AIDS: Men make a difference

JAKARTA (JP): "Eliminate prostitutes! That will solve the AIDS problem." So screams a headline on the website of a well-known professor of psychiatry at the University of Indonesia in his World AIDS Day message. Wish that it was that easy (forgetting for the moment the small matter of human rights).

Are sex workers, in particular, and women, in general, the sole source of the problem or the solution? I think they are not. At last this is being acknowledged in the theme for this year's World AIDS Day: AIDS and Men.

Up to now, our prevention activities have tended to focus upon women, either as "vamps or victims", to use the terms from a well-known female AIDS activist, Robin Gorna. They are either the "immoral" sex workers or the "innocent" housewives.

We ignore the fact that, if women are infected by HIV, the virus that causes AIDS, in most cases they have been infected by men. Either a client, for sex workers, or an unfaithful husband, in the case of 80 percent of women with HIV in the world.

Because of the way their bodies are constructed, women are much more vulnerable to HIV infection than men. Put the other way, men are less likely to be infected during sex with an infected woman than vice versa.

Much less likely. Epidemiologists (experts on the spread of infection) tell us that reducing the infection of women by men would be the fastest way to halt the AIDS epidemic. Surely therefore it makes sense to focus on changing the behavior of men.

Further supporting this approach is the fact that, in general, men have more sex partners than women. This means that a man with HIV is more likely to infect more people than a woman. And men are more likely to force themselves upon women, sometimes even young girls. Women often have limited capacity to determine when, where and whether sex takes place.

As we talk of men's' vulnerability to HIV infection, let us not forget an often forgotten group of men--transvestites. Surveys in Jakarta have shown that these people are among the most vulnerable to infection, with as many as 6 percent infected in 1997, the last time such a survey was carried out. While many may wish to ignore such people, what is often forgotten is that their sexual partners are exclusively men--and it is these male clients who are infecting them. Such clients are usually married and are thus also putting the wives at risk of infection--and through their wives, also their children during birth or breast- feeding.

What can we do about this? In Indonesia, there is frequent criticism of NATO--No Action, Talk Only! And often this is justified. But as has been noted by Nafsiah Mboi, our tireless AIDS activist, sometimes talk is a form of action. And nowhere more so than in connection with the silence which so often surrounds AIDS. Although wives often suspect husbands of risky behavior, they are scared to discuss it, fearing physical or mental violence, or how it will affect their relationship. Parents are unwilling to discuss matters related to sex and drugs with their children, because the subject is taboo, or because they don't know how to start. Businesses put their heads in the sand, hoping that AIDS will bypass their workforce.

To often, AIDS is seen as someone else's problem, one not likely to touch us. All too often it is infection among our family, our friends, or our employees, which disabuses us of that denial--too late.

And when that happens, the burden of care for the infected person usually falls upon women. Men need help to accept their role as fathers, and to be willing to provide care and support, both in the family and the community.

When it comes to AIDS, men do make a difference. But also, with encouragement and with care to avoid the finger pointing which women so often experience, men can make a difference.

--Chris W. Green