Wed, 15 Mar 2000

Education a must for women to fight AIDS

JAKARTA (JP): A woman who rejects her husband is cursed and doomed to go to hell.

That is the belief of many Indonesians. And since a woman would prefer to be noble in the eyes of God, she would be unlikely to refuse her spouse's request for intercourse, regardless of her condition.

If one day she suspects there is another woman, she has decisions to make.

"Do I still want to sleep with him?" Later, perhaps, there will be the question of divorce. Can she make that decision? Does she have choices?

These were questions raised by public health services expert Meiwita Budiharsana, addressing a one-day talk on women and the Human Immunodeficiency Virus (HIV), which leads to AIDS. It was held on Wednesday by the Futures Group, a social marketing organization raising awareness on the importance of condoms, to commemorate International Women's Day.

Meiwita, program officer for gender, reproductive health and women's rights at the Ford Foundation, stressed there were two inseparable ways to reduce sexually transmitted diseases (STDs) -- the biomedical and the behavioral approach.

The latter has been the most difficult, "but we must keep on trying until we find a way".

Difficulty in changing sexual behavior is a major constraint to one of the simple sounding ways to prevent transmission: reducing exposure to a partner infected with a STD.

Meiwita noted the challenge because "there are customary and religious beliefs which make it difficult for a woman to refuse her spouse".

Even if a woman has only slept with her spouse, she is vulnerable to contracting an STD if he is unfaithful -- and the potential health risks are greater for her.

"Women's genitals are more accommodative to viruses and bacteria," Meiwita said.

Data from the Pelita Ilmu Foundation focusing on HIV/AIDS show that as of June 1999 there were 553 males and 330 females who were HIV positive or had developed complications from Acquired Immune Deficiency Syndrome. In a population of about 210 million, the reported figures are believed to be the tip of the iceberg.

While authorities and activists have been marketing condoms for the past 10 years, Meiwita questioned, "why has the rate of condom use remained less than 5 percent (compared to other contraceptives)?"

With higher bargaining power in a patriarchal society, men have the initiative, the choices and the capacity to make decisions, she said. But entrenched sexual attitudes has made it hard to get them to adopt sexual behavior which would be safer for them and their partners.

"A man who's been asked to wear a condom by a prostitute will just go to the other woman next door."

Women's ability to decide for themselves, through education, is thus considered the most feasible strategy toward, at least, combating risky sexual behavior.

Any kind of education would help women gain such autonomy, "but studies have found that formal education is the single channel to the outside world for many women in developing countries", Meiwita said.

"Autonomy is the ability to obtain information and use it as a basis for making choices on private and intimacy concerns."

Access to education is a fundamental human right and is the government's obligation to provide, she said.

It cannot be measured merely by female enrollment in schools, but also through looking at dropout and attendance rates, Meiwita said. "Girls will skip school when their mother is sick, and again when the mother gives birth."

Participants at the event confirmed the high expectations made of daughters.

In a "game" facilitated by health experts Irwanto and Yustina, people were asked to "choose sons or daughters". Twenty-one of 39 chose girls; reasons cited included that girls were "easier to assign tasks to, would readily help mother, would take care of her younger siblings, and would remain a daughter all her life".

The appeal for education for girls has long been voiced by the United Nations.

"Education decisively determines a woman's access to paid employment, her earning capacity, her overall health, control over her fertility, family size and spacing, and the education and health of her family," states a 1991 UN report titled Women, Challenges to the year 2000.

Findings on the vulnerability of women, even those with only one partner, to STDs -- not to mention their breastfeeding babies -- have made health advocates like Meiwita increasingly ardent about stressing that girls should stay in school, at least until early adulthood. Such findings include that women's chances of being HIV positive are three to eight times that of men, according to a leaflet issued by another group focusing on HIV/AIDS, Path Indonesia.

Without autonomy, Meiwita noted women even have difficulty in deciding priorities between their nuclear and extended families -- in-laws and all -- let alone for themselves. It is the reason she would like to see women's access to education even after marriage. After 54 years of national independence, she said, "why are we only expecting that women reach senior high school?"

Many women who were talked into early marriage and leaving school at the age of menstruation have regrets, wrote Meiwita and other experts on women, Rosalia Sciortino and Abdullah Cholil in The Life Saver: The Mother-Friendly Movement in Indonesia.

The reality is that most women put family needs firm, subordinating their own concerns.

Even if a woman is aware of pains in the lower part of her abdomen, for instance, she will likely not go for a checkup, if available funds are needed for other household needs.

"Fifty percent of HIV-positive women (here) don't know of their condition," Meiwita told the audience.

Even if a woman was financially able to seek treatment, the likely questions from health workers or professionals would make them even more reluctant. "Judgmental questions," even more incriminating for a single woman who might have developed symptoms of STDs, she said, were among the constraints to seeking immediate treatment.

"A nonjudgmental, confidential, client-friendly health service is still a dream," Meiwita said.

As in earlier talks, sex education in the home came up as one way of prevention. The facilitators requested participants take part in another game, asking them whether they agreed with the statement that "all parents in cities are ready to give their children sex education". Those who agreed and disagreed were asked to stand in two opposite lines -- but the "agree" line was left empty.

"Parents are not well-equipped because they themselves don't understand, and even if they wanted to, the material suitable for children is difficult to find," one participant said. (anr)