Citra Usadha campaigns against AIDS in Bali

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.