Indonesian women face growing threat of lethal AIDS<\/p>\n
By Harry Purnama<\/p>\n
JAKARTA (JP): Indonesia's safe motherhood plan was still
\nstruggling when the country was confronted with a new public
\nhealth problem -- Acquired Immune Deficiency Syndrome. HIV and
\nAIDS spread into Indonesian households just as the government was
\ntrying to lower the maternal mortality rate, which now stands at
\n425:100,000. The high rate, coupled with the high infant
\nmortality rate (three to six times higher than that of other
\nASEAN countries) has only helped the HIV and AIDS move from a
\nnightmare to reality.<\/p>\n
Dr. Michael Merson of the World Health Organization's Global
\nProgram on AIDS estimates that the spread of AIDS in Asia,
\nespecially in South and East Asia, is the fastest in the world.
\nIn 1994, of the 15 million HIV-positive people in the world, 14
\nmillion were teenagers and adults. One million were infants whose
\nmothers had been infected with the virus. The worldwide ratio of
\nwomen infected with HIV to men was even at 1:1.<\/p>\n
Infected women carry the risk of dying during pregnancy but
\nthe abortion of an infected fetus involves complicated humane and
\nmoral considerations. The more so if the husband has been
\ninfected because of his relationship with an HIV-contaminated
\nspouse. A whole family may die from this fatal disease, or leave
\nthe children orphaned. If this happened in Indonesia, there would
\nbe an uproar.<\/p>\n
Until June 30, 1995, records show that HIV-positive women and
\nAIDS cases are rising in Indonesia. In 1993, the female
\nproportion compared to HIV positive males stood at 1 to 3, while
\nthose with AIDS stood at 1 to 13. On June 30, 1995, the ratio of
\nHIV positive females to males was close to 1 to 2, while those
\nwith AIDS stood at 1 to 10. This means that the HIV\/AIDS threat
\nis not exclusively restricted to males, it also threatens
\nIndonesian women. Every province has AIDS infected inhabitants.<\/p>\n
Why has the HIV\/AIDS threat to women become a public health
\nconcern? Firstly, because the infection is preventable, even
\nthough the ill effects are unsurmountable.<\/p>\n
Secondly, children have the right to a healthy life. The HIV
\nand AIDS threat is a threat against the realization of this
\nblessing and the right to live a secure and happy life.
\nUnfortunately, HIV-infected children tend to be publicly
\nostracized, as happened to thousands of children in Rumania.<\/p>\n
Thirdly, only women can lower the infection rate in future
\ngenerations.<\/p>\n
Fourth, women's contributions to household economies have
\nearned more recognition. The loss of a female spouse would
\nobviously be felt by the husband and children.<\/p>\n
Greater risk<\/p>\n
Why do we fear that women carry greater risk of being infected
\nwith HIV\/AIDS than men?<\/p>\n
Dr. Nafsiah Mboi, a member of the House of Representatives,
\nbrought up the following reasons. The first one is \"biological
\nvulnerability\". Contamination passed on by a male to a female
\nappears two to four times more efficient than when it happens the
\nother way round. From a biological view point, women carry
\ngreater risks than men. Girls are even more vulnerable to the
\ndisease because an undeveloped cervix produces little vaginal
\nmucus, which in adult females acts as a natural preventive agent
\nagainst HIV infection. There is the possibility that women do not
\nseek treatment of sexual ailments since these afflictions are
\ngenerally asymptomatic in nature.<\/p>\n
Other factors are ignorance of symptoms, embarrassment and an
\naversion for medical checkups out of fear for public
\nstigmatization.<\/p>\n
The socio-cultural economic reason fits in the gender of
\nstereotypes. It is generally assumed in Indonesia that knowledge,
\npleasure and initiative are men's prerogatives while innocence,
\nacceptance and duty are characteristics normally attributed to
\nwomen. From this weak position, women find it difficult to
\nnegotiate safe sex, even though they realize the risk of AIDS.<\/p>\n
Research has disclosed that most married females give in to
\nsexual relationships with their husbands as if their lives
\ndepended on it, out of fear of loosing their breadwinners. Some
\nwomen are also involved in unwanted sexual relationships for
\nreasons of survival, as trying to keep a job. Tourists also enter
\nthe country to enjoy sex.<\/p>\n
The ignorance of prostitutes also adds to the risks. With
\nbeauty as their only earning power, these girls are placed in a
\ndifficult position. These women face rape, unwanted relationships
\nand customers who corner them into an unprotected sexual
\nrelationships.<\/p>\n
At the edge of Jatinegara in East Jakarta, for instance,
\nconditions are extremely poor. No party has ever guided the girls
\nin the prevention of HIV and AIDS. Yety, 17, explained that she
\nhad heard of AIDS, but, didn't know how contagious it is. Most
\ncustomers don't use condoms.<\/p>\n
When asked if she accepts customers who refuse to wear a
\ncondom, she answered, \"What do you expect... I can't do anything
\nabout it.\"<\/p>\n
Her answer can be blamed directly on poor access to
\ninformation and social services. Women are regarded as second
\nclass citizens in Indonesia which restricts their access to
\ninformation and services. Geographic, intellectual, social and
\neconomical isolation of women worsen the plight of these women.
