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.
HIV/AIDS is reaching epidemic proportions in Indonesia. It is beginning to affect the general population. Indonesia has the highest number of infected people in Asia – in fact, after sub-Saharan Africa, Indonesia has the highest number of HIV-infected people in the world. Reports now show that the majority of new HIV cases are due to unprotected sex and not intravenous drug use, as was previously believed. As such, there is a nationwide panic for policymakers: how do you make HIV part of the conversation in a conservative Muslim country that teaches only abstinence, if there’s any sexual education at all? Even in the most remote villages, HIV cases are popping up as men start to leave to work in cities, and women that had never experienced such problems are turning up at community health centers with STIs.
In Bali, it is estimated that 1% of the general population is now infected, with a greater number of young people testing positive. In response, the Balinese government is beginning to develop strategies for reaching those that would otherwise have no knowledge of any STIs, especially HIV, by incorporating an outreach program to every hamlet in Denpasar as a start, and introducing this to the wider districts later on in the year. Dr. Sari was invited to give seminars to these hamlets on women’s health and HIV, emphasizing the easy spread of the virus but also other STIs. It’s just as important to know about all the other infections that couples may contract by risky behavior, and that testing negative to HIV doesn’t mean that they should not be careful.
The first seminar was for two hamlets, at the “village head’s” office, perfectly placed within walking distance from an unofficial brothel. Not surprisingly, most of the outreach workers recruited for this program were men. What was surprising was their participation at these seminars. They’re inquisitive enthusiasm meant that this program could work after all. Other than explaining the general anatomy of reproductive organs, and general facts about the common STIs, Dr. Sari incorporated some graphic images of sexual organs that have been infected, to emphasize the need to seek medical attention.
Most government programs take years to implement, and have a lot of formalities and protocols, that make me skeptical of these things reaching the masses. However, I’ve been pleasantly surprised with the swift action Bali has been taking to try and educate and reduce the numbers of new infections occurring. They have been offering support to organizations like YRS that are working directly with those infected and with education and outreach, and are considering introducing proper sexual health education into the school curriculum. One such organization, KISARA, works with youth, and recently filmed a video at YRS showing Dr. Sari offering frank and honest counseling about HIV and the importance of condom use – both male and female. It shows a young girl coming into YRS seeking information and wanting to get checked. She made sure the filmmakers depicted YRS and the problem for what it is, not trying to glamorize the clinic, or sugar-coat the disease. She said that this is often the problem with media in Indonesia, and she hopes that this video will show that coming in is easy, and talking about sex and STIs to a professional is confidential.
Others have also gotten very involved, and an outreach program to get HIV into the conversation by going into high schools was recently launched. They managed to raise enough money to support the program for almost two years through benefit concerts, yoga-thons, and other events, getting everyone that lives in Bali involved – foreigners and locals alike – by making it fun and accessible. That’s been the great thing about the approach in Bali: they are making HIV part of the reality as something that shouldn’t be talked about in a whisper, but as part of the discussion not just in hospitals, or when referring to ‘risk groups’, but in schools, homes, and villages. Such an approach, however, cannot be implemented in the more conservative regions of Indonesia, and I worry that other countries cannot adopt them.
The looming Indonesian HIV epidemic should be taken as an example. If you don’t address the problem from the start and make it a part of the conversation, the numbers start to spin out of control.