Getting condoms to sex workers in Indonesia
28 November 2007
Although Indonesia's HIV/AIDS epidemic is currently concentrated in a few high risk communities, it is vital that infection rates don't rise within these groups, and that the epidemic doesn't cross over into the general population. DFID is currently funding a project which helps to get condoms and other essential HIV services to one at-risk group: sex workers in Malang, East Java.
Encouraging safety
Image courtesy of Yannis Kontos/Panos Pictures
Malang has a large female sex worker population, many of whom operate out of
semi-regulated brothels. Several years ago, however, an increasingly
conservative political climate meant that many of these brothels were closed
down, making it more difficult for HIV prevention services to reach sex workers
and their clients.
To ensure that this did not cause an upsurge in
infections, the
Aksi Stop AIDS (ASA) project worked
closely with the Malang District AIDS Commission and local non-governmental
organisations (NGO). Lobbying the local government and the district parliament,
the Commission eventually won a guarantee that the closures would stop - on the
condition that each brothel put in place strong measures to avoid the spread of
sexually transmitted infections (STIs).
Compulsory protection
The Commission then brought together the local authorities, brothel owners, sex workers and pimps to agree on a practical way forward. All brothel-based sex workers are now required to undergo monthly STI screenings, and the use of condoms in brothels is compulsory. Screening is provided through the local community health centre, with a local NGO, Paramitra, liaising between brothels and the clinic.
By September 2007, more than 750 of the estimated 1,070 sex workers in the
health centre's catchment area had been contacted by outreach workers, and just
under 600 had been screened. Paramitra also interacts regularly with the
sex workers' clients, raising awareness about HIV risks and reinforcing
the necessity of condom use. Already, more than 13,300 people have
been reached in this way.
Back
to top
Winning prizes, saving lives
If 100% condom use is to be enforced, it is important that condoms are readily
available.
DKT, a social marketing organization, works with the local
authorities to provide a reliable supply of good quality condoms at low cost. To
monitor condom use, brothel owners keep track of the number of wrappers
collected by sex workers and report back to the AIDS Commission.
In an innovative touch, for every 20 wrappers, sex workers get a lottery ticket, which offers the chance to win prizes such as televisions and DVD players. The prize draw, sponsored by ASA and DKT, is held every few months. This always proves to be a big occasion, with live entertainment and an opening address by a senior official, such as the deputy head of the district or the chief of the local health service.
But the real prizes on offer are the lives that are being saved. After two years, more of Malang's sex workers are using condoms consistently, and rates of infection are down.
Key facts
- ASA has worked with local NGOs to develop targeted interventions by strengthening their capacities in programme and financial management, planning, monitoring, and behaviour change strategies.
- Technical assistance and training has been provided to local health services, and in particular the community health centres, so that they can offer high quality STI screening and treatment services, as well as voluntary counselling and testing for HIV.
- In 2005, 6.4% of female sex workers in Suko, Malang district, were classed as "always using" condoms, with STI prevalence amongst this community at 31.3%. In 2007, 49.6% always use condoms, and STI prevalence stands at 20.9%.
