As the world approaches the 2030 Sustainable Development
Goals, Indonesian health officials and community advocates
are calling for a stronger people-centred response to HIV
and TB, saying medical treatment alone cannot overcome the
stigma, discrimination, policy barriers and lack of access
that keep vulnerable communities from care.
With only
52 months remaining before the 2030 deadline, Dr Imran
Pambudi, a senior public health leader at the Indonesian
Ministry of Health (currently serving as Director of Health
Services for Vulnerable Populations), said efforts to end
AIDS and TB must move beyond controlling infections to
addressing the realities faced by people affected by the
diseases.
“Ending AIDS and ending TB is not only about
controlling infection – it is about putting people first,”
Dr Pambudi said.
Putting people first is
non-negotiable if we are to move from disease control mode
to disease elimination mode.
He said community-led HIV
and TB interventions should be judged not simply by their
reach or the number of people served, but by their impact on
people’s lives and their ability to remove barriers to
care.
Dr Pambudi has over two decades of experience of
leading national programmes in HIV/AIDS and TB control,
pandemic preparedness, and youth mental health, while
championing inclusive healthcare for marginalised
communities.
Young people still face gaps in HIV
services
For Bella Aubree, a transgender woman and
National Coordinator of Inti Muda Indonesia, who chairs the
Global Fund Youth Council, #PuttingPeopleFirst principle is
particularly important for young people, including those
under 18 who are at risk of HIV but can remain largely
invisible within conventional health
programmes.
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Aubree said Indonesia’s HIV response
broadly targets key populations but lacks sufficient
infrastructure specifically designed for young key
populations under 18 who acquire HIV through horizontal,
rather than vertical, transmission.
The result, she
said, is a “missing wedge” in HIV
programming.
Among the barriers are clinic hours that
conflict with school schedules, fear of disclosure to
parents or guardians, a shortage of adolescent-sensitive HIV
services and limited youth-specific peer
support.
“These” young people, she said, can
remain untested and therefore untreated and/or virally
unsuppressed, or be lost before they are linked to
care.
Aubree described a community-based approach that
combines demand generation, peer outreach, digital
engagement and youth events with practical access to testing
and treatment.
Social media and digital platforms can
build awareness, trust and motivation to test, while youth
festivals, community events and HIV literacy programmes can
improve young people’s understanding of HIV and their
perception of risk.
Bringing HIV services closer to
youth
But creating demand is only the beginning,
Aubree said. Services also must be safe, accessible,
acceptable and youth-friendly.
In Indonesia, this has
included point-of-care and decentralised testing, hotspot
outreach and door-to-door services. Such services remain
particularly important in a country where geographical
distances can make reaching health facilities
difficult.
“Door-to-door services are still needed
by the youth in Indonesia,” Aubree said, adding that
extended clinic hours also are needed for adolescents and
young adults whose school schedules make conventional clinic
hours difficult.
The community response, she said,
also needs mental health and psychosocial assistance,
paralegal support, community-led monitoring and policy
advocacy.
Community-led monitoring allows young people
to provide feedback about the quality of services and use
the findings to advocate for changes with health authorities
and the Ministry of Health of Indonesian government or
sub-national governments in the country.
Aubree
emphasised that community advocacy remains essential even as
new technologies, including artificial intelligence, become
increasingly prominent in health programming.
She said
communities must continue to help bridge the gap between
health providers and people who may distrust formal
systems.
“Marginalised young key populations trust
communities first,” she said.
Policy barriers leave
vulnerable youth invisible
Aubree pointed to a major
policy barrier that young people in Indonesia faced before
2022: access to HIV testing for those under 18 previously
required parental consent.
For young people who feared
anger, discrimination or disclosure within their families,
bringing a parent to obtain an HIV test could be a
significant obstacle.
Community advocacy helped lead
to a Indonesian Ministry of Health regulation allowing not
only parents but also community members and outreach workers
to accompany young people under 18 for HIV
testing.
But Aubree said a policy on paper does not
automatically guarantee implementation.
She and other
advocates have continued pressing for a circular letter to
be sent to health services throughout Indonesia so
facilities clearly understand that young key populations
under 18 can access HIV testing under the new
framework.
She said the advocacy has already taken
years.
“If there is a policy barrier,” she said,
“this is something that we need to change.”
The
issue reflects a broader challenge for Indonesia’s HIV
response: ensuring that national policies translate into
services that people can actually use. Recent reviews of
Indonesia’s HIV programme have also identified continuing
gaps in coordination, service integration and
sustainability, alongside the need for stronger community
support and stigma reduction.
Safety, population
ageing and disability rights must make services more
inclusive
For Dr Pambudi, addressing such barriers is
part of a broader commitment to ensuring that vulnerable
people are not excluded from the HIV and TB
responses.
He identified three priorities: safety, an
end to ageism and accessibility for people with
disabilities.
