HIV in Indonesia

HIV Situation

Commercial sex work is widespread in Indonesia. There are an estimated 190,000-270,000 female sex workers, and clients of sex workers number approximately 7-10 million, with condom use estimated at less than 10%. The majority of infections are concentrated in groups with high-risk behavior, particularly sex workers and injecting drug users. Risk behaviour among injecting drug users by far the most common. HIV transmission in Indonesia was initially related to sexual transmission, but transmission among injecting drug users has increased eight-fold since 1998.

T he epidemic fuelled by drug injection is already spreading into remote parts of this archipelago. Initially there were six provinces established as most heavily burdened, however, this has now increased to 11 provinces. The provinces are: Bali, East Java, Jakarta, Papua, West Java, West Kalimantan, North Sumatra, North Sulawesi, Riau, West Irian Jaya, and West Kalimantan. . UNAIDS Update 2005 reveals that counselling and HIV testing services started by local non-governmental organizations far-flung cities such as Pontianak (on the island of Borneo) are finding alarmingly high rates of infection—above 70% of people who request testing are discovering that they are infected with HIV. An estimated three quarters of them are injecting drug users.

Meanwhile, HIV prevalence as high as 48% has been found in drug injectors at rehabilitation centres in Jakarta. Most of these drug users are young, relatively well-educated and live with their families. Experts warn that if risk behaviours among drug injectors, among male, female and transgender sex workers, and among clients of sex workers do not change from the levels observed in surveillance performed in 2003, Indonesia will be seeing a far worse epidemic.

Surveys have found that although that most injectors know where to get sterile needles, yet close to nine in ten (88%) of them still use non-sterile injecting equipment. Many injectors are reluctant to carry sterile needles with them for fear that police would treat this as proof that they inject drugs (which is a criminal offence). The incarceration of drug injectors is a significant facet of Indonesia’s epidemic. In Jakarta, between 1997 and 2001, HIV prevalence among drug injectors in Jakarta rose from zero to 47%, for example. Subsequently, in the capital’s overcrowded jails, HIV prevalence started to rise two years later, from zero in 1999 to 25% in 2002.

More than half the drug injectors in Jakarta are sexually active and one in five buys sex. Yet, about three quarters of those users do not use condoms during commercial sex (Center for Health Research and Ministry of Health, 2002). Meanwhile, rates of drug injection among male sex workers are higher than among other population groups, with many of these men selling sex to finance their drug habits. A large proportion of male sex workers also have sex with women . Condom use, generally, ranges from being infrequent to rare. In Jakarta, condom use rates during commercial sex hardly changed in 1996–2002, before rising slightly. Again, it is found that women are reluctant to carry condoms as it is regarded as “proof” of sex work by the police who might then arrest them.

In a survey in 2004, three quarters of sex workers operating out of massage parlours and clubs said they had not used condoms with any of their clients in the previous week. In brothel areas of the city, sex workers and their clients were even more averse to using condoms, despite almost a decade of prevention efforts. In such contexts, experts state, it is not surprising to discover that HIV prevalence among sex workers in Sorong, for example, reached 17% in 2003, and that an average 42% of sex workers in seven Indonesian cities were infected with gonorrhoea. Such intersecting networks of risk guarantee that HIV will spread more extensively in the wider population, especially where multiple sexual partnerships are common, such as in parts of Papua province. There, almost 1% of adults in five villages have tested HIV-positive in a sero-survey conducted in 2004.

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