'Kondomisasi' needed to fight AIDS

By Robby Susatyo

JAKARTA (JP): You will not find the word Kondomisasi in your dictionary, not even in your latest, state-of-the-art edition. The word only exists in Indonesian jargon. It is a distorted use of the English suffix-ization to form a noun from a verb, like nasionalisasi from 'nationalization', or rasionalisasi from 'rationalization'. It has been applied not only to words of English origin but also to Indonesian words like Kuningnisasi for making things yellow, to imply the massive campaign activity of the ruling Golkar party, whose official color is yellow.

Kondomisasi is a word that often appears in debates on Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevention programs in Indonesia. Some HIV/AIDS activists assert that condoms can help curb the rapid spread of HIV transmission. But the Indonesian government has taken the clear stance that there will never be a condom campaign in Indonesia. Kondomisasi is taboo.

The HIV/AIDS epidemic in Indonesia is at a critical stage in its evolution. It has been estimated that there are currently between 65,000 and 100,000 people with HIV/AIDS in Indonesia. According to a Center for Health Research study from the University of Indonesia, reported in The Jakarta Post Oct. 29, 1996, between 12,000 and 31,000 people in the country die every year from complications related to AIDS. The number is in great contrast to the official report that says only around 400 people have been confirmed to be HIV-positive.

Only few would argue, however, that the actual number of HIV positive cases is much higher than is stated in the official report. They also agree that the penetration rate increases very rapidly -- some say it doubles every six months.

Another fact is that sexual contact is the dominant mode of transmission and there is a thriving commercial sex industry in many places, especially in big cities.

The controversy is not whether HIV/AIDS is a threat to the nation, it is more about how to save the country and the future generations from the epidemic. We have seen statistics from some neighboring countries like India and Thailand where many people, including housewives and babies, have died of complications related to AIDS.

None of the strategies and efforts to curb the spread of HIV transmission being implemented by AIDS activists in Indonesia focus solely on condom promotion. No one believes that condoms alone can stop or reduce the spread of AIDS. Based on experiences from other countries that have dealt with the problem earlier, three approaches are needed.

First, behavior change communications: creating awareness, concern, motivation and action by people to avoid risky behavior: from promiscuity to using unsterilized needles for injection.

Second, management and control of sexually transmitted diseases. The thesis is that Sexually Transmitted Diseases (STDs) are the gateway to HIV/AIDS, as prevalence is highest in people with STDs.

Third, social marketing of condoms: to improve access and use of condoms in risky sexual encounters.

In the absence of a cure for AIDS, condoms seem to be a practical and effective measure for preventing the sexual transmission of HIV. According to a 1992 study by the Family Health International, AIDSCAP, one in every four people with a HIV-positive partner is infected by the virus if they don't use condoms, but only one out of every 40 couples who use condoms regularly become infected.

The term "social marketing" needs emphasis. By definition, marketing is the process of identifying consumer needs and satisfying those needs by offering the right product to the right people at the price at the right place in the right way.

Kondomisasi in the sense of a mass campaign directed at the general population, contradicts the nature of social marketing. Fears that the campaign will hit everyone in the street, including school children and teenagers, are misplaced if the principles of social marketing are correctly applied.

Indonesians are different from Westerners. We have cultural and religious values that are strongly against promiscuity. Religious groups and others against the safe sex campaign say religious teachings and family values should be enhanced to prevent the spread of HIV/AIDS. They argue that a safe sex campaign could encourage people to be promiscuous. Using condoms, those who now hesitate will feel safe and protected and may go all out in sexual adventures. They also argue that condoms are not effective. They leak, they have pinholes. They are not foolproof, if not correctly stored and used.

We have just examined a two-sided coin. Viewed only from one side, the coin has dimensions invisible from the opposite side. In reality, the coin is worth something only if we look at it in totality. Like a knife, an object can be used for good causes and for evil deeds.

A mass campaign promoting condoms is certainly inappropriate. Consumers who do not have the need should not be tempted to 'convert'.

On the other hand, we cannot blind ourselves to the fact that there are consumers who engage in risky sexual behaviors, like sex workers. But in fact, it is not only sex workers who are the target of the safe sex campaign, but also the clients. And these clients can be found everywhere. They might be construction workers, university students, civil servants or private firm executives. To them, moral messages fall on deaf ears. The messages have been repeated over and over for thousands of years, but for these people they just do not work.

Must we wait until they repent? Must we wait until many housewives and babies are victimized by the recklessness of that relatively small percent of the population and by our reluctance to the look at issues from the right perspective?

It seems that condom use is the only practical measure for them. Some AIDS activists have started promoting the use of condoms in red-light districts, but the results have not been encouraging. There should be more efforts to increase people's awareness on the use of condoms. Kondomisasi is not an appropriate term. It should be changed to condom social marketing with a targeted, systematic and social needs based approach.

The writer is a social marketing consultant for family planning and AIDS prevention projects.