Safe sex? Indonesia's conservatives would rather 'sinners' and sex-workers got Aids

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Katherine Butler reports from Jakarta, where religious intolerance is undermining the fight against Asia's fastest-growing HIV epidemic

Jakarta

Her name may or may not be Rizki. In any case, it’s what the 29 year old with long sleek black hair calls herself for work. In her T shirt with a cartoon character on the front, cropped jeans and sensible sandals she looks as if she could be on her way to a job in one of the factories in Bekasi, an industrial sprawl east of Jakarta that’s home to big international manufacturing giants like Converse and Samsung. 

But Rizki works in a bar in a Bekasi shantytown called Tenda Biru, where every night from 9pm to 3am, she dances with the long distance truck drivers and factory workers who come here to drink and relax after their shifts. If they want sex, she sells that to them too.

“It’s a long story. But I don’t want to go into it”. Rizki says about why she left her village in West Java four years ago to work in a sex and karaoke strip off the main highway to Jakarta. Entering prostitution after a failed teenage marriage is a common story for poor young women in Indonesia.

She “enjoys” her work here, she says, although it would be hard to imagine anyone choosing a job in this labyrinth of narrow, muddy, dimly-lit lanes packed with shacks offering bottled Bali Hai beer, dancing and young women if they didn’t have to. On a hot and humid Tuesday night recently the lanes were thronged with drinkers by 11pm and every bar was pumping out a different pop song, generating a deafening cacophony. A child of about eight, wearing a hijab to cover her modesty, darting in and out of the bars, made the most incongruous sight.

From her two to three customers a night, up to five on weekends, Rizki earns enough, around $50 a week, to cover her rent and pay off a “Mammy” or pimp.  Both Rizki and her friend Melli, 25, say they protect themselves against Aids. “If he won’t use a condom I can walk away”, says Melli.

But both women are single mothers,  so turning down customers isn’t a light choice. Little wonder that some 25 of the 250 of the women who work here are HIV positive.

Indonesia’s Aids epidemic is among the fastest-growing in Asia. From small pockets at the turn of the century it has spread to all parts of the country. At just under 0.2 percent the infection rate is still low compared to parts of Africa. But new infections have tripled in the last six years, and alarmingly, risky sexual behaviour has taken over from intravenous drug use as the main route for its spread. In the words of the plain-speaking new health minister Dr Nafsiah Mboi, the epidemic is driven by “the four Ms: macho men with money and mobility”.

In Tenda Biru, free condoms are available from a shack operated by an NGO which receives funding from the Global Fund to combat Aids, TB and Malaria. The charity also provides three-monthly HIV testing via a mobile clinic.  But culturally, condoms are a problem. Men won’t use them and women are typically too powerless to demand that they do. Three quarters of HIV infections in Indonesia come from unprotected sex. According to one estimate, 19 million Indonesians could be at risk of contracting the disease because of unsafe sexual conduct.

If ignorance or reckless sexual behaviour weren’t problematic enough, the country is now also in the grip of a moral battle over condoms led by Islamic pressure groups arguing that they encourage  promiscuity. Their stance mirrors the Catholic church’s preaching against condom use among the faithful in Aids-ravaged parts of Africa, complete with arguments over whether the virus is too small to be stopped by the pores in the latex.

Dr Mboi, former head of the National Aids Commission was plunged into a firestorm on joining government in June, after launching a campaign to promote safe sex among 15 to 24 year olds. The former paediatrician was denounced as “obscene” by the Islamic Defenders Front or FPI - the group that led protests forcing Lady Gaga to cancel her Jakarta concerts in the spring - and excoriated in a Twitter campaign.

The 70 year old released a YouTube video denying that she ever intended to distribute free condoms to high schools, but warning that unprotected sex was affecting people of all ages, including children. She was summoned to parliament to explain herself where she faced a protest organised by the radical Islamist movement Hizbut Tahrir, accusing her of peddling “free sex”.

