quality and basic equipment is a constant problem as is the lack of refrigeration equipment, vaccines and sterile vaccination equipment.
Access to clean water is a problem for 15 per cent of the rural population. Knowledge of and resources for good sanitation are  very  unevenly  spread.Communicable diseases, including tape worm infection, chlamydia and gonorrhoea, acute respiratory tract infection and diarrhoea are significant health problems. Malaria is endemic, especially in transmigration areas, border areas and certain new socio-economic zones, such as timber industry areas and plantations. Irian Jaya has the highest prevalence   of   malaria   in Indonesia (17 per cent). Other endemic diseases include hepatitis, tuberculosis and pneumonia.Other diseases being treated by missionaries in remote places include ear disease, flu, filariasis and ascarid. Leprosy, despite its eradication around the world, is as high as 38 per 10,000 people in some regions.
Life expectancy for West Papuan women is particularly low, 60.3 years compared to the national average of 62.7. In many  regions  gonorrhoea, although only recently arrived, is widespread. Chlamydia is the major cause of sterilisation among local women and this disease has been allowed to spread untreated  despite  its  simple treatment using antibiotics. The birth rate has dropped by 80 per cent in some areas.
On the basis of women's statements about contraceptive use, fecundity and desire for more children, nearly half the total demand for contraception is unsatisfied. Neither the health services nor the family planning program promote condom or spermicide use, and as a result women at high risk of both pregnancy and infection do not receive  the  "double  protection" afforded by such simple methods.
However,  a local Indonesian health worker has stated that in one remote region of 40,000 inhabitants, 100 per cent of females of child-bearing age are accepters of family planning.  (This sub-district has been extensively surveyed by the Freeport mining company, which plans to extend its existing mining operations into this area, and is targeted as a major  Transmigration  receiving area). Independent studies have been requested by concerned local women and men to monitor the effect on targeted villages of the implementation of family planning, and the long-term effect of the drop in the birth rate.
"A common theme is that the women are not clearly briefed on the risks and benefits of each method being introduced... pill, injectables or implants. They also say it is difficult to refuse the specific method offered by the authorities for fear they might be regarded as anti-Indonesian or a sympathiser of the pro-independence movement." Cases have been reported of bribery of local women into becoming family planning accepters, and "over-zealousness"  amongst  local officials involved in the administering of the government's national "two child" program, particularly towards indigenous women. Complaints have been made of incorrectly fitted IUDs, and general lack of choice and information about side-effects of the progestogen-only contraceptives Depo Provera and Norplan implants (the two long-term injectable methods of fertility control), which are the most commonly provided methods. These methods have been identified by the WHO as presenting the highest potential for interaction with HIV infection.
Specific data on HIV/AIDS in West Papua is limited, despite recording the highest  number  of  carriers  in Indonesia. This is a recent and frightening phenomenon. The official figures show the number of cases tripled between 1990-1995. Increased tourism and the growth in 'prostitution, especially in the main towns and in the Freeport mining community, are a major cause of the increase. In isolated areas it is believed that transmission is likely to occur along the routes of small trading vessels or introduced by foreign workers.
AIDS transmission may be facilitated by: more readily available artificial contraception (other than condoms) leading to more promiscuous behaviour; contamination through unsterile medical equipment (according to WHO this may include the injectable contraception used in the administration of the family planning program); and the problem of weakened immune systems from the general ill health present in the community. AIDS potentially threatens communities with heavy loss of life. It has spread particularly rapidly in places snch as Maluku, where foreign fishing fleets and commercial sex activities have provided the institutional foundation for the establishment of the disease. Support services for people with AIDS are virtually non-existent.