“Safety is health,” Dr Pambudi said,
arguing that violence prevention must be integrated into HIV
and TB programmes because people living in fear may be
unable to access services or adhere to treatment.
He
also called for greater attention to people living and aging
with HIV.
Many people living with HIV are now
long-term survivors, he noted, yet services too often remain
designed primarily around younger populations. Older adults
living with HIV should be included in clinical protocols,
social protection and community support, he
said.
Accessibility, meanwhile, must be treated as a
matter of dignity. Clinics, information systems and outreach
programmes that exclude people with physical or cognitive
disabilities undermine the commitment to put people
first.
Dr Pambudi also called for HIV and TB
programmes to break out of “critical silos” and connect
with mental health, reproductive health and social
protection, while becoming more deeply embedded in schools,
workplaces and digital platforms.
TB survivors
transform from survivors to champions and
leaders
Indonesia’s TB response faces a similarly
important challenge: ensuring that people affected by the
disease have a meaningful role in shaping the
response.
Indonesia remains the country with the
second-highest TB burden in the world, according to Muhammad
Tanwirul Huda, Strategic Partnership Officer with the Rekat
Peduli Foundation Indonesia and host of TB People
Indonesia.
More than 1 million people develop TB each
year in Indonesia, he said.
Although effective
treatment is available, many people affected by TB confront
challenges that medicine alone cannot resolve: stigma,
discrimination and social isolation.
For people with
drug-resistant TB in particular, the burden can include
losing employment, losing hope and feeling that ‘others do
not understand’ what they are experiencing.
“Ending
TB is not only about medical science – it is about
people,” Huda said.
Rekat Peduli Indonesia hosts TB
People Indonesia, a national network of TB survivors with
chapters in nine provinces. The network seeks to ensure that
people affected by TB are not merely recipients of services
but active participants in shaping policies, processes and
programmes that affect their lives, said Huda. TB People
Indonesia’s work includes peer support, community-led
monitoring and training community paralegals to address
stigma, discrimination and barriers to TB
services.
Community paralegals have provided direct
assistance to more than 200 people affected by TB, including
legal and psychological support, treatment navigation and
referrals.
Huda added that TB survivors also serve as
educators, advocates, supporters and community mobilisers.
They help identify people with TB, encourage treatment
adherence, support contact investigation and work alongside
health workers and government institutions.
Community
financing becomes increasingly important
As
international donor funding declines, sustaining these
community responses is becoming more difficult. Huda called
for stronger domestic financing, arguing that community
engagement should not depend primarily on external
donors.
“Communities are not optional partners –
they are an essential part of a resilient health system,”
he said.
Accountability is essential to reaching
2030
For Indonesian Ministry of Health leader Dr
Pambudi, accountability should be central as the 2030
deadline approaches. Success, he said, cannot be measured
only in infections averted. It also must be measured in
dignity.
“We cannot achieve the goals otherwise,”
he said, urging governments and partners to listen to
communities, resource them adequately and close the gap
between “what is proven to work” and “what is actually
implemented.”
Aubree likewise argued that communities
must have a defining role in changing systems, particularly
where policies continue to leave young people
behind.
Dr Pambudi Aubree and Huda, all were speaking
in an event around the largest global AIDS conference of
2026, the 26th International AIDS Conference (AIDS 2026) in
Rio de Janeiro, Brazil.
They all communicated in their
own messaging and contexts that the fight against HIV and TB
cannot be won by health systems working for communities
without communities having a meaningful role in leading the
response.
“Let us move beyond seeing people affected
by TB merely as patients,” Huda said. “Let us recognise
them as partners, leaders, and decision-makers.”
Dr
Pambudi summed up the broader challenge by calling for HIV
and TB interventions that allow every person – young or old,
with or without disability – to live free from disease and
stigma.
If communities are placed at the centre, he
said, the goal is not simply to end AIDS and TB as public
health threats, but to build healthier communities where
people can live longer, experience better mental well-being,
age with dignity and rights, and reach their full
potential.
Shobha Shukla – CNS (Citizen News
Service)
(Shobha Shukla is a feminist, health and
development justice advocate, and an award-winning founding
Managing Editor and Executive Director of CNS (Citizen News
Service). She serves as Chairperson of Global AMR Media
Alliance (GAMA), Host and Coordinator of SHE & Rights
(Sexual Health with Equity & Rights), President of Asia
Pacific Media Alliance for Health, Gender and Development
Justice (APCAT Media), and founder leader of DJOP
(Development Justice for Older Persons). She is the author
of 2026 book “Justice Unbound: Feminist Voices on Gender
Equality, Health Rights, and Inclusive Futures,” and was the
Lead Discussant for SDG-3 at United Nations
inter-governmental High Level Political Forum 2025. GAMA,
led by her, received the AMR One Health Emerging Leaders and
Outstanding Talents Award at UN High Level Ministerial
Conference on AMR 2024. Follow her on X @shobha1shukla or
read her writings here www.bit.ly/ShobhaShukla)
–
Shared under Creative Commons
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