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The Indonesian Military Response to Hiv/Aids: a Focus in the United Nations Peacekeeping Operations

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The Indonesian Military Response to Hiv/Aids: a Focus in the United Nations Peacekeeping Operations THE INDONESIAN MILITARY RESPONSE TO HIV/AIDS: A FOCUS IN THE UNITED NATIONS PEACEKEEPING OPERATIONS Indria Sari Indonesia 45th International Course in Health Development September 22, 2008 œ September 11, 2009 KIT (ROYAL TROPICAL INSTITUTE) Development Policy & Practice/ Vrije Universiteit Amsterdam THE INDONESIAN MILITARY RESPONSE TO HIV/AIDS: A FOCUS IN THE UNITED NATIONS PEACEKEEPING OPERATIONS A thesis submitted in partial fulfilment of the requirement for the degree of Master of Public Health by Indria Sari Indonesia Declaration: Where other people‘s work has been used (either from a printed source, internet or any other source) this has been carefully acknowledged and referenced in accordance with departmental requirements. The thesis (The Indonesian Military Response to HIV/AIDS: A focus in the United Nations Peacekeeping Operations) is my own work. Signature: 45th International Course in Health Development (ICHD) September 22, 2008 œ September 11, 2009 KIT (Royal Tropical Institute)/ Vrije Universiteit Amsterdam Amsterdam, The Netherlands September 2009 Organised by: KIT (Royal Tropical Institute), Development Policy & Practice Amsterdam, The Netherlands In co-operation with: Vrije Universiteit Amsterdam/ Free University of Amsterdam (VU) Amsterdam, The Netherlands ii Table of contents Table of contents.............................................................................. i List of Tables, Figures and Boxes .......................................................iii List of Abbreviations ....................................................................... iv Acknowledgements......................................................................... vi Abstract........................................................................................vii Introduction................................................................................... 1 Chapter 1: Background information of Indonesia ................................. 2 1.1. Geography and demography....................................................... 2 1.2. Health status......................................................................... 2 1.3. Economy.............................................................................. 2 1.4. Indonesian Armed Forces and its Kontingen Garuda.................... 3 1.4.1. The Indonesian Armed Forces ............................................ 3 1.4.2. Kontingen Garuda............................................................. 3 Chapter 2: Problem statement, objectives, and methodology................ 5 2.1. Problem statement................................................................. 5 2.2. Study questions..................................................................... 6 2.3. Thesis objectives ................................................................... 7 2.3.1. General objectives ............................................................ 7 2.3.2. Specific objectives ............................................................ 7 2.4. Methodology......................................................................... 7 2.4.1. Study design................................................................... 7 2.4.2. Study method.................................................................. 7 2.5. Study limitation..................................................................... 8 Chapter 3: United Nations Peacekeeping Operation.............................. 9 3.1. Peacekeeping Operation.......................................................... 9 3.2. HIV testing policy in UNDPKO................................................ 12 3.3. HIV/AIDS intervention for peacekeepers ................................. 13 3.3.1. HIV/AIDS Awareness card............................................... 14 3.3.2. Strategic Action Package................................................. 16 Chapter 4: Indonesian's HIV military programme in relation with Peacekeeping Operation................................................................. 18 4.1. Indonesians in peacekeeping operation................................... 18 4.2. HIV testing policy in TNI ....................................................... 18 4.2.1. Pre-deployment HIV testing............................................. 19 4.2.2. Post-deployment HIV testing............................................ 19 4.3. HIV prevention programme in TNI .......................................... 20 4.3.1. HIV/AIDS peer leaders programme................................... 20 4.3.2. HIV services in TNI ......................................................... 21 4.4. HIV prevention programme targeting Indonesian peacekeepers.. 