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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.
    AgainstAllOdds_Color_32.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
  • 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
  • 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.
    Against All Odds_31.JPG
  • 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
  • David sleeps inside his honai as his wife smokes a cigarette next to him.  His condition has deteriorated despite conducting the adat ritual multiple times.<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.
    _MG_5543.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
  • 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.
    Against All Odds_21.JPG
  • Mama Yuli embraces 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.
    _MG_8382.jpg
  • A family portrait of Mama Yuli with her two young daughters and granddaughter, Anace (8). <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_8473.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
  • Mama Yuli embraces 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.
    _MG_8410.jpg
  • Mama Yuli greets the pastor 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_8293.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
  • 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 />
<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.
    AgainstAllOdds_Color_31.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.
    AgainstAllOdds_Color_17.JPG
  • Mama Yuli holds two ARV pills in her hands on the 8th year anniversary of undergoing Anti Retroviral Treatment (ART). In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. 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.
    AgainstAllOdds_Color_18.JPG
  • Mama Yuli holds two ARV pills in her hands on the 8th year anniversary of undergoing Anti Retroviral Treatment (ART). In 2004 Mama Yuli contracted the HIV virus from her husband who later died from AIDS. 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_18.JPG
  • 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
  • Mama Yuli eats lunch with 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.
    _MG_8441.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
  • 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_8209.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_8211.jpg
  • 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.
    AgainstAllOdds_Color_27.JPG
  • The main public health clinic in Wamena is swamped with over 200 patients a day seeking various forms of health treatment.<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.
    _MG_6479.jpg
  • 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.
    AgainstAllOdds_Final_29.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
  • A mother takes her child to a Puskesmas or Public health center in Wamena, a developing town in the mountainous region of Papua.<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.
    Against All Odds_25.JPG
  • A mother takes her child to a Puskesmas or Public health center in Wamena, a developing town in the mountainous region of Papua.<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_25.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.
    Against All Odds_29.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
  • 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
  • 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
  • Eddie's casket is lowered into the ground. Hundreds of people including family members, friends, neighbors, colleagues, and students attended his funeral.<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_39.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
  • Eddie's casket is lowered into the ground. Hundreds of people including family members, friends, neighbors, colleagues, and students attended his funeral.<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.
    Against All Odds_38.JPG
  • Staffs of Wamena public health clinic prays during the morning rally before the start of their shift.  ..Currently, Wamena has 1,894-recorded HIV/AIDS cases and the number continues to rise.  The main public health clinic in Wamena is busy, with over 200 clients a day seeking various forms of treatment. People who want to take an HIV test must line up in the morning and register with everyone else.  The cramped HIV testing and counseling room is packed with several clients at a time, leaving no room for privacy and confidentiality.  Counselors are unable to spend much time educating clients and addressing their questions. The inadequate lab that is responsible for HIV tests must also conduct tests for various other illnesses including malaria, tuberculosis, and other illnesses.  Thus, the overwhelming burden on both staff and facility reduces the quality of care.  Consequently, despite an increasing desire from the public to get tested for HIV, the clinic limits testing to only 10 clients per day.  The director of the clinic argues that the cap is necessary to maintain quality control and ensure accurate test results.  Nevertheless, as many as 25 clients visit the clinic to get tested for HIV every day.  Turned away, many clients are discouraged and do not return...
    AgainstAllOdds_Color_33.JPG
  • Staffs of Wamena public health clinic prays during the morning rally before the start of their shift.  <br />
<br />
Currently, Wamena has 1,894-recorded HIV/AIDS cases and the number continues to rise.  The main public health clinic in Wamena is busy, with over 200 clients a day seeking various forms of treatment. People who want to take an HIV test must line up in the morning and register with everyone else.  The cramped HIV testing and counseling room is packed with several clients at a time, leaving no room for privacy and confidentiality.  Counselors are unable to spend much time educating clients and addressing their questions. The inadequate lab that is responsible for HIV tests must also conduct tests for various other illnesses including malaria, tuberculosis, and other illnesses.  Thus, the overwhelming burden on both staff and facility reduces the quality of care.  Consequently, despite an increasing desire from the public to get tested for HIV, the clinic limits testing to only 10 clients per day.  The director of the clinic argues that the cap is necessary to maintain quality control and ensure accurate test results.  Nevertheless, as many as 25 clients visit the clinic to get tested for HIV every day.  Turned away, many clients are discouraged and do not return.
    Against All Odds_33.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.
    Against All Odds_37.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 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 />
<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.
    Against All Odds_36.JPG
  • Cargos being unloaded at Oksibil airport.  Oksibil is a remote town in the mountainous region Papua reachable only by plane.  Goods from rice, fish, cement, gas, and household items are imported and sold at premium prices. Gas costs around $4/Liter or almost $20/gallon. Oksibil lacks sufficient health access including ARV for HIV/AIDS and patient must travel to Jayapura receive them and the cost for a round trip airfare is around $200.  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.
