Condom friction in pious Indonesia
By Sara Schonhardt
JAKARTA - The image of a giant condom draped in Indonesia's national red and
white colors towered over the opening ceremonies of National Condom Week in
Jakarta. To coincide with World AIDS Day, the National AIDS Commission crafted
the message, "Use Condoms, Celebrate Life." But some hardline religious groups
don't believe condom use should be promoted, let alone celebrated.
The Islamic group Hizbut Tahrir held banners during a demonstration on Sunday
aimed at urging the government to end programs that provide free condoms to
male and female sex workers, based on the argument that condoms encourage sex
outside of marriage. Like many conservative opponents of the AIDS commission's
plan to increase condom distribution, they say the way to stem HIV transmission
is for people to stop engaging in risky behavior, such as drug use and
commercial sex.
But the AIDS Commission, or KPA, argues that moral posturing should not triumph
over the reality that HIV is quickly becoming one of Indonesia's biggest public
health problems, with the number of reported cases nearly doubling between
December 2006 and March 2009. "Now is not the time to pretend that all
Indonesians are holy-holy," said Nafsiah Mboi, the tenacious head of the KPA.
"Do we want to be hypocrites or do we want to see what's happening?"
Between eight and 10 million men annually visit female commercial sex workers,
but only about 10% say they use condoms consistently, according to the National
Coordinating Agency for Family Planning (BKKBN). That figure concerns HIV
prevention workers, who say Indonesia is at a danger point in its epidemic,
with as many as 19 million people prone to contracting HIV because of their
risky sexual behavior or that of their partner.
Although Indonesia's 270,000 reported HIV/AIDS cases account for only a
fraction of its 240 million population, the risk of the disease's spread is
high as the main route of transmission shifts from intravenous drug use to
unprotected sex.
Programs that discourage risky behavior and make condoms more widely available
have successfully reduced the HIV rate in nearby Thailand. But a lack of
political will coupled with backlash from conservative religious groups in
Indonesia poses big barriers to prevention and treatment, with some of the
worst forms of discrimination occurring at health centers.
"People here don't really care about HIV," said World Vision's Katarina
Hardono. "They think people who contract the disease are being punished for
engaging in risky behavior." The Christian humanitarian organization recently
hosted an interactive HIV exhibit to reduce discrimination against HIV carriers
in Indonesia. But Hardono and others working to curb the virus' spread say that
their efforts need more government support.
KPA figures show positive results when the government puts its efforts into
sex-related programs. The commission began mapping the prevalence of HIV/AIDS
in Indonesia in 2006 to determine what populations were most at risk. It found
that HIV was most highly concentrated among injecting drug users and geared its
national action plan toward providing treatment, care support and prevention.
When the commission began drafting its budget for 2010, it found condom use
among injecting drug users had soared while the number of new HIV cases had
fallen. Condom use among the clients of female sex workers, however, had hardly
increased at all.
In July, with an inflow of about $120 million from the Global Fund to fight
HIV/AIDS, the KPA began a condom use campaign focused on expanding education
and outreach to youth and men most likely to visit sex workers. Social stigmas
that associate condoms with prostitution and homosexuality are a major barrier
to their use, said the BKKBN's Nelly Nangoy at the launch of National Condom
Week.
Although condoms are available in convenience stores and pharmacies around
Indonesia, many people don't want to be seen purchasing them, partly from
embarrassment, but also out of fear. Legislation that criminalizes people
living with or vulnerable to HIV infection fuels stigma and discrimination in
many countries.
In Indonesia, that criminalization extends to latex, said Robert Magnani,
country director of the non-profit Family Health International. He explains
that bylaws in some districts of Indonesia allow for a woman to be prosecuted
on prostitution charges if she is caught carrying a condom.
"Indonesia's rapidly rising HIV rate is not a problem of finances,
underdevelopment or low education levels among Indonesian citizens," said
Michael Buehler, a postdoctoral fellow in Southeast Asian Studies at Columbia
University in the United States. "The Indonesian government just does not have
the political will to stand against conservative Islamic pressure groups that
say condom distribution promotes premarital sex."
The fact that President Susilo Bambang Yudhoyono chose to address culturally
sensitive subjects such as sex work and homosexuality during an August speech
at the International Congress on AIDS in Asia and the Pacific was a positive
sign that the government may support the KPA's condom promotion agenda.
Yudhoyono created the AIDS commission in 2007 to help coordinate efforts by
government and non-governmental entities, including the private sector, to
tackle the spread of HIV.
Meanwhile, conservative Islamic parties have become more marginalized,
garnering only 16% of the vote at April's national parliamentary election.
Advocates have welcomed a changeover at the Ministry of Health from a leader
who zeroed out money for condom promotion to a more reformist figure.
It is not only Islamic groups that have lashed out against condom use in
Indonesia. The Catholic Church and even the US government under the former
George W Bush administration, which steered funding toward prevention programs,
have promoted abstinence over protection. The Catholic Church forbids the use
of condoms as a family planning device, explained Mboi. "Does it also forbid
the use of condoms to save lives?"
Her challenge has drawn in Catholic universities, such as Atma Jaya, which is
working with DKT, the largest condom distributor in Indonesia, to increase the
use of contraceptives. Current figures show sales of 110 million condoms per
year in Indonesia, a five-fold increase since 1996, but still far from where it
needs to be, said the DKT country director, Todd Callahan.
Meanwhile, the KPA's current campaign actively focuses on Indonesian youth,
raising concerns that public health messages are targeting politically safe
populations. But Callahan disagrees that Indonesians are squeamish when talking
about sex. The biggest challenge to selling condoms in Indonesia, he said, was
the perception that sex with a condom was not pleasurable.
As part of this week's activities, DKT plans a concert and a "condom climb".
The KPA has named sultry, hip-shaking singer Julia Perez as its condom
ambassador, a decision that drew criticism from conservative groups who think
her presentation is at symbolic odds the government's short-term goal of
increasing condom use by 3%. "We have to change the message to say that with
condoms you enjoy sex more ... scare tactics just don't work," said Mboi.
Sara Schonhardt is a freelance writer based in Jakarta, Indonesia. She
has lived and worked in Southeast Asia for six years and has a master's degree
in international affairs from Columbia University.
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