21 4.5. Ethical issues on HIV/AIDS in TNI .......................................... 23 Chapter 5: Risky sexual behaviour among Indonesian peacekeepers .... 24 5.1. Knowledge of HIV among TNI personnel.................................. 24 5.2. Sexually Transmitted Infections issues among Indonesian peacekeepers ............................................................................ 27 5.3. HIV incidence among TNI personnel ....................................... 29 i 5.4. HIV incidence among Indonesian peacekeepers........................ 29 Chapter 6: Discussion.................................................................... 31 Chapter 7: Conclusions and Recommendations.................................. 35 References:.................................................................................. 36 Annexes ...................................................................................... 41 Annex 1: Framework (Andersen‘s behavioural model)..................... 41 Annex 2: Referral military hospitals for HIV/AIDS cases in Indonesia . 42 Annex 3: Peer leader training schedule in TNI................................. 43 ii List of Tables, Figures and Boxes Table Table 1. Current peacekeeping operation and the HIV prevalence of host Countries ............................................................................. 10 Table 2. Top ten TCC and levels of HIV infection.................................... 10 Table 3. Risky sexual behaviour among TNI personnel............................ 28 Table 4. The result of HIV testing among Indonesian peacekeepers .......... 30 Figure Figure 1. Source of HIV training in the mission area ................................ 15 Figure 2. Comprehensive knowledge of HIV among peacekeepers in Liberia ................................................................................. 15 Figure 3. Knowledge level about HIV prevention (BSS 2003) .................... 24 Figure 4. Right perception about HIV/AIDS (BSS 2003) ........................... 25 Figure 5. Comprehensive knowledge level about HIV prevention and right perception about HIV/AIDS (BSS 2003).................................... 26 Figure 6. Knowledge level about HIV prevention (IBSS 2007) ................... 26 Figure 7. Comprehensive knowledge level about HIV prevention and right perception about HIV/AIDS (IBSS 2007) .................................. 27 Figure 8. HIV incidence in TNI .............................................................. 29 Box Box 1. Six key points of the Indonesian achievement in peacekeeping operation ............................................................................ 3 Box 2. HIV/AIDS policy in UNDPKO.................................................... 13 iii List of Abbreviations AIDS Acquired Immunodeficiency Syndrome CD4 Cluster of differentiation 4 CHG Commission on HIV/AIDS and Governance in Africa CMA Civil-Military to combat HIV/AIDS DFID the United Kingdom Department for International Development DHAPP Department of Defence HIV/AIDS Prevention Program DoD Department of Defence of the United States ELISA Enzyme-linked immunoabsorbent assay FmedO Force Medical Officer FHI Family Health International FSW Female Sex Workers HBsAg Hepatitis B serum antigen HIV Human Immunodeficiency Virus HRM High Risk Men ICES International Centre for Ethnic Studies IDU Injecting Drug User ISS Institute for Security Studies MONUC Mission del 'Organisation des Nations Unies en Republique Democratique du Congo/United Nations Organisation/Mission in the Democratic Republic of Congo MSM Men who have Sex with Men NAC National AIDS Commission PKO Peacekeeping Operation PL Peer Leaders PLHIV People Living with HIV Puskes (Ind.) Pusat Kesehatan/Health Centre RTC Regional Training Centre SAP Strategic Action Package SGOT Serum Glutamic-Oxalocetic Transaminase SGPT Serum Glutamic-Pyruvic Transaminase STIs Sexually Transmitted Infections TNI (Ind.) Tentara Nasional Indonesia/the Indonesian Armed Forces UNAIDS Joint United Nations Programme on HIV/AIDS UNAMSIL United Nations Mission in Sierra Leone UNDPKO United Nations Department of Peacekeeping Operations UNIFIL United Nations Force Interim in Lebanon UNGASS United Nations General Assembly on HIV/AIDS UNDPKO United Nations Department of Peacekeeping Operations UNPKO United Nations Peacekeeping Operations UNSC United Nations Security Council UNTAC United Nations Transitional Authority in Cambodia USPACOM United States Pacific Command iv VCT Voluntary Counselling and Testing VCCT Voluntary and Confidential Counselling and Testing WHO World Health Organisation v Acknowledgements I would like to express my gratitude to Netherlands Education Support Office in Indonesia, which awarded me with the StuNed scholarship. Several senior in Indonesian military service were kind enough to share their experiences in dealing with HIV/AIDS and provide comments on the
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