My article, which was awarded the Wang Gungwu Prize for the best article in the Asian Studies Review in 2024, focused on the experiences of young Indigenous Papuan women in Manokwari, West Papua, Indonesia. My analysis drew attention to worsening conditions for women, both moral and material, that were obscured by the false narrative of the (Indonesian) ‘housewife’. The housewife rhetoric promises that if women conform to gendered domestic ideals, not only should they be safe from HIV, but if they contract HIV, they should be considered ‘innocent’ and receive care and support. The participants were women who were HIV positive or considered at risk. Their experiences showed that there was no idealised housewife role available to them amid increasing gender inequality. Women with HIV, even if they adhered to gendered norms, experienced stigmatisation and abandonment by the community and the government.

The article was based on data collected in 2011-2012 as part of a larger partnership between an international NGO and a Papuan NGO. Peduli Sehat was led by Mateus Marisan, who unfortunately passed away in 2015. This work aimed to understand Papuan-led approaches to community development, including HIV prevention. I wrote about some of the findings soon after, but I held onto some of the women’s narratives while I found a way to make sense of their experiences beyond simply demonstrating their suffering. I was later able to situate their experiences as reflective of increasing structural violence against Papuan women throughout a period of accelerated urban development in Manokwari.

In this short piece, I reflect on the ongoing problem of HIV/AIDS in West Papua. Over a decade has gone by and the situation appears much worse, even as clinical aspects of testing and treatment have arguably improved. My view is that recent approaches shore up state power and patriarchal stigma. Regeneration of critical community approaches is needed to address HIV and other issues like maternal mortality.

What is the current state of HIV prevalence in West Papua?

Recent government data reported by UN Indonesia suggest that HIV prevalence in Papua (all of the western half of New Guinea put together) is at least 7 times the national average. UN Indonesia also reports that about half of the people living with HIV in Papua are unaware that they have the virus. 2025 news reports indicate about 23,000 HIV/AIDS cases have been recorded in what is now ‘Central Papua’ province, 19,000 in Papua province (with just 20% on ARV treatment), and 10,000 in Papua Highlands Province. A 2013 provincial government biological survey suggested a much higher prevalence among Indigenous Papuans (2.3%) than non-Papuans but subsequent large surveys have avoided demonstrating the disproportionate impact on Indigenous Papuans.

In West Papua Province (2025) there are an estimated 12,050 HIV/AIDS cases but only 4681 detected (39%). Only 1400 people are on active treatment (2025). In Kaimana regency, a relatively isolated and sparsely populated area on the southern coast of West Papua province, in 2025, 29/407 people tested positive, a prevalence of 7%.

HIV among pregnant women is an important indication of how women are faring in terms of sexual and reproductive justice. There are no publicly-available provincial data but reports from district health offices show the prevalence of HIV in pregnant women is about double the Indonesian national average.

What are the strategies and interventions?

Indonesia has implemented some innovative HIV programs, but these have largely avoided Papua. Unfortunately, the responses epitomise tired government and international agendas framed around targets.

The HIV approach in Papua is largely framed around the UNAIDs and SDGs ‘three zeroes’ which have existed since around 2011: No new infections, no deaths, and no discrimination, with the aim of overcoming HIV by 2030. The related UN 95-95-95 targets refer to 95% of people living with HIV knowing their status, 95% of people who know their status being on antiretroviral therapy (ART), and 95% of those on ART achieving viral suppression. Indonesia is nowhere near meeting those targets.

A continuing problem in Papua is that major initiatives focus on urban locations like Sorong, Jayapura and Manokwari, where Indigenous Papuans are a minority relative to non-Indigenous migrants. Without intentional efforts to include Indigenous Papuans, the response continues to be limited. The coordination of the HIV response should lie with the government’s AIDS Prevention and Management Commission (Komisi Penanggulangan AIDS/KPA). Acting head of KPA Papua Meki Wetipo explained in 2023 that there was no funding for KPA activities and most local district branches were not functioning.

Still stigmatising

As my earlier article reported, stigmatisation of people with HIV is still very prominent. Some of this stigmatisation seems to come directly from health officials and other government leaders. Public statements reinforce the idea that HIV is caused by having more than one sexual partner, often glossed as ‘free sex’ or promiscuous behaviour. This kind of statement is usually followed by advice to abstain from sex outside marriage and to be faithful to one partner, neither of which are effective for preventing HIV.

For about two decades, public messaging has reinforced the idea that HIV is caused by moral failure. The stigma of sex and sexuality is evident in the criminalisation of sex outside marriage, which disproportionately harms women through blame, STIs or pregnancy. So long as HIV is attached to accusations of promiscuity, people with HIV will be stigmatised, and continue to avoid HIV testing and treatment. In our earlier research we found that when women were told they were HIV positive during antenatal testing they frequently cut off all communication with the health care system.

Structural violence is ignored

In HIV responses, there is almost no mention of structural violence driving prevalence or deterring engagement with health care. HIV treatment must be proactively anti-racist to combat entrenched discrimination against Papuans. Experts and officials sometimes display a mistaken understanding of what social determinants of health really mean – this is evident in the examples they give: youth sexual behaviour, lack of knowledge, lack of condom use, lack of life skills, cultural practices. These reflect typical public health perspectives that focus on individual behaviour, knowledge, and practices rather than what puts people at risk in the first place or why they engage in ‘risky’ sexual activities even if they know about HIV.

Structural violence may also be amplified when HIV interventions are led by urban non-Papuans or non-locals who approach rural and remote Papuans as ‘targets’ in their brief campaigns. For example, a recent effort in West Papua province conducted health inspections on “left behind, frontier, and remote” areas and seemed to presume that some Papuans, by virtue of where they live, know nothing about looking after themselves.

Indonesian military actions routinely cause fear, injury, death and displacement of Papuan civilians, yet the military is still conducting health care campaigns. In this news story from the PNG-Papua border region a soldier wearing a helmet and bullet proof vest is weighing a baby at a village health post.

A state-centred approach to knowledge and practice

Over a decade ago, the community and NGO sector was very active in HIV prevention. I was part of some community-based work that advocated for policies that promote and protect Indigenous life in all spheres as a guiding ethos to inform HIV and other health care. This work also documented community efforts to restore relationships and revitalise cultural knowledge of health.

A “health system strengthening” approach took over about a decade ago, and it favoured institutional interventions focused (once again) on ‘key populations’ (particularly men who have sex with men and female sex workers and their clients). Decentring more flexible and community-defined approaches that sought to unite Papuans, health system strengthening empowered the Indonesian state and concentrated resources in the state knowledge system.

Behind HIV prevention is a knowledge apparatus that favours research led and often conducted by non-Papuans and non-Papuan universities. A few examples include a study by Inti Muda (Jakarta) and University of Padjadjaran (Bandung/West Java) on HIV services in Papua; A disease prevention survey in 2025 led by Ministry of Health, The Global Fund, and Universitas Indonesia, and studies led by non-Papuan researchers which feature no Papuan authors. This approach carries on the historical trend of excluding Papuan experts and sidelining leaders, elders, and others.

Respecting biographies of hardship

When I spoke with my informants over a decade ago, some were demoralised, symptomatic and struggling to keep up with treatments. Others were joking and irreverent. I do not think it would surprise them that HIV/AIDS is still a neglected issue. My hope is that HIV prevention and management may grow again from critical community perspectives, challenging ill-fitting, apolitical interventions led by officials and experts who seem content to carry on with stigmatising and simplistic admonitions.

Image: Facilitating community-based HIV/AIDS education in West Papua (author’s image).