Low condom use hampering HIV prevention in Indonesia

Low condom use hampering HIV prevention in Indonesia

Ben Harkness, Jakarta

As of July, 2004 the official number of HIV/AIDS infections in
Indonesia recorded by the Indonesian Department of Health was
4,389. However, a widely accepted estimate of the true number of
cases is between 100 000 and 150 000. The most common means of
transmission (around 49 percent) is heterosexual contact but
intra-venous drug use is rapidly becoming an equally common way
for the virus to spread. The highest number of cases is found in
Jakarta followed by Papua, East Java, Bali and Riau. HIV
infections are also beginning to spread into non-high risk groups
within the community.

This problem is not going unchecked. A number of government
bodies, international and local NGOs, health centres, and
religious organisations are working to address this problem,
particularly in the sex industry and injecting drug user (IDU)
community. However, their efforts are still being hampered by
ignorance, apathy and taboo. Generally low levels of sexual
health knowledge within the community, for example, have resulted
in widespread myths and misinformation about condoms and sexually
transmitted infection (STI) prevention.

Many people still believe condoms have pores and are therefore
useless, condoms are difficult to put on or reduce the enjoyment
of sex, STIs including HIV can be prevented by taking antibiotics
before or after sex, and someone's HIV status can be determined
from their physical appearance, if they seem outwardly healthy
condoms are not necessary. As a result, condom use both for
protection in commercial sex transactions and as a means of
contraception remains very low.

Unlike many other large cities, prostitution in Jakarta is
through indirect sex with brothels themselves being a relatively
rare phenomenon. Instead, various karaoke bars, health spas and
massage parlors, in addition to offering the advertised services,
will often facilitate sexual transactions between clients and
workers.

This scenario of indirect sex, however, has implications for
HIV/AIDS prevention. While many local government officials and
law enforcers are fully aware of the true nature of such venues,
they officially uphold the pretense that a massage parlor only
provides massages and a karaoke bar is home only to off-key
renditions of Rod Stewart and Frank Sinatra.

When public outcry becomes too loud, law enforcers will
conduct raids on various venues, looking for evidence that sexual
transactions are taking place. While these raids are usually just
a means of extracting payment from managers rather than any
genuine attempt to uphold moral standards, the fear of being
fined or shut down means such venues will rarely stock condoms
for their clients.

Both the reluctance for clients to use condoms and for venues
to stock them has dramatic implications. Condoms are the only way
to prevent the spread of STIs and HIV through sexual contact.
With the estimated number of Indonesian males visiting female sex
workers each year ranging from 6.9 million to 9.6 million,
Indonesia runs the risk of widespread STI infection.

There have, however, been some positive developments in the
fight against HIV. Police are beginning to show increased levels
of tolerance, no longer arresting venue workers for simply
stocking condoms. Arrests are now only made if direct evidence
of prostitution is found. This increased level of tolerance has
also meant managers are beginning to provide condoms for their
clients and staff.

Several managers have even taken more active steps in the
fight against HIV and formed the Communication Forum for
Entertainment Venues Concerned with HIV/AIDS, abbreviated in
Indonesian to the slightly catchier name of Forkihpa. This forum
actively approaches other venue managers not involved in HIV
prevention education to explain the social and financial impacts
HIV can have. This forum is also providing input to relevant
government bodies in designing more effective HIV/AIDS prevention
legislation.

In addition, research by Yayasan Kusuma Buana, a Jakarta-based
public health NGO, has shown that the percentage of sex workers
in the "always use condoms" category has increased from 10
percent to 39 percent with similar improvements in the "usually
use condoms" category. These results have been attributed largely
to the HIV/AIDS education activities being conducted by NGOs like
Yayasan Kusuma Buana in Jakarta's red-light districts. However,
for the spread of HIV through the sex industry to be prevented,
there needs to be 100 percent condom use.

Government policy on prostitution in Indonesia has always been
confusing. There are laws prohibiting the facilitation of
commercial sex transactions (acting as a pimp) and the trade of
women and children but there is no law in Indonesia that
prohibits prostitution itself. Despite this, it is usually sex
workers rather than managers or clients who attract the
condemnation of society or the attention of police. Often
referred to in Indonesian as "women without morals", female sex
workers are often targeted as needing social rehabilitation. The
role of clients in perpetuating the cycle of prostitution, in
comparison, largely escapes public criticism.

At present the West Jakarta district government is drafting a
decree that would enforce compulsory condom use in entertainment
venues throughout West Jakarta. The decree represents an enormous
opportunity for the government to take effective and meaningful
steps towards curbing Indonesia's growing HIV/AIDS infection
rates.

If the decree allows for increased discussion on condom use,
encourages a multi-sectoral approach to HIV/AIDS prevention in
the sex industry, and introduces penalties for establishments not
enforcing condom use with their clients then significant
behavioural change is possible. However, if the decree contains
ambiguity and rhetoric or lacks the means for effective
enforcement then HIV infection rates will continue to climb.

The writer is currently working in Jakarta through Australian
Volunteers International (AVI).