Tuti Alawiyah, a former Women’s minister, reacted to the health minister’s initative by telling the Jakarta Post that condoms would just encourage pre-marital sex. “Keep the disease away with preventive action by improving the nation’s morality. There are positive ways to prevent HIV transmission, ways that do not follow the Western style”.

There is nothing “Western style” about the commercial sex on offer in Bekasi. The clients are all Indonesians and despite the conservatives’ preoccupation with “crimes against decency” which is sometimes interpreted to include prostitution, a similar sex trade is booming (and widely tolerated) all over Indonesia. “There isn’t a bus terminal in the country that doesn’t have prostitutes”, one official told me.

Aldo Saragi, who runs an advocacy group campaigning for the rights of sex workers blames hypocrisy among conservative law makers for driving the sex industry underground making it more difficult to educate people about safe sex and treatment.  Nationally, only around 30% of sex workers are believed to be using condoms and only 10% of men who visit prostitutes use them.

“The religious groups try to use HIV as an excuse to criminalise prostitution. But prostitution will go on because there is so much demand for it. The problem when they break up regulated prostitution zones is that then we can’t check every hotel or carpark, so it becomes even more dangerous for the spread of HIV/Aids”.

The poverty that drives single mothers like Rizki and Melli to the sex trade is the neglected underbelly of Asia’s biggest recent economic success story. In ten years Indonesia has gone from tanks on the streets, bankruptcy and total economic collapse, to democratic rule and an annual growth rate averaging 6% even as the rest of the industrialised world is mired in recession.

The optimism of new money is on show in downtown areas of Jakarta, with its shiny megamalls and high rise business hotels filled with international investors from the Asia-Pacific region. No wonder Barack Obama didn’t recognise much when he returned here for the first time since the years of his childhood spent in the city.

But the rise in religious intolerance, illustrated by the Lady Gaga episode, is becoming a potential threat to investors’ confidence in a moderate strain of Islam that sits easily with the rule of law. In recent months Christian churches and some Muslim minorities have been targeted by sectarian violence, women in some cities have been ordered by local authorities to cover up, and last month there was outcry after an atheist civil servant was jailed for posting the slogan “God does not exist” on Facebook. At the same time, the government is fostering a new atmosphere of economic nationalism, making life tougher for foreign-owned businesses.

While mainstream Muslim groups are fully involved with the Government’s anti-Aids campaign, the disease is increasingly a battleground for hardliners because it requires official acknowledgement of the extent of prostitution and sexual promiscuity. “HIV/Aids is a disease of sinners as far as the conservatives are concerned so why spend public money on them is the atttiude”, Dr Mboi says.

Vast sums of money from international donors have poured into Indonesia’s anti-Aids campaign; nearly $500 m from the Geneva-based Global Fund to combat Aids, TB and Malaria alone, since 2002. This has subsidised free life-saving Anti-Retroviral drugs which would otherwise cost about $80 a month, unaffordable to Indonesians surviving on or under the average monthly income of $200. 

But this effort is thwarted by having to constantly play down Aids prevention to avoid antagonising religious extremists. “We have to package our broadcasts about condoms on community radio so that they are not too vulgar or explicit” says Tri Irwanda Maulana, spokesman for the West Java division of the National Aids Commission. Despite that, he laments: “We are still struggling with condom use. The religious leaders refuse to allow it. Even though the provincial vice-governor publicly supported condoms in the campaign against Aids”.

In West Java, which has a population of 43million, the incidence of sexually transmitted HIV is higher than anywhere else in Indonesia.

Asep Gufron a local authority official in an area of Bandung, West Java’s capital,  where impressive work is being done by Muslim voluntary groups to lower the stigma around TB (TB and HIV usually go hand in hand) denies that there is a problem advocating the use of condoms  – for married people. “It is not a taboo, we use condoms for family planning purposes but tackling Aids needs to be about safe behaviour and that means abstinence and delaying the first sexual intercourse for young people”.

