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Cheap sex, high risk - the challenge of AIDS prevention

AIDS campaign, Indonesia. Obinna Anyadike/IRIN

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, 22, 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, 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 had 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-heeled 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.

A female former heroin addict on a methadone programme in Jakarta, Indonesia.
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's well-respected 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."


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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