INDONESIA: Female condom programme falters

Photo: Hera Diani/IRIN

Some women are intimidated by the large size of female condoms, but their relatively high cost and problems with distribution and supply have also hampered the government's attempts to promote them.

JAKARTA, 28 August 2007 (PlusNews) - Ningsih [not her real name], 22, was taken aback when she was handed a pack of two female condoms in Jakarta, capital of Indonesia, but was even more surprised when she opened one. Measuring 17cm long and 7cm in diameter with a sponge attached inside, the female condom is indeed large compared to a male condom.

"My, it's so huge. Will it be painful using it?" asked the self-professed freelance sex worker, who was hanging out at a sidewalk stall in the Pramuka area of East Jakarta, a well known pick-up spot.

She told IRIN/PlusNews she was not willing to try the female condom; she was fine with a tri-monthly contraceptive injection, which kept her from getting pregnant.

What about sexually transmitted infections (STIs)? "I heard condoms might prevent that, but most of the clients don't want to use them, and I don't dare to insist, although I sometimes provide them," she said. "If a client ejaculates inside me I wash with Betadine," she added, referring to a popular feminine hygiene product.

INDONESIA: Cheap sex, high risk - the challenge of AIDS prevention

Photo: IRIN

Safer sex message needs ears to listen

JAKARTA, 24 September 2007 (PlusNews) - We were kerb-crawling for sex workers near the railway station in the grimy Cipinang district of Jakarta, Indonesia's sprawling capital, with Endang Supriyati providing a running commentary from the back seat of the car.

"There, do you see those women there, sitting next to the drink vendors?" said Supriyati, project manager for Yayasan Bandung Wangi, a local association that provides HIV/AIDS information and condoms to women working the streets in the eastern suburbs of Jakarta.

"They're sex workers? They look like they're selling drinks."

"No, they're sex workers," said Supriyati, pointing to women dressed in nondescript jeans and t-shirts; waiting, bored, among the night-time pavement traders along the traffic-choked main road.

"Can we get out and talk to them?"

"No," responded Supriyati, 22, who was having second thoughts about the evening's plan. "They'll ask, 'Who are you bringing, what do you want?'." Her concern was that if our voyeurism was spotted and perceived as snooping, it would ruin the relationship she has built with the women.

Selling sex is technically not a crime in the world's most populous Muslim country, but soliciting, pimping and procuring are. Indonesia's sex industry, although smaller that that of other South East Asian nations, still reportedly rakes in the equivalent of somewhere between 0.8 percent and 2.4 percent of the gross domestic product.

The previous authoritarian regime had encouraged designated "brothel complexes" in an attempt to regulate the sex trade. In the last 10 years, the rise of populist Islamic parties under Indonesia's new democratic order has brought the closure of established red-light areas by conservative local councils, wary of being seen as encouraging prostitution.

A booming sex industry

In spite of the new piety, swarms of massage parlours, karaoke bars and nightclubs have opened, cashing in on Indonesia's economic boom. They discreetly offer sex to better-healed punters, but in areas like Cipinang there is no façade. From the kerbside to a nearby alleyway, or shacks by the railway line - the only privacy an industrial rate of intercourse can afford - a streetwalker would be hard-pressed to charge more than US$1.50 for a quick round.

That sad fact undermines the advocacy efforts of activists like Supriyati: in a country where condoms are not popular and sex is cheap, market forces mean men "get sex the way they want it".

"The problem on the streets is that you have to compete [for clients]," said Supriyati. Insisting on condoms would not only be bad for business, but would "suggest the sex worker is HIV-positive". The harsh reality is that 23 percent of sex workers are living with the virus, according to the National AIDS Commission (NAC).

By the standards of the region, Indonesia has a serious HIV problem. In the eastern province of Papua it has become a generalised epidemic, with prevalence at 2.4 percent. In the rest of the country it is yet to break out of the sub-populations of injecting drug users (IDUs), prisoners and sex workers; but these subcultures are expanding as a result of lopsided economic growth.

"Two things force girls into this industry: poverty and lack of opportunity," said Supriyati. Although she must have told the story many times before, she cried when she remembered how her father had sold her, at the age of 12, to settle his debts to an aunty who was running a brothel in east Jakarta. "If he wasn't poor, he wouldn't have done it," she insisted.

Photo: Obinna Anyadike/IRIN

Recovering heroin addict - drug addiction adds to the risk

But working the upmarket bars and clubs can also be lucrative, and there's a chance of finding a husband among the expatriate workers that hang out at the pubs of the big hotels. "It is often assumed that all sex workers join the industry under duress because they lack other employment opportunities ... But the data suggests that many women in the booming economies of East and South East Asia choose sex work because it can pay comparatively well," said a report by the Monitoring AIDS Pandemic Network (MAP), a group of internationally recognised experts.

