This study involved 23 participants, comprising 11 women and 12 men [Table 1]. Meanwhile, their mean age was 52 years, and none of the eligible persons refused to participate when they were contacted. Additional participants’ characteristics are shown in Table 1. This study identified the core of the category “keep being a good Papuan” which depicts the indigenes’ perception of the program in the past 15 years and the way it needs to be run in order to be highly accepted among the community despite the existing skepticism. The composition between implementers and recipients is shown in Table 2.
Table 1
Characteristics of Participants (n = 23)
Participants (n = 23)
|
Highland
|
Coastal
|
Wamena
|
Timika
|
Merauke
|
Serui
|
Jayapura
|
Mean age 52 (range: 45–68 years)
|
Gender
|
Male 52% (n = 12)
|
2
|
3
|
2
|
2
|
3
|
Female 48% (n = 11)
|
2
|
2
|
2
|
2
|
3
|
Working status
|
Pension 40% (n = 9)
|
1
|
2
|
2
|
3
|
1
|
Actively working 60% (n = 14)
|
3
|
3
|
2
|
1
|
5
|
Table 2
The composition between implementers and recipients among participants
Coding Name (Pseudonym)
|
Age
|
Sex
|
Location
|
Status
|
Profession
|
F1
|
52
|
Female
|
Wamena
|
Recipient
|
Housewife
|
F2
|
50
|
Female
|
Wamena
|
Recipient
|
Teacher
|
F3
|
54
|
Female
|
Timika
|
Recipient
|
Priest
|
F4
|
53
|
Female
|
Timika
|
Implementer
|
Retired
|
F5
|
52
|
Female
|
Merauke
|
Implementer
|
Retired
|
F6
|
52
|
Female
|
Merauke
|
Recipient
|
Nurse
|
F7
|
49
|
Female
|
Serui
|
Recipient
|
Priest
|
F8
|
45
|
Female
|
Serui
|
Implementer
|
Housewife
|
F9
|
45
|
Female
|
Jayapura
|
Recipient
|
Politician
|
F10
|
48
|
Female
|
Jayapura
|
Recipient
|
Lawyer
|
F11
|
50
|
Female
|
Jayapura
|
Implementer
|
Nurses
|
M1
|
52
|
Male
|
Wamena
|
Implementer
|
Retired
|
M2
|
56
|
Male
|
Wamena
|
Implementer
|
Retired
|
M3
|
50
|
Male
|
Timika
|
Implementer
|
Priest
|
M4
|
69
|
Male
|
Timika
|
Implementer
|
Retired
|
M5
|
50
|
Male
|
Timika
|
Recipient
|
Employee
|
M6
|
55
|
Male
|
Merauke
|
Implementer
|
Retired
|
M7
|
45
|
Male
|
Merauke
|
Implementer
|
Politician- Retired
|
M8
|
45
|
Male
|
Serui
|
Recipient
|
Priest
|
M9
|
48
|
Male
|
Serui
|
Implementer
|
Government employee
|
M10
|
50
|
Male
|
Jayapura
|
Implementer
|
Government employee
|
M11
|
67
|
Male
|
Jayapura
|
Recipient
|
Retired
|
M12
|
55
|
Male
|
Jayapura
|
Recipient
|
Retired
|
Table 3
Linkage between one category and another in the paradigm scheme through examples of quotes.
Themes
|
Categories
|
Quotes
|
Keep being a good Papuan
|
culture-religion
|
As a member, I do not have the heart to reject people because they were wrong in the past. Our religion teaches us to spread love to others.
