Does flood of AIDS await Indonesia?

Christopher Purdy, Director, DKT Indonesia, Jakarta

In case you had not noticed, AIDS is here in Indonesia. In the last 12 months, the Ministry of Health released data indicating that 80,000 to 120,000 Indonesians were infected with HIV. The government stated that transmission rates of HIV among "high- risk" groups such as sex workers, transvestites, and intravenous drug users are higher (in some cases, much higher) than 5 percent.

This technically re-classified the AIDS epidemic in Indonesia from a "low" to a "concentrated" prevalence rate, repeating an all-too-familiar pattern of the epidemic's evolution to larger populations and communities -- primarily in urban areas.

This new information was important because it marked the government's decision to bravely address "uncomfortable" issues such as sex and intravenous drug use. By confirming that HIV rates were much higher than previously reported, the government significantly created political space to find solutions to these problems and increase prevention efforts. This is a welcome development but is accompanied by a new kind of challenge.

In Indonesia, talking about sexual behavior poses problems. While Indonesia struggles with self-identity and cultural shifts associated with modernization and globalization, a generation of young Indonesians are exploring their sexuality (and getting pregnant!). Commercial sex establishments are tolerated and, by all reports, continue to run a brisk business. Since the economic crisis, an increasing number of young women have been forced into commercial sex, moving among brothels, massage parlors, and bars. Sales of energy drinks and traditional herbs (jamu), widely considered to contain aphrodisiacal qualities (mostly caffeine) that improve sexual performance, are reportedly strong.

However, talking about sex or disease prevention remains a taboo subject, liable to send most Indonesians running or laughing. While many young Indonesians are indeed conservative, most are simply terribly embarrassed by the subject of sex. While they publicly shy away from discussions about sex, they privately yearn for knowledge. Because there is no publicly accepted forum for discussion, many young Indonesians turn to the internet, VCDs, and their friends for information about sex.

How then, will Indonesia combat an issue like HIV/AIDS? Without straightforward dialog about disease prevention and sexual behavior, this remains a serious challenge. Condom advertisements, for example, cannot be aired before 9 p.m. for fear that young people might see them. However, if youngsters do not see such advertisements, when will they be exposed to issues regarding personal safety? How will they know how to prevent disease? Who will tell them?

If the recent flooding in Jakarta is any metaphor, careful planning and preparation are critical to prevent an overflow of HIV transmissions in the future. However, Indonesians must not look only to their government bodies to address and solve this problem. Individuals and communities must open up the floodgates of education and clear a pathway for fresh thinking and behavior.

Frank and open discussions about HIV, including the promotion and use of condoms, are required (if you have never counseled your adolescent children about HIV and condoms, do so today!). Public dialog about HIV prevention from pop culture icons (such as movie stars, singers, and athletes) and community, business, and cultural leaders will make discussing HIV/AIDS and condoms more acceptable and less embarrassing.

However, this must be done aggressively and continually. Unlike the waters spilling across the Jakarta streets, a flood of HIV will not be so easily controlled and will not recede.

DKT Indonesia is a part of the Washington-based international organization focusing on HIV prevention and family planning.