The devastating flaw in this message becomes obvious during a visit to the Hasan Sadikin hospital in Bandung. Doctors at the hospital’s HIV clinic explain that married women are increasingly testing positive at a rate that is rising more quickly than for sex workers.

“Housewives are being infected by their partners. It used to be drug users, but after 2009 heterosexual infection rates soared” says Dr Nirmala Kesumah the head of the clinic.

The Global Fund pays for caesarean sections for pregnant HIV positive women to minimise the risk of transmission from mother to child. But they still have more than 100 babies and children registered at the clinic, aged 1 to 14. “We have no experience of how to disclose to a child that they are HIV positive” says Dr Rudi Wisaksana. It is an enormous burden, they want to know why they have it, and they find it hard to accept that they have to be on medication for the rest of their lives”.

Even without religious tensions, Aids would be a massive challenge for Indonesia. Its population of 230 million people is geographically spread over 17000 islands and there are hundreds of different cultures and languages. It takes eight hours to fly from Aceh at one tip of the country to West Papua at the other. This doesn’t hinder the mobility of the citizens: at the domestic terminal at Jakarta’s Soekarno-Hatta airport, low budget flights to all parts of the archipelago take off and land every few minutes.  But the dispersal makes risky behaviour easier, and poses a massive challenge to a coherent implementation of a national anti-Aids strategy.

Local laws often run counter to national policy, in particular when dealing with prostitutes and other high-risk groups. When democracy arrived in Indonesia after the overthrow of the dictator Suharto in 1998, the 33 provinces gained more control over their affairs, and some are more conservative than others. In semi-autonomous Aceh, sharia law is in force and sex outside of marriage is criminalised. Adultery is an offence punishable by stoning and homosexuality (although legal in Indonesia) by public floggings and steep prison sentences. Women are regularly stopped for such transgressions as wearing tights and shorts.

“Decentralisation is one of the biggest problems” says Aldo Saragi of the sex workers’ collective.  “Aceh is the only part of Indonesia that has sharia law, but others are following their lead”.

For the government in Jakarta to either keep up with what’s going on in far-flung areas, or to challenge by laws that are unconstitutional, seems to be a political high wire act it’s unwilling to take on. The President, Susilo Bambang Yudhoyono, has been criticised for pandering to hardliners for political gain.

Sex worker Aldo Saragi argues that foreign donors bankrolling Indonesia’s Aids programme could do more to safeguard the rights of minorities like gays, lesbians and the transgender community. “Look, if Lady Gaga was rejected by the religious leaders, they have the power. So there is no choice but to work with them. But right now, we in the civil society groups are almost being driven underground, we are scared of these religious groups”

Meanwhile, austerity in donor countries is raising the spectre of the flow of money to foreign aid programmes, including for HIV/Aids, being scaled down. The Global Fund subsidisation of Aids drug treatment has been transformative in helping to reduce the stigma of Aids Dr Mboi says. “We have been able to say to people, look if you test positive, then you will get free treatment, and that has been hugely important”.

Although she insists that Indonesia is a “lower middle” income country, not a “middle income” one, she believes it will maintain public spending on Aids prevention and treatment even if foreign cash runs dry. “Our dignity as a nation means we should provide the funding when the Global Fund is gone”.  But she admits that if Aids programmes revert to a decentralised control, the impact would be unpredictable, even disastrous, in certain areas. “Who knows what would happen to the epidemic?”

Meanwhile, under an illustrated poster showing couples how to avoid HIV infection, Dhafik Rizki, 26, in skinny jeans, and a hoodie waits in a queue to see doctors at the HIV clinic in Bandung. His sleeping toddler, Merrijane is stretched out in his arms. Dhafik’s wife died last year of Aids. Merrijane, 2, inherited HIV from her mother. “I didn’t know anything about this disease until she became ill” Dhafik says. “The government is telling us every day on the radio and TV about Aids, but people don’t listen”. How will he tell his daughter that she has the disease?. “If we continue to get the right medication, then it’s ok, we will cope”.

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