    AAO_Scans2_309.jpg
  • Hundreds of patients wait for their names to be called before getting medical treatment at the main public health clinic in Wamena.<br />
<br />
Currently, Wamena has 1,894-recorded HIV/AIDS cases and the number continues to rise.  The main public health clinic in Wamena is busy, with over 200 clients a day seeking various forms of treatment. People who want to take an HIV test must line up in the morning and register with everyone else.  The cramped HIV testing and counseling room is packed with several clients at a time, leaving no room for privacy and confidentiality.  Counselors are unable to spend much time educating clients and addressing their questions. The inadequate lab that is responsible for HIV tests must also conduct tests for various other illnesses including malaria, tuberculosis, and other illnesses.  Thus, the overwhelming burden on both staff and facility reduces the quality of care.  Consequently, despite an increasing desire from the public to get tested for HIV, the clinic limits testing to only 10 clients per day.  The director of the clinic argues that the cap is necessary to maintain quality control and ensure accurate test results.  Nevertheless, as many as 25 clients visit the clinic to get tested for HIV every day.  Turned away, many clients are discouraged and do not return.
    AgainstAllOdds_Final_30.JPG
  • Mama P. leaves her house carrying 60kg (132 lbs.) bags filled with crops to be sold at a local market. As a single parent, she works hard to provide for her 3 children<br />
<br />
Mama P. is HIV+ but she has been taking ARV (Anti Retroviral) medication regularly for the last 3 years improving her health significantly. Mama P. receives assistance from Jayapura Support Group (JSG), a local community support group in Jayapura, who monitors her condition and provides rice, cooking oil, milk, and vegetables as well as counseling. Despite her excellent health, Mama P. still keeps her status from her children who only knows that she is sick but not from HIV. Nevertheless, her children still provide support by reminding her to take medication and help get refills. Family support is essential but due to fear of discrimination many people living with HIV/AIDS keep their status a secret.
    AgainstAllOdds_Final_02.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
  • 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
  • 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_Papua33.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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Yayasan Harapan Ibu (Mother's Hope Foundation), a local NGO in Jayapura, demonstrates the use of a condom at public places to help prevent the spread of the HIV virus.<br />
<br />
In Papua, the majority of HIV transmission occurs through sexual encounters.  The consistent use of condoms is perhaps one of the most effective ways to reduce or prevent HIV infection.  Nevertheless, condoms are seen as taboo and frequently associated with sin, misconduct, and shame.  Condom usage is often opposed or disregarded by religious and community leaders, and rarely discussed in public.  Moreover, health staff endorses abstinence more frequently.  Due to the lack of low condom education and promotion, the use of condoms is extremely low since many people in Papua do not know how to use them and many of them are embarrassed to obtain it despite its availability.  More importantly, they do not understand the benefits of condom usage in reducing or preventing STDs and HIV infection.
    Against All Odds_12.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
  • 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
  • Juliana Yarisetou works as an AIDS advocacy officer for the international NGO Family Health International in Jayapura. She contracted HIV from her husband in 2004. She is open with her status and often gives her testimony on living with HIV. "I've been infected since 2004. I got very sick in 2005 and weighed 22 kg - before that I was 86 kg. I went to the hospital but it was very difficult to get treatment - the doctors didn't know much about HIV/AIDS. They told me to go home and rest. I thought it was just for sex workers, and I kept asking, "Why me?" After the community knew I was HIV positive all of them discriminated against me; they didn't want to be around me, eat or drink with me. An NGO came to the village and educated the community, the church also gave support. Since then I have been open about my status."
    HIV/AIDS_Papua10.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
  • 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
  • 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).
    AAO_Scans2_25.JPG
  • The least expensive method of transportation in Wamena is a "becak" or "bicycle taxi" costing $1 to travel 1-2km.<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_129.JPG
  • 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.
    AAO_Scans2_40.jpg
  • A pig is used to perform "adat", a traditional healing ritual in Tanah Papua.<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.
    Wesley_Web_10.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), a Wamena based NGO.
    Papua_Portrait_2.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_Color_35.JPG
  • Mandisa (25) who is in the late stage of AIDS clings to her life.  Family members hopelessly gather around her, as she lay unconscious at the brink on death.  Doctors did all they could to save her.<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.
    AgainstAllOdds_Color_36.JPG
  • Nurse Febe checks the tonsil of an HIV-positive patient at Klinik Kalvari.<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_Color_28.JPG
  • A man wearing the traditional Papuan attire from the village Asolo Gaima located 40km from Wamena is getting tested for Sexual Transmitted Disease (STD) at the public health clinic.<br />
<br />
Sexual Transmitted Diseases increase the transmission of the HIV virus. In Papua, education HIV/AIDS and STD as well as condom promotion is significantly low.
    AgainstAllOdds_Color_22.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.
