Tag Archives: AIDS

Let’s Talk About Sex: Are Indonesia’s Youth Ill-Prepared?

Indonesia, the country with the largest Muslim population in the world, is not an advocate for teaching formal sexual education in schools. Instead, sex education is integrated into biology, social studies and religious classes in an implicit manner, including teachings on abstinence. There is an ongoing debate about the correct way to combat the spread of HIV and sexually transmitted diseases (STDs), as well as preventing unplanned pregnancies, with disagreements generally taking place between the government and non-governmental organizations, religious leaders and sexual health experts. The question is, what effects are the decisions of today’s adults going to have on the children of tomorrow if they are not equipped with the proper information they need about sex?

According to a survey in 2011 by the Ministry of Health, only 20 percent of Indonesians aged 15 to 24 had comprehensive knowledge of HIV. This, coupled with information from UNAIDS that Indonesia is one of Asia’s fastest-growing HIV and AIDS epidemics, shows the urgent need to ramp up education about sex in the country. Indonesia’s first case of the HIV virus was reported in 1987 and in 2012, 610,000 were estimated to be living with the virus according to UNAIDS HIV.

In Surabaya, instead of pushing a sex education agenda, recent news saw Mayor of Surabaya, Tri Rismaharini—through the Department of Trade and industry—forbidding the sale of contraceptives in minimarts and supermarkets to unmarried individuals and under-21s. The move was made in an effort to “protect children as the future generations, as well as minimize the negative effects of the misuse of contraceptives,” said head of the Department of Trade and Industry of Surabaya, Widodo Suryantoro, to Kompas.

Dewi Candraningrum is Chief Editor of Jurnal Perempuan, a publication aiming to educate and train readers of gender equality, opposing any forms of violence against women. Candraningrum believes that banning the sale of condoms to unmarried individuals in Surabaya is a bad sign. “This could lead to many unsafe abortions and unwanted pregnancies, which at the end endangers the lives of women,” she said. “Regulations are not clear in Indonesia. Sometimes they promote [the use of condoms], sometimes not; everything is so arbitrary if related to sexuality,” she continued.

In January, East Java’s city of Jember announced a plan to carry out virginity testing to high school girls, not allowing them to graduate if they failed the test. The plan sparked widespread condemnation, especially among human rights and women’s rights groups, including Jurnal Perempuan. Indonesian officials have recently apologised over said proposal, after top Islamic clerical body, the Ulema Council, announced the tests were not compatible with Islam. The city council of Jember apologized for any offence caused to women and Indonesian students.

How can such proposals to combat the spread of disease and unplanned pregnancies be put forward in the first place, and could they be linked with the general lack of sexual health education in the country? Vidia Darmawi is an independent consultant for the evaluation and review of HIV programmes, having worked with Family Health International and AusAID on HIV projects in 2002-2010. She thinks “it is not because of low-educated local authorities; it’s just that we don’t have an enabling environment or support from the government.”

Sex education in Indonesia is considered a taboo and Candraningrum says that teaching it “is considered harming the life of girls.” The government and education institutions view sex education as promoting ‘free sex’, a term coined by conservatives in an effort to ban sexual education, which Candraningrum believes should be changed to ‘safe and responsible sex’.

 In 2012, former Education Minister Muhammad Nuh said he objected to sex education being taught in Indonesia’s secondary schools, stating that children don’t need formal education about sex because they will learn it “naturally”.

In the same year, the newly appointed Health Minister Nafsiah Mboi declared that the Education and Cultural Ministry should address the spread of HIV/AIDS by providing proper education for schoolchildren. Nafsiah, a Catholic, added that she would promote condom-use to youngsters, which resulted in backlash rallies by Muslim groups considering the move an act of promoting indecency among the country’s youth. Consequently, several weeks later, Nafsiah withdrew her plan of kondomisasi (distributing free condoms), reported to have said: “With confidence, I do not agree with the distribution of condoms to our young people, absolutely not.”

Several countries in Asia have documented large reductions in common STDs through successful condom programmes. In a World Health Organisation (WHO) report, Thailand measured a 95% drop in common curable STDs during the 1990s, following introduction of the 100% condom-use programme, implemented by STD clinic staff working with sex trade establishments – in Indonesia we see 40-50 percent condom-use at best. Cambodia measured large decreases in STDs over five years following a similar intervention.

