Wed, 29 Oct 1997

AIDS volunteers mingle at Bali's busy Kuta beach

By Leyla Alyanak

KUTA, Bali (JP): Agus scans the new group of Japanese tourists with precision, weighing his chances like a pro. Most of the women are with their friends or husbands. But one of them, fortyish and with cropped hair, is alone. Agus has found his mark.

Not letting her out of his sight, he waits until she has settled on the beach for the day.

"Are you looking for a boyfriend?" he asks, sitting gingerly on the burning hot sand.

"Oh no," she answers coyly. After a few moments of silence, she adds: "Perhaps you can help me with transportation?"

Once Agus has become acquainted with his new friend, they will spend the next two weeks together, visiting Bali, going to cultural shows, and at night, often but not always, sleeping together.

And so it is in Kuta, a fast-lane and hard-drinking resort where local groups say at least half the tourists are looking for sex.

"The 'beach boys' make their living from escorting tourists," said Christian Supriadinata, a volunteer with a local AIDS drop- in center. "But often they don't know much about HIV/AIDS, so they may have unprotected sex."

But this is beginning to change as volunteers from the Drop-In Center Kuta, known as DICK, take to the streets.

"We hang out at the beach and surf, or we walk along the streets," said Puddi, another volunteer.

"We give out condoms and talk about safe sex to young people, and usually they are people we already know, so they trust us. We are young men, just like them."

The drop-in center and its street outreach program is just one of the many successful activities of Yayasan Citra Usadha Indonesian (YCUI), a Balinese non-governmental organization launched in 1992 to stem the spread of AIDS on the island. What makes YCUI special is its use of peers to reach higher-risk groups -- the homosexual community, students in the tourism sector, transvestites and prostitutes.

YCUI is the brainchild of Tuti Parwati Merati, who runs the department of tropical and infectious diseases at Sanglah Hospital in Denpasar, Bali's provincial capital.

Burnt

Since she discovered Indonesia's first ever AIDS case in 1987 -- carried by a Dutch tourist -- Parwati has been relentless in her efforts to track AIDS on her native island. She has traveled to Australia to learn more about the disease, and is in constant contact with specialists abroad.

"That first case was widely publicized in the press," she said, "and initially people were scared. All the equipment used to treat the tourist at the hospital was burnt, including the mattress and the linen. People were afraid because they just didn't know anything about the disease."

Initially people wouldn't listen, she said, because most Indonesians believed the disease could only be caught by foreigners.

"I wanted to understand it so I started to collect blood samples. I found that some Indonesians in Bali were indeed being infected," she said. Her system of random blood testing was so successful it is now used by nearly half the provinces in the country.

Further research funded by international groups pinpointed the high-risk groups and highlighted the trouble spots. Money was also used to prepare educational materials.

AIDS figures are still low on Bali, with only 37 officially known cases, a third of Indonesia's total.

Parwati says condom use is up and there are fewer reports of sexually transmitted diseases of any kind. But she says vigilance is now more important than ever because HIV/AIDS figures are doubling every six months.

Health workers worry because the island is a hotbed of sexual lure and a magnet not only for tourists, but for construction workers and other migrants whose constant travels push up the risk.

"There are more temptations here," Parwati said. "Our culture also promotes the spread of AIDS because there is little or no discussion among couples about sex. More people are coming through here, there is a lot of migration, and there is much mobility."

Bali has the country's third highest AIDS rate, outstripped by the remote border province of Irian Jaya and the overpopulated main island of Java. Greater Jakarta alone has a third of Indonesia's reported HIV cases, and counts between 20,000 and 40,000 sex workers.

"Java is a volcano which will burst at some point," said George Loth, the senior country program adviser for UNAIDS in Jakarta. "We can already feel its heat and smell the fires."

Java is the scene of massive migration, packed with seaports, budding industry and a booming construction business. Most of these sectors attract men without families, and prostitution usually follows.

Low

But the number of reported AIDS cases in Indonesia remains ridiculously low at 119 by end 1996. While insignificant compared to those of neighbors such as Thailand, figures are nonetheless twice what they were in 1994. Officials are taking them seriously.

Most people involved in the HIV/AIDS health sector agree the number of cases is vastly underreported.

According to a World Bank report, the ratio of males to females, the white blood cell count for those with HIV, and the age of reported victims are all at odds with figures reported from other countries. Also, cultural taboos are so strong that those who can afford it often go abroad to get tested, so those cases too go unreported.

The government recognizes Indonesia's vulnerability to HIV. The nation's 13,000 islands make it the world's largest archipelago, and its land and sea borders with eight countries ensure heavy migration.

Indonesia also has most of the other conditions needed for the spread of HIV/AIDS -- the existence of high-risk behavior groups, poverty, a high rate of other sexually transmitted diseases, and increasing urbanization.

The government has been watchful since the epidemic began. It launched an AIDS control program in 1988, just a year after the country's first AIDS case was reported.

By 1989, a national AIDS committee had been set up, with short- and medium-term national plans. In 1994, AIDS programs accelerated.

A presidential decree that year created a multisectoral AIDS prevention and control commission, and a national AIDS strategy was developed.

Indonesia is now more than halfway through a five-year national action plan which extends to 1999 and centers on raising awareness, prevention, testing and counseling, treatment and research.

Despite a steadily increasing upward trend, Parwati believes Bali still has some breathing space.

"Figures are low and this is still a golden age," she said. "We must use it to push prevention as much as we can. I am optimistic."

But the high turnover of tourists and migrants combined with the island's permissive lifestyle means no one can take that breathing space for granted.

For each Agus who has learned to use condoms and become HIV- savvy, another newcomer steps freshly off the bus or boat, armed only with dreams of dollars and bright lights. That newcomer may have never even heard of AIDS.