The U.S. Department of Defense is committed in its partnership with the Indonesian military (TNI) in their efforts to fight HIV/AIDS in Indonesia. The FY 2010 COP activities for DoD renews this commitment with a focus on prevention and testing efforts within the Indonesian military, and will assist in the strengthening of the TNI medical infrastructure in their efforts to fight the AIDS epidemic. In the TNI, all recruits are screened for HIV prior to induction and HIV positives are not accepted into the military. Although the TNI supports force-wide testing each year, there are not sufficient resources to accomplish this goal, and it may not be a cost effective strategy in a low prevalence epidemic. There is an active peer-to-peer prevention program focused on recruits and other critical high risk groups or situations (e.g., STI clinics, pre-deployment to high prevalence regions, etc.). However, the lack of trained human resources as well as financial constraints have limited the upgrade of necessary laboratory facilities and severely restricted the development of a more robust HIV/AIDS program. These shortages are particularly acute in high prevalence areas such as Papua. It is also important to point out that approximately 75% of the patients seen in military hospitals are civilians. Military HIV treatment hospitals are appointed and certified by the Ministry of Health. Although some HIV-related supplies and equipment are provided by the MOH, significant shortfalls exist in the military. Over the past few years, the DoD PEPFAR program has provided critical laboratory support through the partnership with TNI. As we move forward, the DoD will promote an increased emphasis on prevention among high risk members, increased linkages to counseling and testing, and the development of additional capacity to support counseling and testing as well as treatment.

The DoD program has faced a number of challenges over the past few years and, in response to the Red Light section of the OGACS notification letter, the Office of Defense Cooperation, US Embassy Jakarta, in coordination with the Naval Health Research Center and USPACOM decided to realign the management of the DoD component of the PEPFAR program in Indonesia in FY 2009. Because of programmatic challenges, the Red Light by OGAC and the resulting realignment, the DoD program was not as active in FY 2009 as it has been in the past. However, the Country Team has approved an ODC request to hire an in-country program manager who duties will include routine interface with the Indonesian military health community, planning and coordination for all PEPFAR funded workshops and training, procurement and disbursement of PEPFAR funded supplies, and development of DoD portions of all Country Team PEPFAR plans and assessments. Additionally, PEPFAR funding will no longer be managed by USPACOM's Center of Excellence in Disaster Management and Humanitarian Assistance, but will be sent directly from NHRC to the ODC, where the PEPFAR program manager will work closely with ODC Resource Managers in the management and administration of funds. Under this realigned management, DoD has programmed FY 2010 activities in Adult Treatment, Counseling and Testing, Other Sexual Prevention and Lab Infrastructure.

FY 2010 funds for HTXS will be used to coordinate, plan and execute treatment, care and support workshops for military medical officers and other medical staff that work within the military community. This will include training of trainers (TOT) of medical officers, nurses and other ancillary healthcare workers. Training will reinforce the understanding of opportunistic infections (OI), adherence to anti-retroviral therapy (ART), working with patients and their families to ensure that they have knowledge of HIV, OI, ART, etc., with the goal of achieving continuity of care.

DoD will expand and provide support to VCT activities. Funds will be used to procure much needed HIV/AIDS rapid test kits (2-3 brands to satisfy testing algorithms), as well as consumables to augment testing (gloves, needle and waste disposal supplies, etc.). Distribution of supplies will be targeted to facilities designed by the TNI as high prevalence areas or hospitals with critical shortages. Test kits will be those approved for use by the Indonesian Ministry of Health (MOH) so that they may be used both for military personnel and civilians accessing military health facilities.

FY 2010 funds will also be used to provide technical assistance in the form of training of staff at VCT centers (including counselors and testers). In addition, funds will support travel as required.

The overall goal of this activity is to decrease new HIV infections in the military through behavior change communication (BCC) with a focus on correct and consistent use of condoms. While some soldiers practice sexual abstinence and fidelity, factors such as separation from families, mobility, and age increase their HIV risk.

In FY 2010, DoD will continue to assist the Indonesian Defense Forces (TNI) in implementing community-based activities among soldiers, their sexual partners, and surrounding communities to promote safer sexual behaviors. Key prevention strategies include peer education and interpersonal communication (IPC) sessions, and the promotion of correct and consistent condom use. Many of these efforts will focus on the development of strategies to reach individuals who are at higher risk (e.g., pre-deployment to a high prevalence area, STI Clinic patients, etc.). DoD will collaborate with TNI in updating information, education and communication (IEC) materials to reflect best practices in the areas of peer education. In FY 2010, TNI/PUSKES will continue these activities emphasizing correct and consistent condom use, ensuring condom access and availability (including minimizing the stigma surrounding condoms), and promoting a counseling and testing campaign (Know Your Status) among higher risk members. Additional IEC materials promoting condom use will be developed. FY 2010 will see a greater number and geographic distribution of peer education activities. These workshops will further provide the opportunity for TNI/PUSKES to develop their own peer leader workshops and developing and adapting their IEC materials.

FY 2010 funding for HLAB will go towards the strengthening of laboratory infrastructure at military hospitals that provide HIV testing facilities. In recent years DoD provided TNI/PUSKES with new CD4 machines for the purpose of HIV testing. HLAB funds from FY 2010 can be used for the purchase of reagents for these machines, overall maintenance of equipment and supplies, training of laboratory technicians, etc. DoD will also assist TNI in the procurement and disbursement of equipment, and training of lab personnel.