An anti condom programme poster by Umat Islam Indonesia Menolak Kampanye Kondomisasi (Muslims against a condom distribution programme)
An anti condom programme poster by Umat Islam Indonesia Menolak Kampanye Kondomisasi (Muslims against a condom distribution programme)

Namibia, a country that once had one of the highest rates of HIV, took aggressive action to reduce the spread of the virus. In a five-year plan (2010/11-2015/16), in conjunction with the US government, life skills-based HIV prevention is being taught at secondary schools, more than 25 million condoms are distributed every year to the public sector, and over 60% of men and women aged 15-24 have advanced knowledge of HIV, compared to Indonesia’s 20%, mentioned earlier. Sex before the age of 15 has also dropped in Namibia, as has the percentage of people reporting multiple partners. Could Indonesia take a leaf out of Namibia’s book?

In 2013, Terence H. Hull—Emeritus Professor at the Australian National University—along with Iwu Dwisetyani Utomo, Peter McDonald, Anna Reimondos and Ariane Utomo produced a report titled Sex Education: Do primary students understand how pregnancy can occur? A comparison of students in Jakarta, West Java, West Nusa Tenggara and South Sulawesi, Indonesia, to understand Indonesian students’ understanding of conception. The study covered students from a wide variety of backgrounds in four different regions of Indonesia with contrasting economic, geographic and sociocultural and population characteristics. 1,762 grade 6 students (11 to 12-year-olds) provided answers to the following list of behaviours and processes, indicating whether they believed each behaviour or process could lead to pregnancy:

1) When a man and a woman kiss

2) When a man and a woman hug

3) When a man and a woman have sex

4) When the sperm comes into contact with the egg.

Just over half of the students showed an advanced understanding of conception, correctly identifying that hugging and kissing do not lead to pregnancy and that sexual intercourse and the sperm coming into contact with the egg does. An additional 16% of the students had a purely biological understanding of pregnancy, and the remaining third were categorized as ‘other’, indicating a poor understanding of conception. Students in general schools and those in top-rated schools were more likely to have an advanced understanding of the causes of pregnancy than students in Islamic religious schools and schools with average performance. Location also had a significant effect on the understanding of conception, with West Nusa Tenggara and South Sulawesi showing particularly lower odds in comparison with Jakarta.

Studies in the West have proven that children have the intellectual capacity to understand the process of sex and reproduction by the end of primary school, and children as young as six are able to understand the fundamentals of how conception occurs.

Hull and co. observed “the obstacle to providing children with comprehensive sex education thus has less to do with the children’s ability to understand than it does with the strong apprehension of parents, teachers and policy-makers, to discuss sex with children…”

What happens when children are not provided with accurate information at an early enough age? They are most likely to turn to other sources, for instance their friends, the media and the ever-available Internet. Due to the quality of information available from these sources, adolescents are increasingly at risk of practicing unsafe sex.

Much effort is needed to overcome challenges provided by Indonesia’s current decentralized school system. Due to decentralisation, even current topics such as HIV and AIDS, which are included in the minimum standards for the national curriculum, do not always reach the district or school levels and are not always adhered to by textbook publishers, as reported by UNESCO (2010). Teachers are often found to shy away from talking candidly about sex to pupils, due to the sensitive nature of the topic, and teacher training must be implemented. Darmawi would like to see the education ministry “equip selected teachers with good materials and skills on how to convey [the message]” adding that “parents should also be involved in pre and post [class] discussions on sex education.”

Darmawi says, “In general, we’re really making progress in Indonesia compared to 10 years ago. HIV services can be accessed widely, information on safe sex can be more easily found in hotels (in red light areas), shops and posyandu (children and pregnant women clinic).” Hull and co.’s report concludes, “In the interim… for individual schools or districts, the local content curriculum provides some opportunities for including reproductive health material.” When asked whether any progress has been made since his report in 2013, Hull responded: “No improvement is likely.”

First published in Indonesia Expat (March 11, 2014)

Treating a Growing HIV and AIDS Epidemic in Indonesia

Yayasan Kasih Suwitno at Ruang Carlo Community Centre: Non-discriminatory, friendly and free services for people with HIV and AIDS in Jakarta, Indonesia. 

World Aids Day took place on 1 December 2014 and according to UNAIDS, HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) in Indonesia is one of the fastest growing epidemics in Asia, due to the lack of awareness, lack of education and health services, not to mention the social stigmas attached to having HIV or AIDS. Indonesia’s first case of the HIV virus was reported in 1987 and in 2011, 310,000 were reported to have the virus, with 8,700 annual reported deaths.

Today, the highest concentration areas are Papua, where 2.7% of the population have contracted the virus, followed by Jakarta, East Java, West Java, Bali and Riau. In Wamina, West Papua, 30% of the population have HIV, and nearly 100% have either Chlamydia or Gonorrhea, as these particular STDs are closely linked with the HIV virus.