From my experience, they invited me to capital city for that program. It was just one day. What do you expect from a day training? HIV is complicated.
|
dealing with modernisms
|
We need to rent boat if you are going to that island. At least we need a couple hours to reach that place.
|
tailoring program
|
Every year, we have a budget to allocate in specific urgency such as health issue and we invited scholars to do research.
|
stigma reduction
|
Of course, I heard community abandoned PLHW in one house, nobody fed them. Then we knew they dead.
|
In Table 3, it was discovered that “keep being a good Papuan” emerges from 4 interconnected categories, including 1) Culture and Religion, 2) Dealing with modernisms, 3) Tailoring program and 4) Stigma reduction. As a substantive theory underpinning the experiences of indigenous people with the programs, “Keep being a good Papuan” was a way of overcoming a series of problems and dealing with modernism to eliminating HIV. This is largely focused on the local culture, therefore any adjustment needs to balance keeping their tradition and welcoming modernism.
Culture and Religion Concepts
Challenges in dealing with modernism and keeping traditional values have never really been counted for by Papuans. Occasionally, people deviate from tradition and religion. Since the early days, the concept of Christianity and local values have had a significant effect on the Papuans' lives. They felt that they need to help PLHW overcome their burden, and these tend to vary.
“We have the ability to cheer, support, and give assurance to HIV patients. As a mother, we treat our children similarly, and there is a need to support them no matter their personality. It is believed that the participation of women aids in tackling this problem immediately. These victims are embraced based on experiences” [Female, 46, Coastal]
Regarding lack of trust in the available HIV medication, Papuans encourage PLHW to adhere to their medication because they believe that it attracts God’s forgiveness.
“We believe in the existence of God, and societal norms help us to bound in many ways. There is a need to trust that existing medication needs to be accepted as a form of hope.” [Male, 61, Highland]
The Papuans found it difficult to believe that the term ART is merely suppresses rather than kills the virus. Based on its uncertainties, they accepted that living with HIV is a miracle. To make this program accepted in the community, there need to be testimonies on their survival.
“In early days, these activities were routinely run in the community. Besides creating awareness, the campaigns motivated the community to have more contact with adherent patients. They are encouraged not to be scared of the virus…” [Male, 68, Coastal]
The participants agreed that deterrent effects need to be excluded from the HIV programs. Meanwhile, the happenings in the early days traumatized both the PLHW and the community. A woman revealed that the way PLHW were treated in the past did not reflect their values. It was further emphasized that HIV is still a burden, although the reaction of the community towards victims is much better.
“It seems just like yesterday when nothing was done except take for granted the fact that someone was HIV-positive. They believed being infected meant immoral acts and disrupted their values. However, they do not have the right to punish anyone. Although, it is difficult to forget.” [Female, 54, Highland]
This disease triggered several issues, including gender inequality. The patriarch system is dominant among the Papuans; however, it is perceived as a 2-edged sword by the women because it protects them from harassment and, at the side, time blames them for being the source of transmission.
“Our values teach them to respect women, which is evident especially in Serui [name of a district] because it is believed that women give birth to the younger generations. It is also believed that their descendants are bound to be unhealthy, supposing their women are HIV-positive” [Female, 47, Coastal]
“The communities are usually hesitant to mention HIV rather, they refer to it as women's disease. They feel embarrassed, and it serves as a reminder that they are the source of the virus. This is really degrading for the women. “[Female, 47, Coastal]
The men accept all forms of gender equality because they believe inequalities tend to affect their daughters.
"To be honest, parents are bound not to allow their daughters to get married to infected males. They prefer to kick against the marriage rather than allow their daughters to suffer. "[Male, 60, Highland]
Dealing with modernisms
In this era, participants agreed that traditions need to be integrated with modernism. Furthermore, some adjustments have to be made. Papuans also discovered that internet use is advantageous in terms of connecting with people all over the world. Irrespective of this fact, Papuans prefer face-to-face meetings when creating awareness about HIV. The information that HIV is transmitted by sexual intercourse is a taboo.
“As a leader in this community, it has been communicated that HIV is a problem. The leader further stated that they intend to ensure that this information reaches members residing in remote areas. They are isolated from the urban regions, and they also deserve to be informed about the seriousness of this disease and the need for it to be tackled in their communities. However, information regarding the spread of this virus is effectively conveyed face-to-face. “[Male, 45, Coastal]
A woman stated that the relevance of getting children in the highlands informed.
