Condom campaign encounters resistance

JAKARTA (JP): When the government, with the strong support of non-governmental organizations (NGOs), embarked on a nationwide campaign to promote the use of condoms to check the spread of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), there was optimism that the campaign would be a success.

But after several years, condom use has not gained in popularity and its promotion as the best protection against HIV/AIDS remains controversial.

The use of condoms has been a main theme in the AIDS campaign, which has received backing from a number of international organizations, including USAID, KfW of Germany and the World Bank.

Long before AIDS came to Indonesia, condoms were widely accepted as a contraceptive. However, a controversy emerged when condoms began to be promoted as part of the effort to prevent the spread of HIV. Opposition came from religious groups, which likened the condom campaign to the tacit promotion of "free sex", adultery and prostitution.

In February last year, for example, activists from the Indonesian Family Planning Association became the targets of a protest by the Catholic community in Belu, East Nusa Tenggara, when they attempted to distribute free condoms as part of the AIDS campaign.

The locals accused the association of "promoting prostitution".

But the strongest opposition to the promotion of condoms in the AIDS campaign has come from Islamic religious leaders.

This opposition has put the NGOs behind the AIDS campaign, such as the Indonesian AIDS Society and Gaya Nusantara Organization, in a difficult position. Nevertheless, the campaign is forging ahead, albeit in a low-key fashion.

"The promotion of condoms (in the AIDS campaign) is necessary but it has to be implemented very carefully in view of the local cultural and religious traditions," says Abdul Manaf, chief of the directorate for the prevention of communicable diseases at the health ministry.

"The approach that we use in (dominantly Christian) Irian Jaya, for example, is totally different from what we do in (dominantly Muslim) Aceh."

Those who are opposed to the promotion of condoms to prevent HIV suggest that the AIDS campaign focus on discouraging promiscuity.

While the controversy remains, HIV/AIDS continues to take its toll in Indonesia.

According to official statistics, as of the end of February this year the number of people living with HIV reached 604 and another 235 people had full-blown AIDS. Since the first AIDS case was reported in 1987, 113 people with AIDS have died.

Jakarta has the highest number of HIV/AIDS cases with 243, followed by Irian Jaya with 211 cases and Riau with 107 cases. Aceh, Lampung, East Nusa Tenggara and East Timor have the fewest cases with "only" one case each.

New AIDS cases have been steadily on the rise in Indonesia. In 1987, two new cases were reported. Since then, new AIDS cases have shown an upward trend, reaching 12 in 1991. But the most dramatic jump was from 34 new cases in 1997 to 74 last year.

No condom, no sex

The sensitivity surrounding the condom promotion has forced the government to focus their campaign on high risk groups, particularly prostitutes, homosexuals, fishermen and truck drivers.

In its latest move, the government has introduced the "100 percent condom use" policy for brothels. The policy was apparently inspired by a similar tactic in Thailand which has reportedly been a success. The motto for the policy is "No Condom, No Sex".

"But since customers' awareness about safe sex is so low, the policy is doomed to end up a failure," said an AIDS activist.

Manaf said health ministry officials across the country were told to implement the 100 percent condom use policy "without causing unrest in their respective areas".

A behavioral surveillance survey conducted in several major cities across Indonesia showed that the use of condoms among high risk groups was not very encouraging.

The survey found that 47 percent of prostitutes' customers in Jakarta in 1997 used condoms, while that number was 30 percent in Surabaya and 29.5 percent in Manado.

In a 1998 survey the results were just as discouraging. In Denpasar, close to 70 percent of prostitutes' customers used condoms, while in Kupang, East Nusa Tenggara, that number was 52 percent and in Ujungpandang only 33 percent of the customers used condoms.

Manaf said that many people refuse to use a condom simply because they believe that wearing a condom will make intercourse less enjoyable, although they are well aware of the risks of unprotected sex.

There have been suggestions that to provide its AIDS prevention policies teeth, the government should initiate legislation similar to that enacted in Thailand.

Manaf cited the need for legislation which, for example, would require prostitutes to be tested for sexually transmitted diseases on a regular basis.

However, he said, the problem was that prostitution, which is illegal in Indonesia, is not always organized in brothels.

"What can we do with streetwalkers who work independently," he asked?

Prostitution has become an even more complex social and health problem due to the economic crisis. More sex workers are taking to the streets as many night spots that once served as prostitution fronts went bankrupt or were forcibly closed down by citizens. It is also feared that the economic crisis will force even larger numbers of women into prostitution. (pan)