    AgainstAllOdds_Color_23.JPG
  • Yayasan Harapan Ibu (Mother's Hope Foundation), a local NGO in Jayapura, demonstrates the use of a condom at public places to help prevent the spread of the HIV virus.<br />
<br />
In Papua, the majority of HIV transmission occurs through sexual encounters.  The consistent use of condoms is perhaps one of the most effective ways to reduce or prevent HIV infection.  Nevertheless, condoms are seen as taboo and frequently associated with sin, misconduct, and shame.  Condom usage is often opposed or disregarded by religious and community leaders, and rarely discussed in public.  Moreover, health staff endorses abstinence more frequently.  Due to the lack of low condom education and promotion, the use of condoms is extremely low since many people in Papua do not know how to use them and many of them are embarrassed to obtain it despite its availability.  More importantly, they do not understand the benefits of condom usage in reducing or preventing STDs and HIV infection.
    AgainstAllOdds_Color_12.JPG
  • A man wearing the traditional Papuan attire from the village Asolo Gaima located 40km from Wamena is getting tested for Sexual Transmitted Disease (STD) at the public health clinic.<br />
<br />
Sexual Transmitted Diseases increase the transmission of the HIV virus. In Papua, education HIV/AIDS and STD as well as condom promotion is significantly low.
    Against All Odds_22.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.
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  • Annie (16) sits next to a pile of fruits that she picked and ready to be sold at a nearby market.<br />
<br />
Annie found out that she was HIV-positive 6 months ago.  Her condition worsened and she spent 3 weeks in the hospital.  Fortunately, Annie received support and counseling from a local NGO, Public Health Development Foundation (YPKM).  With their assistance, Annie is currently on Antiretroviral Therapy (ART).
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  • Melina (25) and her daughter, Emily (9).<br />
<br />
Initially when Melina learned that she was HIV-positive she didn't believe it.  She neglected to get care and her health declined.  On the hospital bed when Melina's condition was critical, she gave directions to Emily, who was just 5 years old at the time, how to get home using public transportation just in case she didn't make it.  However, Melina made full recovery and is currently on Antiretroviral Therapy (ART).
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  • Mama Yuli, HIV-positive mother and activist. <br />
<br />
In 2004, Mama Yuli contracted HIV from her husband, whom later died from AIDS.  Prior to the diagnosis Mama Yuli had never heard of HIV or AIDS.  As a Christian and a faithful wife she never thought that she would get infected.  At her worst point, Mama Yuli was just skin and bones weighing only 22 kilograms (48 pounds).  After falling ill she experienced discrimination from her neighbors.  Kids used to pick mangoes from the tree in front of her house but their parents barred them from coming to her yard due to fear of infection.  Mother’s Hope Foundation, another local NGO based in Jayapura, came to her aid and provided her with assistance.  They also provided HIV/AIDS education to Mama Yuli’s neighbors and family members, reducing stigma against her.  <br />
<br />
After regaining her health Mama Yuli made her status public by giving a testimonial in front of her church congregation.  She courageously disclosed her status and shared her experiences publicly throughout Papua.  Mama Yuli’s came forward in an effort to raise awareness, reduce stigma, encourage others to get tested for HIV and to take ARV medication regularly.  Ultimately, Mama Yuli wants to prove by example that one does not have to die from HIV/AIDS and that a diagnosed person is still able to provide for their family and live a productive life.  In 2012 Mama Yuli celebrated her 8-year anniversary of taking ARV.
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  • Nara (15) who has been HIV-positive for 6 months but she is not currently on Antiretroviral Therapy (ART).  Her father is also HIV-positive and he is in poor health.
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  • Danita (21) has been positive for one year but she is not undergoing Antiretroviral Therapy (ART).  Her child died due a sudden illness.  <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.
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  • Husband and wife who recently discovered they are HIV-positive.  They must travel 70km roundtrip to reach the nearest health center for care and treatment.
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  • Villagers in Pugima walking home. Only a vehicle with 4-wheel drive can navigate through the difficult terrain.   ..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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  • 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_Papua78.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_Papua76.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_Papua75.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
  • 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_Papua36.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_Papua32.jpg
  • Juliana Yarisetou works as an AIDS advocacy officer for the international NGO Family Health International in Jayapura. She contracted HIV from her husband in 2004. She is open with her status and often gives her testimony on living with HIV. "I've been infected since 2004. I got very sick in 2005 and weighed 22 kg - before that I was 86 kg. I went to the hospital but it was very difficult to get treatment - the doctors didn't know much about HIV/AIDS. They told me to go home and rest. I thought it was just for sex workers, and I kept asking, "Why me?" After the community knew I was HIV positive all of them discriminated against me; they didn't want to be around me, eat or drink with me. An NGO came to the village and educated the community, the church also gave support. Since then I have been open about my status."
    HIV/AIDS_Papua11.jpg
  • Food packages given by YPKM, which includes 2kg of rice, cooking oil, sugar, milk, and infant formula (costing approx. $25), to those who are in the late stages of AIDS and mothers who cannot breastfeed their infants.  The health condition of almost every person receiving this monthly food package has greatly improved.<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.
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  • Mama P. arrives at home carrying vegetables and fruits on her back.  She earns a living to support her three children by keeping a small garden and selling the crops at a nearby market.<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.
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  • Yosua attends Sunday worship with his family.  He is grateful and thanks God for his health.
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  • 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.
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  • 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.
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  • 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.
    AgainstAllOdds_Color_33.JPG
  • 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.
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Andri Tambunan

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