This blog post was contributed by Sara Al-Lamki, one of the fifteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.
1 in 4 sex workers in Bali are suffering from HIV. And those are the ones that have already been tested, not the host of others that have not. That is quite a large percentage, but these women have been tested, and many are being treated. The real problem lies in the housewives and the newborns, whose diagnosed number is on the rise. These are the real victims as they are out of reach from the various innovative programs going on that target sex workers and ‘at risk’ groups. These women have contracted it from their partners without knowing, and only realize there’s anything wrong when they show late symptoms. This, of course, is a huge problem. YRS (my host organization) does counseling and testing of all STI’s and specifically educates all their clients on HIV prevention and testing. And though they treat and counsel hundreds of women, there are still the many that don’t come in to the clinic routinely. Enter the Peer Educator (PE).
From the very beginning, the YRS centre was an educational one, and though all the staff partakes in outreach on a daily basis, there are still hundreds (even thousands!) of other women in and around the market that they cannot reach. For this purpose Dr. Sari recruited and trained 10 PEs to do further outreach work and become information posts at various areas of the market. These women were completely reproductively unaware prior to their post, but had a keen interest in health and the female form and were not coy or shy and so were able to spread the message. They consist of women from various market jobs, from vendor to laborer to guide, day and night.
On this World AIDS Day, the PEs were given a focus group discussion by Dr. Ari from the Burnet Institute, to examine their level of knowledge not only of HIV/AIDS, but sexual health in general. It’s not easy to talk about these things with women in Indonesia, so to witness these women partaking animatedly in this discussion, offering their thoughts and understandings of sex and reproductive health, and laughing was refreshing and I couldn’t help but smile, and be proud of such a moment. The mammoth task of improving global maternal health seems a little smaller when I witness moments such as this one. One must also keep in mind the leaps and bounds these women have come—from not knowing to becoming PEs. And the confidence they gain by the everyday education, whatever their education level, pushes them to learn more and not be ashamed to say ‘I don’t know’ but refer to those that do.
It’s worth remembering also the myths prevalent in these communities. Where the belief that fellatio by a transsexual man will remove any STI, and STIs only befall men with many partners, and that condoms cannot prevent HIV. It is not easy to get people willing to talk so freely and encourage safe sexual practice, especially when most women believe asking their husbands to use a condom is akin to pushing them into the arms (or legs) of sex workers! It is not an easy environment to promote certain practices, and harder still to get women from within the community to promote it.
As part of increasing awareness, we folded over 800 red ribbons and split them up between the PEs. I followed one around the market to observe the way she did her work. She worked fast, weaving through the complicated lanes and calling out people by name, distributing brochures on HIV and Pap smears, and of course sticking the red ribbon on their chest. Speaking to a few of them after, I could see the pride in them as they talk about being PEs and teaching their friends about the various STIs. Not only is their existence promoting safe sexual practices and awareness, but it is also empowering these women that are often otherwise marginalized.