\nResearch conducted in Thailand, India and Indonesia by Geeta-Rao
\nGupta (1993), an Indian expert on AIDS, have found that some
\nwomen do not know the anatomy of their own bodies, let alone the
\nprocess of pregnancy and birth. The constraints women feel about
\ndiscussing sex with their husbands isn't helped by the
\nmisconception many doctors have about AIDS.<\/p>\n
Added to this, parents and children also find it difficult to
\ndiscuss sex.<\/p>\n
Santi (not real name), an attractive 18-year-old girl working
\nat a singing hall in Mangga Besar in downtown Jakarta, has never
\nbeen informed about sex, let alone AIDS, by her mother.<\/p>\n
\"No one has ever talked about AIDS with me, my mother wouldn't
\nknow, although she should be the one to inform me,\" the young
\nwoman explained.<\/p>\n
If sex workers were as enlightened as Mona, a prostitute in
\nKramat Tunggak, North Jakarta, the threat of HIV\/AIDS could be
\nslowed.<\/p>\n
\"I dare to suggest that customers use condoms which I keep at
\nhand. And, amazingly, they use them. The poster in my room makes
\ncustomers ask, 'What's that Mona?' Then I start explaining and
\nsuggest that they use a condom,\" the 40-year-old sex worker said,
\npointing to a poster which reads \"Enjoy as long as you stay
\nHealthy\". The poster was produced by Hotline Surya, Surabaya.<\/p>\n
Several sex workers supported by the Kusuma Buana Foundation
\nhave been educated, but there are many more Indonesian
\nprostitutes and women who have never been informed or educated
\nabout HIV and AIDS.<\/p>\n
The foundation's peer education approach follows the
\nactivities of the WHO Global Program on AIDS. But, of the 1,800
\nto 2,000 sex workers and 300 pimps in Kramat Tunggak, only 80
\npeer educators have been motivated by this NGO program. Even if
\nthe program draws satisfactory results, extension of the program
\nfaces funding restrictions.<\/p>\n
The peer education program, which helps the women of Kramat
\nTunggak to becoming more aware and self assured when talking
\nabout safe sex, is still extended free of charge. The program
\ntherefore fails to recover its costs, which in turn makes
\nextension to other women difficult. Large scale intervention to
\nhalt HIV and AIDS threatening women and children faces the
\nconstraints of sustainability.<\/p>\n
Dr. Nafsiah Mboi outlined her endeavors to fight HIV and AIDS
\non National Children's Day last July 23.<\/p>\n
\"Millions of children in the world have been adversely
\naffected because their parents died of AIDS. We have to act now,
\nif we want to prevent Indonesian children suffering the same
\nfate.\"<\/p>\n
Only two Indonesian children have been registered as suffering
\nfrom HIV\/AIDS so far. This was done outside official government
\nregistration. The potential for more children to be infected
\nrises with the number of HIV infected women.<\/p>\n
This fact opened Dr. Nafsiah Mboi's eyes and forced her direct
\nher plea for adults and youngsters to adopt a responsible and
\nhealthy life style. Her plea doesn't only extend to sex, it
\nincludes proper blood transfusions, safe and hygienic childbirth
\nand utilizing proper equipment during operations. This is
\nnecessary because the HIV virus has been found to withstand
\ndisinfectants.<\/p>\n
Harry Purnama holds a Master's degree in of Public Health. He is
\na graduate of Monash University, Australia.<\/p>",
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