Citra Usadha campaigns against AIDS in Bali

By Dini S. Djalal

Kuta, Bali (JP): It is midnight in Kuta, Bali. The packaged tourists and their families have retired to their air-conditioned hotel rooms. Taking their place are single travelers and surfers, and the prostitutes, male gigolos, drug dealers, and hustlers who wait to serve them.

Wandering among them are two youths, distributing condoms and advice. They are from the staff of the Outreach program of the Bali-based Citra Usadha Foundation, a non-governmental organization working in HIV/AIDS prevention and education. Every night, they are on Kuta's streets teaching the community about the danger of AIDS. Bali currently has Indonesia's third highest cases of HIV/AIDS, with 21 HIV cases and 11 AIDS patients.

It is a difficult task even for the streetwise. Widi, a petite 23 year-old Outreach worker, remembers being punched by a drunken man. She herself is no stranger to the brutality of the underworld. When Widi first joined Citra Usadha, she was often drunk or high. Today she is a trusted member of both Citra Usadha and the community she is helping.

It took the will of a concerned doctor to launch Citra Usadha. Tuti Parwati began her HIV/AIDS prevention research in 1987, when the Indonesian government sent her and other medical workers to Australia to study the disease. With funding from USAID, she returned to set up a system to analyze random blood samples, and soon established who, in the community, are "high-risk". Citra Usadha was established in 1992 with funding from various organizations, including the Ford Foundation and PATH (the Program for Appropriate Technology in Health). Citra Usadha's activities now range from the Revolving Condom Program, which trains street vendors to sell condoms and give HIV/AIDS prevention information, to the Outreach program, which targets sex workers.

Parwati is a tireless campaigner. Her day starts at 7:30 a.m. at Denpasar's Sanglah Hospital, where she chairs the Tropical and Infectious Diseases Department. After 3:00 p.m., she presides over matters at Citra Usadha. Her private practice and counseling activities begin after 6:00 p.m. Throughout the day she calls her two teenage kids. "I'm so worried about them -- they are at such a difficult age", she sighs.

Youth groups, however, are vital to the campaign. The Traditional Youth Groups Research Project, funded by San Francisco's Center for AIDS Prevention Studies and based in Kuta, Ubud, Candidasa, and Lovina Beach, trains youth groups in HIV/AIDS information and communication techniques, so that they may spread the message to their peers.

Parwati believes that one of the biggest problem in HIV/AIDS prevention is the lack of sex education among youth, either in schools or by the family. "We need more openness", she says, "especially in the big cities, where social controls are weaker and the people are anonymous". She adds that teenagers are now more sexually active than the public admits -- some due to ignorance. "Some girls become pregnant without even knowing it, because they don't know how you can become pregnant. This is why sex education is so important", she says.

Other important sources of advocacy are artists, comedians, and dalangs (shadow puppeteers). "They are all potential informants", says Parwati, "especially because they travel all over the island, from hotels to villages, and have a big audience which we may not reach otherwise". Comedians are particularly effective, because, "they slip in the message between jokes, so the audience will be more receptive to it", she says.

The quantitative effect the program has on HIV/AIDS prevention remains unclear. Only five percent of the national population uses condoms. Parwati offers that this may soon change. "It's difficult to say in numbers, but qualitatively, condoms are now more prestigious and trendy. If men carry condoms now, they look more macho", she explains.

Yet again, whether these condoms will be used is debatable. Parwati admits that one of the most difficult obstacle to condom use is the conviction that AIDS is a foreign disease. "Many people will not use a condom because they say they never sleep with bules (Westerners)", she says. The categorization of partners is also pervasive amongst sex workers. "People still believe in the myth that only foreigners have AIDS, so prostitutes will sleep with Indonesians without condoms", Made Setiawan, an Outreach worker, said.

The bias goes both ways. Some tourists arrive in Indonesia with visions of unspoilt beaches and communities. "Many tourists come here and won't use a condom because they believe there is no AIDS here", says Parwati.

The situation is aggravated by the ambiguity of prostitution in Bali. One of the negative effects of Bali's tourism boom is the proliferation of prostitutes, 90 percent of whom are allegedly from outside of Bali. "Prostitution is a big problem in Bali, because there is no localization (unlike in other major cities, where many sex workers live in one compound, such as Jakarta's Kramat Tunggak), so it is difficult to help them", Parwati says.

Gigolo

Yet, many women are not necessarily prostitutes, but merely dependent on their temporary boyfriends. "Many women have no homes", says Widi, "and instead move from boyfriend to boyfriend. These women are the most difficult to reach". Those who are prostitutes are easily persuaded. "For an extra Rp 5,000 (about US$2.20), the prostitutes will not use a condom", Widi says.

Changing partners is also popular among local males. "The majority of HIV cases are male gigolos, who are not necessarily sex workers. But change partners often, going out with tourist women, or men, until their tourist visas expire", says Parwati.

Yet even to categorize these men as gigolos is simplifying the issue. "No one will admit they're a gigolo. Some just like having lots of girlfriends", Setiawan says. The competitive and brutal nature of Kuta's cash-oriented environment also makes occupations unpredictable. "Some people here will do anything for money -- hustle when there are women, deal drugs when there is a shipment, become petty thieves when desperate", Setiawan explains.

Drugs is a particularly sensitive issue to discuss. Although advocacy is important, those who need help most are often in danger of police arrest. One of Setiawan's most important target groups are intravenous drug-users, who may obtain the virus through dirty needles. This campaign is especially difficult, Setiawan says, because the police sometimes follow him in order to get to the drug dealers, endangering the addicts.

Setiawan remains relentless despite the hindrances. Having trained dozens of street volunteers and vendors, who dispense free condoms to clients, he now plans to open a drop-in center in the middle of Kuta. He admits the work is hard, but necessary. "I've nearly been stabbed a few times, trying to break up fights, and many people were suspicious of me initially, thinking I was a narcotics officer", Setiawan discloses. "But you have to keep coming back. When they know that you are there every night, ready to give advice, they will ask for your help", Setiawan says.