural area of Lani Jaya, David's village lacks an adequate health facility, and he must travel hundreds of miles to Wamena to receive care.  Staying in a relative's honai or traditional hut, David's condition deteriorated.  YPKM or the Foundation for the Development of Public Health in Wamena 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 the typical 700.  At the hospital, David received saline solution and medicines that significantly improved his condition.  YPKM also gave David rice and milk to help him with his recovery.  Nevertheless, after three days in the hospital, David forcefully checked himself out because he wanted to conduct the adat ritual, and the health staff could not prevent him from leaving.  David spent several hundred dollars to purchase two pigs for the ritual.  However, his health deteriorated to the point where he was unable to stand up on his own.  A week after checking himself out from the hospital, David chartered a vehicle to go back to his village to die.
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  • 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.<br />
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In Papua, all indigenous Papuans have access to health insurance, called Jamkesmas or Jaminan Kesehatan Masyarakat Miskin, provided at no cost by the provincial government. However, 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, and medicines to treat opportunistic infection and antiretroviral therapies.
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  • Dewi's body is cradled by her uncle as a pastor prayed and blessed her lifeless body.<br />
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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.  Before her death, Dewi's family used a traditional healing method of cutting her body to let "dirty" blood out in order to cure her illness.  Outside, men cut wood into small pieces and stacked them to prepare for her cremation.  A local NGO called Caring Hands donated money for cremation, since Dewi's family was too poor to have her buried.  A pastor led the ceremony and prayed before Dewi's body was place on top of the funeral pyre.  <br />
<br />
It is common for husbands to keep their status from their wives or vice versa due to shame and fear of discrimination or punishment.  Even after testing positive for HIV, many still disregard using condoms to avoid drawing suspicion.  As a result, HIV is often passed on to their spouse.
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  • 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. At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds). With ARV she is now healthy to work and support her family.<br />
<br />
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 started providing ARV therapies in 2003. In that year only 7 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% of those with HIV/AIDS are undergoing ARV therapy.<br />
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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 provide misleading information and perception such as "there is no medicine for HIV/AIDS."<br />
<br />
As a general practice health personnel often evaluate patients for their adherence in taking their medication and keeping up with appointments before allowing them to undergo ARV therapy. Indigenous Papuans tend to fall short of this assessment and fail to return for their check-up because many of them live too far from the health centers.  At times, they do not fully understand the benefits of ARV medication and the importance of taking them properly due to poor counseling from the health staff.  Also, many of them are unable to keep their appointments or take medication regularly because they still keep their status a secret from their immediate family members or spouse.
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  • 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.<br />
<br />
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.
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Andri Tambunan

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