Low condom use hampering HIV prevention in Indonesia<\/p>\n
Ben Harkness, Jakarta<\/p>\n
As of July, 2004 the official number of HIV\/AIDS infections in
\nIndonesia recorded by the Indonesian Department of Health was
\n4,389. However, a widely accepted estimate of the true number of
\ncases is between 100 000 and 150 000. The most common means of
\ntransmission (around 49 percent) is heterosexual contact but
\nintra-venous drug use is rapidly becoming an equally common way
\nfor the virus to spread. The highest number of cases is found in
\nJakarta followed by Papua, East Java, Bali and Riau. HIV
\ninfections are also beginning to spread into non-high risk groups
\nwithin the community.<\/p>\n
This problem is not going unchecked. A number of government
\nbodies, international and local NGOs, health centres, and
\nreligious organisations are working to address this problem,
\nparticularly in the sex industry and injecting drug user (IDU)
\ncommunity. However, their efforts are still being hampered by
\nignorance, apathy and taboo. Generally low levels of sexual
\nhealth knowledge within the community, for example, have resulted
\nin widespread myths and misinformation about condoms and sexually
\ntransmitted infection (STI) prevention.<\/p>\n
Many people still believe condoms have pores and are therefore
\nuseless, condoms are difficult to put on or reduce the enjoyment
\nof sex, STIs including HIV can be prevented by taking antibiotics
\nbefore or after sex, and someone's HIV status can be determined
\nfrom their physical appearance, if they seem outwardly healthy
\ncondoms are not necessary. As a result, condom use both for
\nprotection in commercial sex transactions and as a means of
\ncontraception remains very low.<\/p>\n
Unlike many other large cities, prostitution in Jakarta is
\nthrough indirect sex with brothels themselves being a relatively
\nrare phenomenon. Instead, various karaoke bars, health spas and
\nmassage parlors, in addition to offering the advertised services,
\nwill often facilitate sexual transactions between clients and
\nworkers.<\/p>\n
This scenario of indirect sex, however, has implications for
\nHIV\/AIDS prevention. While many local government officials and
\nlaw enforcers are fully aware of the true nature of such venues,
\nthey officially uphold the pretense that a massage parlor only
\nprovides massages and a karaoke bar is home only to off-key
\nrenditions of Rod Stewart and Frank Sinatra.<\/p>\n
When public outcry becomes too loud, law enforcers will
\nconduct raids on various venues, looking for evidence that sexual
\ntransactions are taking place. While these raids are usually just
\na means of extracting payment from managers rather than any
\ngenuine attempt to uphold moral standards, the fear of being
\nfined or shut down means such venues will rarely stock condoms
\nfor their clients.<\/p>\n
Both the reluctance for clients to use condoms and for venues
\nto stock them has dramatic implications. Condoms are the only way
\nto prevent the spread of STIs and HIV through sexual contact.
\nWith the estimated number of Indonesian males visiting female sex
\nworkers each year ranging from 6.9 million to 9.6 million,
\nIndonesia runs the risk of widespread STI infection.<\/p>\n
There have, however, been some positive developments in the
\nfight against HIV. Police are beginning to show increased levels
\nof tolerance, no longer arresting venue workers for simply
\nstocking condoms. Arrests are now only made if direct evidence
\nof prostitution is found. This increased level of tolerance has
\nalso meant managers are beginning to provide condoms for their
\nclients and staff.<\/p>\n
Several managers have even taken more active steps in the
\nfight against HIV and formed the Communication Forum for
\nEntertainment Venues Concerned with HIV\/AIDS, abbreviated in
\nIndonesian to the slightly catchier name of Forkihpa. This forum
\nactively approaches other venue managers not involved in HIV
\nprevention education to explain the social and financial impacts
\nHIV can have. This forum is also providing input to relevant
\ngovernment bodies in designing more effective HIV\/AIDS prevention
\nlegislation.<\/p>\n
In addition, research by Yayasan Kusuma Buana, a Jakarta-based
\npublic health NGO, has shown that the percentage of sex workers
\nin the \"always use condoms\" category has increased from 10
\npercent to 39 percent with similar improvements in the \"usually
\nuse condoms\" category. These results have been attributed largely
\nto the HIV\/AIDS education activities being conducted by NGOs like
\nYayasan Kusuma Buana in Jakarta's red-light districts. However,
\nfor the spread of HIV through the sex industry to be prevented,
\nthere needs to be 100 percent condom use.<\/p>\n
Government policy on prostitution in Indonesia has always been
\nconfusing. There are laws prohibiting the facilitation of
\ncommercial sex transactions (acting as a pimp) and the trade of
\nwomen and children but there is no law in Indonesia that
\nprohibits prostitution itself. Despite this, it is usually sex
\nworkers rather than managers or clients who attract the
\ncondemnation of society or the attention of police. Often
\nreferred to in Indonesian as \"women without morals\", female sex
\nworkers are often targeted as needing social rehabilitation. The
\nrole of clients in perpetuating the cycle of prostitution, in
\ncomparison, largely escapes public criticism.<\/p>\n
At present the West Jakarta district government is drafting a
\ndecree that would enforce compulsory condom use in entertainment
\nvenues throughout West Jakarta. The decree represents an enormous
\nopportunity for the government to take effective and meaningful
\nsteps towards curbing Indonesia's growing HIV\/AIDS infection
\nrates.<\/p>\n
If the decree allows for increased discussion on condom use,
\nencourages a multi-sectoral approach to HIV\/AIDS prevention in
\nthe sex industry, and introduces penalties for establishments not
\nenforcing condom use with their clients then significant
\nbehavioural change is possible. However, if the decree contains
\nambiguity and rhetoric or lacks the means for effective
\nenforcement then HIV infection rates will continue to climb.<\/p>\n
The writer is currently working in Jakarta through Australian
\nVolunteers International (AVI).<\/p>",
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