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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