“It is an undeniable fact that the government promotes HIV prevention through the media, especially radio and community health center programs. However, only a few people listen to the radio. It was also discovered that community health centers combined HIV programs with integrated services post. Therefore, they are mainly concerned about children and female” [Female, 45, Highland]
In the early days, Papuans hardly accepted used condoms which are perceived as a preventive measure however women discovered that the modern lifestyle causes young people to have early sexual debut. Regarding the evidence that condom use is an effective preventive measure, women had no option but to accept it with a heavy heart.
“Of course, as parents, it is difficult to accept that young people engage in early sexual debut. This is an undeniable condition therefore condom is needed to prevent the transmission of the virus. Don’t you think as parents it is easier to inform the children about the use of use? Of course not… “[Female, 52, Coastal]
Men were equivocal to this alternative because it is bound to cause problems with their partners.
“I think a condom is useful although it also gives hard tensions to their partners. This indirectly implies the promotion of extramarital sex. “[Male, 68, Coastal]
Tailoring program
Participants reported that adequate efforts are needed to curb the spread of HIV in Papua. They believe that working together with stakeholders tends to be useful. Some sectors such as education, health, women empowerment, and child protection need to be integrated into these programs. It was also revealed that no one size fits all, and to increase acceptance among tribes, they need to be aware that some programs are more effective.
“We collaborated with scholars and all parties brings about Merauke, a successful means of curbing HIV reduction. Hospitals and NGOs are encouraged to carry out studies on reproduction as well as HIV. It was discovered that tribal and religious leaders were in full support of the program. They claimed to be the only district in Papua that successfully curbed the spread of this virus “[Female, 46, Coastal]
Even though the government is the leader of these programs, the participants revealed that they failed to recruit the appropriate personnel. The grand design of the HIV program was missed from the government's views.
“Government needs to employ competent people in this field. They have to be from the local government, educational, and health departments as well as be able to work together. They need to map the needs of each area and collaborate with local or international organizations in terms of adjusting to their requirements. Presently, all stakeholders tend to engage in similar programs, and this tends to overlap. “[Male, 62, Highland]
Collaboration between faith organizations and customary institutions is necessary and needs to be continued. Working with them makes the acceptance of these programs easier. Besides, deterrent effects are reduced, and Papuans tend to listen to these organizations. The participants agreed that Papuans respect their faith and tribe leaders.
“Our experiences working with churches showed that many young people from remote and urban areas were enthusiastic about attending the programs. They need to invite them to participate in these initiatives actively, it is believed that they are able to find a way to curb the spread of HIV and the community needs to accept PLHW as part of the” [Male, 50, Coastal]
A woman reported that the government underestimated their initiative to be part of these programs. Based on the government’s perspective, Papuans seem to be users rather than implementers.
“... They do not know the reason the government invited them to attend the training however, after they returned to the community, there was no avenue for them to be part of the programs. They were trained to be users, not implementers” [Female, 47, Coastal]
Stigma reduction
Papuans concluded that some programs failed after HIV prevalence increased over time and the stigma was normalized among PLHW. The participants were concerned with the fact that activities initiated to reduce stigma were not yet included in the programs. Meanwhile, men and women had different opinions regarding its performance in the community. One of the men stated that stigma reduction is carried out physically.
“Shelters were built for them to meet people with similar condition and in order not to feel excluded.” [Male, 68, Coastal]
Conversely, women encourage the support of family members. They help them to visit health facilities and remind PLHW to be faithful. Moreover, women understand the fact that disclosure status is unnecessary because they know it has a greater impact on the family.
“There is a need to look after the family because it is believed that members are willing to help, although sometimes this is impossible because they feel excluded by the community. It is understandable when parents hide their children's status as long as they are able to help them. This need not be neglected, and their decisions need to be respected “[Female, 52, Highland]