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Indonesia's looming AIDS crisis
The Diplomat (Tokyo) - February 3, 2011
Gillian Terzis – Social stigma, cash-strapped NGOs, and moralising politicians are stopping Indonesia taking necessary action to prevent an epidemic.
Moral outrage is a staple of Indonesian politics, which makes for entertaining – if somewhat predictable – political theatre. So it hasn't been any surprise to see the majority of Indonesian politicians trying to score easy political points the past couple of weeks by targeting the usual suspects: sex, lies and moral decadence.
Yet while the chattering classes have been consumed by the government's plan to implement a pornography filter on the ubiquitous Blackberry smart phone, a more insidious threat to Indonesia's future has been growing.
Indonesia faces a looming AIDS epidemic that could wreck the big economic, political and social gains it has made in recent years. UN figures show Indonesia already has an estimated 300,000 HIV/AIDS sufferers and one of the fastest growing infection rates in Asia. The situation is particularly dire in Papua and West Papua, which have the highest HIV/AIDS infection rate outside of Africa – 3 percent of the population is infected with the virus, about 20 times the national average.
But despite the looming crisis, Indonesia's attitudes to sex are remarkably imprudent. Last year, federal Education Minister Muhammad Nuh objected to creating a formal sex education curriculum, arguing that students will learn about it "naturally." It's unsurprising, then, that many Indonesians are unfamiliar with HIV and AIDS.
Data released last year by the Central Statistics Agency illustrate the nation's uphill battle in promoting awareness – a mere 14.3 percent of Indonesians aged 15-24 had reasonable knowledgeable of HIV, far fewer than the 70 percent needed for the country to reach the Millennium Development Goal on HIV/AIDS.
So far, the problem is entrenched in populations that are isolated geographically and socially, such as sex workers, drug users and homosexuals. A survey conducted by Indonesia's AIDS Prevention and Control Commission, for example, highlighted the plight of waria (transsexual sex workers), among whom the HIV prevalence rate is 34 percent in Jakarta, 28 percent in Surabaya and 16 percent in Bandung.
Yet despite these alarming figures, less than half of those surveyed were using condoms on a regular basis. Indeed, many clients refuse to wear condoms – and many waria, desperate for money, comply.
It's perhaps not surprising that so many waria feel they have little choice but to sell themselves to try to make ends meet. The Department of Social Affairs classifies the waria as mentally handicapped, which severely hinders their chances of securing regular employment. In addition, the Indonesian government has been reluctant to recognize waria as a distinct category. This means that for many, the sex trade is the only occupation that offers them any semblance of financial security while still allowing them to embrace their identity.
Dewi, a waria who works the streets of Taman Luwang in Jakarta's tree-lined sub-district of Menteng, says she worked intermittently at a beauty parlour before finally committing fully to sex work. She says it's the only way someone in her situation can earn a decent wage as most employers show her the door as soon as they see her. "As a waria I'm officially classified as a male, but I identify myself as a woman," she says. "I dress as a woman. So tell me, who's going to employ me as a secretary in an office?"
Sexual clients are less discriminatory. On a good night, Dewi says she can take home $5-6 dollars, although she adds that there have been a few times she has gone home empty-handed.
"Sex work pays more than triple what I was paid at the salon," she says. "I knew about the risks involved, but I'm always very careful. I don't have sex with clients who won't wear condoms because of the risk of getting infected. But many other girls don't have that luxury." Dewi adds that although she doesn't have HIV, many of the other girls she knows have contracted it through unprotected sex or by sharing needles.
But the problem isn't confined to waria. Indonesia's HIV epidemic is becoming increasingly feminised, as many female drug users are resorting to prostitution to secure drugs more easily. In an interview in The Jakarta Post, Ratna Mardiata, a former director of the Drug Dependence Hospital in East Jakarta, estimated that between 70 percent and 80 percent of female injecting drug users are involved in informal sex work.
Yet many remain reluctant to attend treatment centres because of the stigma attached to infection. Overall, only 10 percent of Indonesia's HIV/AIDS sufferers are reportedly receiving antiretroviral treatment, thanks to a combination of factors, including the sense of shame felt by many people living with HIV/AIDS; shortages of antiretroviral medicines in remote areas and the simple fact that many Indonesians are unaware that they are infected.
Meanwhile, the local NGOs that are Indonesia's best chance of providing outreach to marginalised populations with HIV/AIDS face their own obstacles. NGOs remain a fairly recent phenomenon in Indonesia, and tend to be concentrated on the island of Java, the archipelago's cultural, political and commercial hub. Local NGOs are also often hamstrung by a lack of funding from central and district governments, with 61 percent of funding for HIV/AIDS initiatives coming from foreign donations.
Indeed, Aditya Wardana of Indonesia's United Nations General Assembly Special Session implies NGOs might be an unexpected victim of the country's economic success. He says that as Indonesia's economy continues to boom, foreign donors may well start to "question why they should channel funds to Indonesia." This could already be happening, he suggests, noting the example of 100 civil society groups that were forced to abandon their clients when a foreign donor pulled the plug on funding.
A recent UNAIDS report underscored the significant challenges faced by civil society groups in Indonesia, and argued that they lack the political and financial support that would enable them to participate at higher levels of decision-making. As a result, these key groups aren't part of the government's frontline assault on HIV/AIDS.
But issues of funding aside, one of the main reasons the government has failed to take a proactive stance on tackling AIDS/HIV is the stigma that's still attached to the disease. The government faces strident ideological opposition from some Islamic groups who actively oppose attempts to implement formalised sexual education programmes in schools across the archipelago.
Some hard-line Islamic groups, such as Hizbut Tahir, have urged Indonesians to "support the application of Shariah in an Islamic caliphate so that (the country) will be free of AIDS." While some local governments have provided thousands of free condoms to high-risk populations, for example sex workers in Papua, other provincial officials remain wilfully ignorant.
For many, it seems, it's convenient to pretend that the sub-populations worst hit by the disease simply don't exist. But the implications for the entire population of rapidly rising infection rates should give them pause for thought – HIV/AIDS epidemics ultimately undercut a country's economic growth by cutting the labour supply, lowering the morale of communities and undermining communities' capacity for regeneration and population growth.
The situation in Papua, where infection rates are among the worst in the country, should serve as a warning to officials inclined to treat the problem as a minority issue to be swept under the rug. Official records for 2010 released last month showed that the majority of HIV/AIDS infection cases were housewives – who had apparently caught the disease from their husbands.
[Gillian Terzis is a freelance journalist based in Jakarta and Melbourne. Her work has appeared in Foreign Policy, The Jakarta Post, New Matilda and Arena.]