The prevalence and burden of communicable diseases, particularly that of HIV/AIDS and TB, are considerable in Indonesia.

HIV/AIDS

Indonesia experiences the ‘fastest growing HIV epidemic’ among southeast Asian countries  (Agustina et al., 2019, p. 83). According to UNAIDS, approximately 630,000 (lower to upper estimates 540,000-740,000) people lived with HIV in 2016. By 2018, this number was estimated to have reached 640,000 (550,000-750,000). The majority of people living with HIV were aged 15 or over (620,000). Among these, an estimated 17% (15%-20%) accessed antiretroviral therapy. Furthermore, there were an estimated 48,000 (43,000-52,000) new HIV infections and 38,000 (34,000-43,000) AIDS-related deaths in Indonesia (UNAIDS, 2018).

By December 2019, cases of HIV/AIDS have been reported in 93.2% of districts and in 34 provinces across Indonesia. The provinces with the highest number of HIV infections were DKI Jakarta (65,578), followed by East Java (57,176), West Java (40,215), Papua (36,382), and Central Java (33,322) (Ditjen P2P Kementerian Kesehatan RI, 2020).

TB

According to WHO, Indonesia is ranked among the countries with the highest burden of tuberculosis (WHO, 2019) . It is estimated that there are about 1 million new cases of TB per year and prevalence is estimated to be at almost 400 cases per 100,000 people (Agustina et al., 2019, p.83; WHO, 2017, p.1). According to the WHO TB report 2019, notifications of TB in Indonesia increased from ‘from 331 703 in 2015 to 563 879 in 2018 (+70%), including an increase of 121 707 (+28%) between 2017 and 2018’ (WHO, 2019, p.2).

Mortality of TB was substantial, as Indonesia was estimated to be among the group of five countries where 40 or more deaths per 100,000 population were associated with TB (WHO, 2017, p.35). This is paired with low levels of TB treatment. The WHO reports that Indonesia belongs to the group of countries with 50 per cent of less treatment coverage in 2016 (WHO, 2017, p.78). Furthermore, ‘high levels of underreporting of detected TB cases’ was found following the 2013-2014 national TB prevalence survey with Indonesia ranging among the top three countries (16% gap between TB incidence and reported cases) (WHO, 2017, pp.180).

The WHO report further shows a substantial gap between the funding required for prevention, diagnosis, and treatment and the actual funds available. In Indonesia this funding gap is estimated to amount to US $98 million (WHO, 2017, p.115). Of the available funds, 61 per cent were provided from domestic sources and 39 per cent by donors (WHO, 2017, p.117).

The previously reported growing burden of HIV/AIDS together with the high burden of TB further complicates the situation in Indonesia. In combination with the described underreporting, this leads to a situation where only 14% of people with TB had a reported HIV status and ‘less than 50% of HIV patients were started [on the recommended] ART’ treatment in 2016 (WHO, 2017). In 2019, Indonesia remained among the 20 high TB/HIV burden countries as well as among the ‘20 countries with highest estimated numbers of incident [multi-drug resistant TB] (MDR-TB) cases’ (WHO, 2017). Despite low reporting and high burden, it is reported that Indonesia had an ‘85 per cent treatment success among people with new and relapse TB’ and ’60 percent treatment success among people with new and relapse HIV-positive TB’ in 2015 as well as ’51 per cent treatment success among people with rifampicin-resistant TB in 2014’ (WHO, 2017, pp. 88,90).

Other relevant infectious diseases are malaria, with approximately 40,000 death per annum as well as arboviruses, dengue fever, chikungunya, nipa, avian influenza, and Zika (Agustina et al., 2019, pp.83).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Ditjen P2P Kementerian Kesehatan RI. (2020). Laporan Perkembangan HIV AIDS & Penyakit Infeksi Menular Seksual (PIMS) Triwulan IV Tahun 2019.

UNAIDS. (2018). Country factsheets: Indonesia. https://www.unaids.org/en/regionscountries/countries/indonesia

WHO. (2017). Global Tuberculosis Report 2017.

WHO. (2019). Global Tuberculosis Report 2019. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1