Wednesday, June 29, 2016

Indonesia - HIV in Indonesia: Breaking down taboos

HIV rates have declined across the world but are on the increase in a handful of Asian countries, including Indonesia, where it remains hidden from view. Things are slowly changing as the Indonesian government gets proactive in treatment and prevention, and NGOs help breakdown the taboos associated with the disease.

While an estimated five million people are infected with HIV in Asia, the rate of new infections has dramatically slowed in the last decade, except in Bangladesh, Sri Lanka, The Philippines, and Indonesia – which now has an estimated 660,000 people living with HIV. “Indonesia has a growing HIV burden in the sense that many more people are becoming aware, undergoing testing, and beginning antiretroviral therapy,” says Emily Rowe, Program Manager at Kerti Praja Foundation which runs a clinic and outreach program in Denpasar.

Rowe reports that in Bali an estimated 13,235 people are currently living with HIV, which is quite a spike from 4041  reported in 2007 , yet some say this is just the tip of the iceberg. Obtaining true figures is dependent on people actually getting tested and with so much stigma associated with HIV and so little public awareness, this has proved difficult. According to Dr Steve Wignall from Bali Peduli, “Overall the problem is that people don’t know their status. If they don’t know their status and continue to have high-risk sexual behaviour, more people are going to get infected.”

The Indonesian Government has become increasingly responsive to the epidemic and now provides free testing and treatment, so the recent jump in infections may simply indicate more people accessing services. According to Rowe, “The apparent ‘growing’ number of people infected is also reflective of the number of people still alive and living well with HIV through antiretroviral adherence and positive life change. ” While antiretroviral drugs are not a cure, they do help control the virus, allowing people to live longer, healthier lives. They also reduce the risk of infecting others.

Prevention is the only real answer and that requires informed dialogue, which has been a problem as it isn’t part of the school curriculum, and is barely even talked about. A number of NGOs have stepped in to fill the information void, conducting valuable outreach work in the community to help spread awareness.

“There is a taboo on talking about HIV,” says Indonesian writer Amahl Azwar who blogs about living with HIV. “There's something about the word 'HIV' that makes people very nervous. So basically people are still uneducated about it and they are stuck with the image of this virus just like it was portrayed in the 1990s.” He hopes that by sharing his story people will be less afraid, and more willing to get tested. “I think the main reason for the spread of HIV in Indonesia is the ignorance of the people, he says.

Some people here still think that HIV is God's punishment for being a sinner. For being an adulterer.

Lack of information is rife, even at a state level. Tifatul Sembiring, former Minister for Communication and Information, is well known for tweeting jokes about the disease, and once referred to HIV as “The result from genital misuse”. While last year, then Trade Minister Rachmat Gobel, told journalists, “Used clothes can transmit skin disease. People can even suffer from HIV. It’s true. There is a laboratory study that has proven it.” He later apologised.

A.A Raka Sutariyani believes stigma is a huge hurdle for HIV prevention, especially in rural villages, where there is little access to information. “While kids are taught biology in school, they are not taught about sexual health, so there are many misconceptions,” she says. Sutariyani runs the organisation, AYO! Kita Bicara HIV/AIDS, which translates as “Hey! Lets talk about HIV/AIDS”.  The organisation, which was founded by Bali Spirit Festival, targets youth with free concerts, a weekly radio program and ‘edu spirit’ workshops. The workshops, which have reached thousands of kids in remote regions of Bali, feature a unique, Balinese approach that includes singing and yoga. Facilitators also address common misconceptions – such as only sex workers and the gay community are at risk, that you can’t catch HIV if you love someone, or that if someone appears ‘clean’, they are safe. They have been so successful that AYO! has created a module to train more facilitators and has recently gained sponsorship from various government departments.

HIV was first reported in Indonesia among intravenous drug users in 2000, but currently around 70 per cent of infections are caused through unsafe heterosexual practices. While sex workers and their clients record the highest number of infections, Rowe tells SBS, “In recent years the epidemic has become more generalised, with increasing numbers of housewives and their children being infected.” The Kerti Praja Foundation estimates that approximately 60,000 females in Bali are vulnerable to HIV infection through unsafe behaviours of their male partners.

The island has a large number of sex workers working in karaoke bars, clubs and bars. At dingy roadside brothels sex can be found for as little as RP 30,000 (AUD $3). Sample testing by the Department of Health in 2012 revealed 16 per cent of sex workers in Bali tested HIV positive. Kerti Praja distributes free condoms to sex work sites daily and Rowe reports that condom use is relatively high, but adds “because of gender inequity and a constellation of other issues, it is difficult for them to always successfully carry out condom negotiation.”

Because of gender inequity and a constellation of other issues, it is difficult for them to always successfully carry out condom negotiation.

While NGOs have long standing connections with collectives and organised sex workers, and are able to hold focus groups and make frequent visits to venues with their mobile testing units, a secondary group known as ‘indirect sex workers,’ are harder to reach. These women may be supplementing their income by operating independently out of bars and clubs, but deny being ‘professionals,’ often seeking longer term ‘boyfriend’ clients.

What does all this mean for tourists? Well, Bali is a party island and people tend to let their guard down. There seems to be an attitude that what happens in Bali stays in Bali; but STIs come home with you so if you’re planning on some big nights out on the Bintang, it’s wiser to wear a condom than beer goggles.

Rowe believes that the major barrier to preventing the spread of HIV/AIDS is “the attitude of society, and the fact that HIV is related to behaviours that people often lie about, such as visiting a sex worker, cheating on their spouse or injecting drugs. Indonesians have a fear of HIV which often eventuates in stigma and discrimination, but even the most well-educated can stigmatise, and this is by no means unique to Indonesia.”

Alison Bone

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