Small clinic gets word out about HIV transmission

By Achmad Solikhan

World AIDS Day 1997 falls today on the heels of a sobering UN report estimating 16,000 people contract the Human Immunodeficiency Virus each day, much higher than previous figures. In Indonesia, the average monthly cost of about Rp 2 million for drugs and treatment for a person with Acquired Immune Deficiency Syndrome is beyond the finances of many patients. The following reports include a profile of a Yogyakarta clinic, founded 13 years ago, whose staff fear their job has barely begun.

YOGYAKARTA (JP): In an alley in Yogyakarta, children can be heard shouting just like in any other area. But when night falls scantily-dressed thickly made-up women mingle with men seeking sex.

This is the red-light area some 200 meters from Jl. Pasar Kembang in the Sosrowijayan village.

One of the rented houses in the alley, a 45-square-meter building, hardly stands out from the rest, except for a wooden sign which reads Klinik Griya Lentera.

A small "AIDS" sticker is on the entrance door.

There are only two rooms in this building where 10 volunteers work. One is used as a meeting room and the other, smaller, room is used as an examination room.

In the meeting room there is a bookcase containing books on health, including AIDS. The walls are covered with posters warning of the dangers of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS).

The clinic provides medical examinations and consultations, particularly in relation to venereal disease. Two physicians from Sardjito General Hospital receive patients on Tuesdays and Thursdays between 1 p.m. to 5 p.m., a period when sex workers, who make up the greater part of the clinic's patients, are not working. Each patient pays only Rp 1,500.

"Generally they come to the clinic of their own free will," Titin Rezeki, Griya Lentera's project manager, said.

As prostitution in this area is not officially recognized by the government, there are no government health facilities, particularly with respect to venereal disease.

Originally set up to deal with family planning, the Yogyakarta chapter of the Indonesian Family Planning Association (PKBI) later decided to also deal with sexually transmitted disease (STD).

In November 1984 they set up the Lentera clinic to provide health services to Sosrowijayan locals, especially the sex workers.

"The spread of HIV/AIDS prompted the association to also handle sexually transmitted diseases," said Budi Wahyuni, executive director of the Yogyakarta chapter of PKBI.

To support its activities the Lentera Institute was also established.

Through these two establishments, PKBI conducts seminars and discussions at schools, villages and prostitution districts, on the dangers of STDs and HIV/AIDS.

Talks must vary to hold interest -- they also include lectures on the use of cosmetics. Other topics touch on much needed knowledge related to the locals' lives -- such as divorce settlements.

So far the clinic has not found a sex worker infected with HIV, but sex workers feel they are more vulnerable if they have sex with foreigners.

Two foreign tourists believed to be HIV-infected who once spent a night here may have triggered this conviction.

The clinic volunteers feel their work is still very limited given their 13 years in the village.

"We can only distribute free condoms and share knowledge about HIV and AIDS," Rezeki said.

Once every four months PKBI distributes 3,500 condoms to Griya Lentera, which in turn distributes then to sex workers, who, in fact, need some 7,500 condoms a month.

Only some 50 to 60 sex workers out of an estimated 300 operating in this area are willing to join in the clinic's activities, despite apparent support even from pimps.

"My girls (sex workers) do not have to consult specialists and pay a lot of money to them. If they would like to get medical treatment from Griya Lentera and join its activities, they are quite free to do so," said "Mami," a 50-year-old pimp.

According to Rezeki, many sex workers are reluctant to join because others may think they have contracted the virus or a venereal disease.

"Once it is known that we have a venereal disease, we may be asked to leave, or rest until we have recovered," said "Indah," 27.

Nevertheless, Griya Lentera has influenced the attitude of sex workers in the village.

Rezeki says sex workers active in the clinic's activities now ask their customers to use condoms.

Indah notes the common obstacle to a more widespread use of condoms: "Maybe they do not get full satisfaction using one," she said. "And customers would find other girls if we insist."

Indah, who has attended lectures on HIV and AIDS several times, said she is "horrified" by the potential dangers.

But she can only say: "If I get AIDS or HIV, that is the risk of my job."

While the fear of HIV/AIDS is relatively new, Indah and her colleagues have long stopped worrying about contracting a venereal disease.

"What counts is that I earn a lot," said Indah, who sets a rate of Rp 25,000 for 'short-time' services.

Obstacles to self-protection are addressed by the Lentera Institute, which also runs various courses on options for sex workers should they want to change jobs.

"Obviously they cannot earn money as sex workers all their lives," said Priyadi Prihaswan, a Lentera project manager.