NAC deputy secretary Kemal Siregar told IRIN/PlusNews that regular condom use among sex workers was between 30 percent and 40 percent. Three-year-old surveillance data among brothel-based workers suggested condom use of around 15 percent (compared to almost 98 percent in the Thai capital, Bangkok). Worse still, just under half of all clients buying sex in Indonesia were deemed "high-risk": truck drivers, sailors and port workers.

If safer sex has been a hard sell among female sex workers, male and transgender prostitutes are in a neglected league of their own. "Almost everywhere it has been measured, condom use in commercial sex between men and women is consistently higher than condom use in commercial sex between men, even though sex between men carries a far higher risk of HIV transmission," the MAP study noted.

Sex and drugs

The use of putau - low-grade heroin - has exploded over the last 10 years, adding a further dimension of risk. It is typically injected, often with needles shared by many addicts, speeding the potential rate of HIV transmission. The medical technician in charge at a small government-run methadone programme in east Jakarta told IRIN/PlusNews that 86 percent of the former IDUs who were tested this year were HIV-positive.

Addicts sell and buy sex, and the barrier between those sexual networks and the rest of society is highly permeable. "I've noticed that a lot of parents of young men who are drug users are encouraging them to marry early, to change them. But the fact is that they infect their wives and children," said NAC secretary Nafsiah Mboi.

Islamic leaders are wrestling with the issue of condom use. "We agree condoms should be in red-light areas, but it should be sex workers that buy them; they should not be for everyone, like students for example," was the less than ringing endorsement of Aelhi Laksono, an outreach officer at the Angung Sunda Kelepa mosque in Jakarta.

"The figures show that [HIV prevalence] has nothing to do with good or bad people; a certain percentage of the population will engage in high-risk behaviour, and from them it will enter into the general population," Mboi responded. "The people that don't care about abstinence or being faithful need condoms."

Supriyati acknowledged that even her group, Indonesia's only advocacy organisation made up of former sex workers, has struggled to get its message across. In her depressing assessment, "Until they get infected, Indonesian people will not realise how important safe sex is."

Kenya: Muslim Opposition to Condoms Limits Distribution

Photo: IRIN

Muslim leaders say promoting condoms is tantamount to promoting adultery

MANDERA, 17 September 2007 (PlusNews) - The strong anti-condom stance of religious leaders in northern Kenya means few people there are using them and traders are refusing to stock them, which AIDS activists warn is jeopardising the fight against the pandemic.

"I will never sell condoms in my shop; it is like promoting adultery and operating a brothel," Sharrif Mohamed, who owns a shop in Isiolo, Eastern Province, told IRIN/PlusNews.

Most traders in the mainly Muslim northeastern part of the country have refused to stock condoms, which are usually only available at government health centres.

Zamzam, a single mother of three in Garissa, a town North Eastern Province, dismissed condoms as "a thing for the prostitutes", saying, "I use my brain and intelligence when I want to sleep with a man, and can tell who is sick [with HIV/AIDS]; I am not a prostitute to use it." This level of ignorance is common across the region, where literacy levels are the lowest in the country.

"The HIV/AIDS pandemic is a curse and punishment because people have engaged in immoral acts and offended Allah [God]," Maalim Hussein Mohamud, a teacher at a 'madrassa', or Islamic school, in Mandera, near the Somali border, told IRIN/PlusNews. "They have to repent, observe religious teaching and not use condoms."

Mohamud said the only way to prevent the viral infection was to observe religious teachings, abstain from 'illegal' sexual acts and avoid the use of condoms.

"Our position is very clear: we shall never support the use of condoms; Muslims must shun acts that will endanger their lives. To be safe [from HIV], youths must pray five times daily, fast, and refrain from looking at women; extramarital affairs must be avoided and women must dress decently," he insisted.

Noor sheikh, who works at the government's HIV/AIDS and sexually transmitted infection control programme in North Eastern Province, said stiff opposition to the use of condoms was proving to be a hindrance to HIV prevention. "Our region has the lowest use of condoms in the country," he said. "Of course it is a factor responsible for many cases of infections."

Some activists have complained that the government has not done enough to educate the local population about condom use, particularly in rural areas, and it was also often very difficult to obtain condoms.

"Many youths are informed about the use of condoms, but have said they are not available in remote parts of the region," said Margaret Leshore, of the Samburu Women's Empowerment Programme, a non-governmental organisation advocating women's rights.

The condom is one of the main HIV prevention strategies employed by the government, and free condoms are available at most health centres around the country.

Although northern Kenya has some of the country's lowest prevalence rates, concerns have been raised about low awareness of the pandemic and the region's continued resistance to condom use.