Steve Wignall, Founder of Yayasan Kasih Suwitno (YKS) in Jakarta and Yayasan Bali Peduli (YBP) in Bali, has been working in Indonesia for 30 years and is an expert in HIV and AIDS. Due to an increase in cases in young people, in 2011 Steve and Dr. Emon Winardi (Director of the clinic) and their friend Johan set up YKS at Ruang Carlo Community Centre to provide services to patients that were friendly, efficient, easy to access and most importantly, free.

The clinic is located in the Saint Carolus Hospital and is a comfortable and discreet area, closed off from the rest of the hospital. Walls are painted a calming cream, service is friendly and knowledgeable, and there are different areas where patients can wait in peace.

“For young people with a chronic sickness, it’s very hard. They don’t have a lot of disposable income; the system often doesn’t respect their time and the cost of transport back and forth,” Steve tells me on my visit to the clinic in the centre of Jakarta.

Today the clinic has six full-time staff and is a wonderful example of a public-private partnership, working with the government who provide the reagents and drugs, and the NGO providing the environment and resources to make it accessible to people.

A common misconception is that HIV is a death sentence, when this is no longer true. If a person is tested early, before their immune system is damaged, medication is free and they will be able to live happy, healthy lives, have families and not infect other people. People are afraid to come for testing because of the stigmas associated with the virus.

Steve Wignall and Dr. Janice of Ruang Carlo Community Centre, Jakarta
Steve Wignall and Dr. Janice of Ruang Carlo Community Centre, Jakarta

Dr. Janice Tandraeliene works at Ruang Carlo Community Centre and believes stigmas are the main reason why people don’t take the test. “Some people are afraid to come, not just here but to all health facilities that test for HIV. There are many reasons, including the stigma, because they’re alone and don’t know what to do. When people come here alone, we try to consult and explain about HIV and make them comfortable so that they want to take the test.” If the result is positive, patients will be guided by therapy and given medication, which they are expected to take for the remainder of their lives.

The medication given to HIV patients is called anti-retroviral therapy and works by suppressing the virus and stopping the progression of the disease. Killing the virus is not possible, but these drugs stop it from developing. HIV is different from other viruses and infections because it becomes one with the DNA, integrating and hiding within it. Patients do not die from HIV; they die from infections, viruses and funguses, which are able to attack the weakened immune system.

“Unfortunately, HIV goes for the dalang (mastermind) of our immune system, the CD4 positive T cells, a type of white blood cell that is vital to fighting off infection. We’re all exposed every day to viruses and funguses but our immune system takes care of that,” Steve explains.

HIV is transmitted in key infected populations: injecting drug users – a problem that is decreasing in Indonesia as people are switching to amphetamine-like substances –, female commercial sex workers – 10-15% of whom are HIV positive -, and men who have sex with men – a rapidly expanding population of over 1 million individuals. In Jakarta in 2003, studies showed that 2% of gay men were found to be HIV positive; in 2007, 8%; and in 2011, 17%. At YKS today, an average of 27% of young men tested, are HIV positive.

What is the reason for this growing statistic? Social medias are providing a new platform for young people to meet and sex is happening at a younger age. Unfortunately, this is not coupled with adequate sexual education in local schools, and not at an early enough age, by teachers who are able and willing to talk openly about sex.

One of the fastest growing groups in Indonesia are housewives infected by their husbands who are visiting sex workers or are having sex with other men. In Bali, one in 200 pregnant women have contracted the virus from their husbands.

Steve believes the focus should shift towards men. “The focus often goes to the women, but it’s really the man that’s the problem. There’s only a sex industry if there’s a market to sell sex; if men didn’t buy it, there would not be women selling it. Getting men who buy sex to use condoms is a challenge and we need to continue to work on that; the best we see is 40-50% condom use.”

Antonio giving a consultation to a patient at Ruang Carlo Community Centre
Antonio giving a consultation to a patient at Ruang Carlo Community Centre

Antonio is Case Manager at Ruang Carlo Community Centre and is HIV positive. He’s passionate about helping others who are going through what he has. “My life has become more positive, living healthily, and getting support from family and friends. Of course, I want to be a role model for other friends so they do not feel despair and can continue to enjoy their lives by giving and sharing information about the ups and downs of life with HIV, and supporting each other.”

The only way to break the process of infection is for people with high risk behaviours to get tested. “We’re only going to be able to break this chain of infection if people know their status,” reminds Steve. Recently, the team at YKS have been bringing free HIV testing to certain high-risk establishments in Jakarta, resulting in a much higher number of people agreeing to be tested.

How to help

YKS would like to provide more mobile testing, and welcome your donations to help them continue to run their operations. 

Donations can be made to: 

Yayasan Kasih Suwitno

Panin Bank

148 5 017678

Harco Mangga Dua Blok I no. 5 A-B


 First published in Indonesia Expat December 2014