Indonesian women face growing threat of lethal AIDS

Indonesian women face growing threat of lethal AIDS

By Harry Purnama

JAKARTA (JP): Indonesia's safe motherhood plan was still
struggling when the country was confronted with a new public
health problem -- Acquired Immune Deficiency Syndrome. HIV and
AIDS spread into Indonesian households just as the government was
trying to lower the maternal mortality rate, which now stands at
425:100,000. The high rate, coupled with the high infant
mortality rate (three to six times higher than that of other
ASEAN countries) has only helped the HIV and AIDS move from a
nightmare to reality.

Dr. Michael Merson of the World Health Organization's Global
Program on AIDS estimates that the spread of AIDS in Asia,
especially in South and East Asia, is the fastest in the world.
In 1994, of the 15 million HIV-positive people in the world, 14
million were teenagers and adults. One million were infants whose
mothers had been infected with the virus. The worldwide ratio of
women infected with HIV to men was even at 1:1.

Infected women carry the risk of dying during pregnancy but
the abortion of an infected fetus involves complicated humane and
moral considerations. The more so if the husband has been
infected because of his relationship with an HIV-contaminated
spouse. A whole family may die from this fatal disease, or leave
the children orphaned. If this happened in Indonesia, there would
be an uproar.

Until June 30, 1995, records show that HIV-positive women and
AIDS cases are rising in Indonesia. In 1993, the female
proportion compared to HIV positive males stood at 1 to 3, while
those with AIDS stood at 1 to 13. On June 30, 1995, the ratio of
HIV positive females to males was close to 1 to 2, while those
with AIDS stood at 1 to 10. This means that the HIV/AIDS threat
is not exclusively restricted to males, it also threatens
Indonesian women. Every province has AIDS infected inhabitants.

Why has the HIV/AIDS threat to women become a public health
concern? Firstly, because the infection is preventable, even
though the ill effects are unsurmountable.

Secondly, children have the right to a healthy life. The HIV
and AIDS threat is a threat against the realization of this
blessing and the right to live a secure and happy life.
Unfortunately, HIV-infected children tend to be publicly
ostracized, as happened to thousands of children in Rumania.

Thirdly, only women can lower the infection rate in future
generations.

Fourth, women's contributions to household economies have
earned more recognition. The loss of a female spouse would
obviously be felt by the husband and children.

Greater risk

Why do we fear that women carry greater risk of being infected
with HIV/AIDS than men?

Dr. Nafsiah Mboi, a member of the House of Representatives,
brought up the following reasons. The first one is "biological
vulnerability". Contamination passed on by a male to a female
appears two to four times more efficient than when it happens the
other way round. From a biological view point, women carry
greater risks than men. Girls are even more vulnerable to the
disease because an undeveloped cervix produces little vaginal
mucus, which in adult females acts as a natural preventive agent
against HIV infection. There is the possibility that women do not
seek treatment of sexual ailments since these afflictions are
generally asymptomatic in nature.

Other factors are ignorance of symptoms, embarrassment and an
aversion for medical checkups out of fear for public
stigmatization.

The socio-cultural economic reason fits in the gender of
stereotypes. It is generally assumed in Indonesia that knowledge,
pleasure and initiative are men's prerogatives while innocence,
acceptance and duty are characteristics normally attributed to
women. From this weak position, women find it difficult to
negotiate safe sex, even though they realize the risk of AIDS.

Research has disclosed that most married females give in to
sexual relationships with their husbands as if their lives
depended on it, out of fear of loosing their breadwinners. Some
women are also involved in unwanted sexual relationships for
reasons of survival, as trying to keep a job. Tourists also enter
the country to enjoy sex.

The ignorance of prostitutes also adds to the risks. With
beauty as their only earning power, these girls are placed in a
difficult position. These women face rape, unwanted relationships
and customers who corner them into an unprotected sexual
relationships.

At the edge of Jatinegara in East Jakarta, for instance,
conditions are extremely poor. No party has ever guided the girls
in the prevention of HIV and AIDS. Yety, 17, explained that she
had heard of AIDS, but, didn't know how contagious it is. Most
customers don't use condoms.

When asked if she accepts customers who refuse to wear a
condom, she answered, "What do you expect... I can't do anything
about it."

Her answer can be blamed directly on poor access to
information and social services. Women are regarded as second
class citizens in Indonesia which restricts their access to
information and services. Geographic, intellectual, social and
economical isolation of women worsen the plight of these women.
Research conducted in Thailand, India and Indonesia by Geeta-Rao
Gupta (1993), an Indian expert on AIDS, have found that some
women do not know the anatomy of their own bodies, let alone the
process of pregnancy and birth. The constraints women feel about
discussing sex with their husbands isn't helped by the
misconception many doctors have about AIDS.

Added to this, parents and children also find it difficult to
discuss sex.

Santi (not real name), an attractive 18-year-old girl working
at a singing hall in Mangga Besar in downtown Jakarta, has never
been informed about sex, let alone AIDS, by her mother.

"No one has ever talked about AIDS with me, my mother wouldn't
know, although she should be the one to inform me," the young
woman explained.

If sex workers were as enlightened as Mona, a prostitute in
Kramat Tunggak, North Jakarta, the threat of HIV/AIDS could be
slowed.

"I dare to suggest that customers use condoms which I keep at
hand. And, amazingly, they use them. The poster in my room makes
customers ask, 'What's that Mona?' Then I start explaining and
suggest that they use a condom," the 40-year-old sex worker said,
pointing to a poster which reads "Enjoy as long as you stay
Healthy". The poster was produced by Hotline Surya, Surabaya.

Several sex workers supported by the Kusuma Buana Foundation
have been educated, but there are many more Indonesian
prostitutes and women who have never been informed or educated
about HIV and AIDS.

The foundation's peer education approach follows the
activities of the WHO Global Program on AIDS. But, of the 1,800
to 2,000 sex workers and 300 pimps in Kramat Tunggak, only 80
peer educators have been motivated by this NGO program. Even if
the program draws satisfactory results, extension of the program
faces funding restrictions.

The peer education program, which helps the women of Kramat
Tunggak to becoming more aware and self assured when talking
about safe sex, is still extended free of charge. The program
therefore fails to recover its costs, which in turn makes
extension to other women difficult. Large scale intervention to
halt HIV and AIDS threatening women and children faces the
constraints of sustainability.

Dr. Nafsiah Mboi outlined her endeavors to fight HIV and AIDS
on National Children's Day last July 23.

"Millions of children in the world have been adversely
affected because their parents died of AIDS. We have to act now,
if we want to prevent Indonesian children suffering the same
fate."

Only two Indonesian children have been registered as suffering
from HIV/AIDS so far. This was done outside official government
registration. The potential for more children to be infected
rises with the number of HIV infected women.

This fact opened Dr. Nafsiah Mboi's eyes and forced her direct
her plea for adults and youngsters to adopt a responsible and
healthy life style. Her plea doesn't only extend to sex, it
includes proper blood transfusions, safe and hygienic childbirth
and utilizing proper equipment during operations. This is
necessary because the HIV virus has been found to withstand
disinfectants.

Harry Purnama holds a Master's degree in of Public Health. He is
a graduate of Monash University, Australia.