A new survey has revealed a mixed picture of HIV cases, with cases in commercial sex workers in Bali showing a downward trend for the last two years.
D.N. Wirawan, a medical professor at Udayana University in Denpasar, who is also a noted researcher in HIV/AIDS, theorized that there were three possible major reasons for the drop in HIV/AIDS cases in this particular group of society.
“The first reason is the increasing mortality rate of sex workers with HIV/AIDS; secondly the number of sex workers infected with HIV was indeed decreasing; or a combination of these causes,” the professor said.
Based on the annual survey, conducted since 2000 through 2012, the prevalence of HIV cases reached its peak in 2010 with 22 percent of sex workers in Bali infected with HIV. In 2011, around 19 percent of sex workers had HIV, and in 2012 only 16 percent of sex workers were identified as infected with the disease.
The survey team interviewed 400 direct sex workers: those whose primary income is generated through sex work and who perceive themselves as sex workers. The health authority and NGOs estimated that there were around 2,000 sex workers operating in illegal, but mainly tolerated, brothels and red-light districts across the island. The number of indirect sex workers was estimated at 6,000. Indirect sex workers work mainly in the entertainment/hospitality industry — in cafes, karaoke bars, clubs and massage parlors, carrying out sex work sporadically and under different conditions to direct sex work.
Yayasan Kerti Praja, a grassroots foundation dealing with HIV/AIDS outreach programs and healthcare services, carried out voluntary counseling and testing (VCT) among sex workers operating in Badung regency (which includes the glittering Kuta, Nusa Dua and Jimbaran tourist spots) and in Denpasar mayoralty.
According to the foundation’s data, the number of condom users among sex workers had increased
to 60 percent in 2012, as compared to the mere 40 percent in the previous year.
“Despite this relieving portrait, we cannot conclude that most sex workers are already using condoms. Many times, they were trying to satisfy the surveyor by saying that they were using condoms, while in fact, they were doing otherwise,” said Wirawan, who is also a director of the foundation.
More comprehensive surveys and studies would be needed to cross check the results of the previous surveys.
It would need quite a lot of funding to undertake detailed studies to confirm whether HIV infections were indeed now decreasing among sex workers, and whether the usage of condoms was already widespread among them, he added.
“To carry out such a comprehensive survey and study will be very challenging as the mobility of these sex workers is very high,” the professor added.
Between the period 2000 and 2004, HIV/AIDS cases in Bali mostly affected injecting drug users (IDU).
However, between 2005 and 2012, the number of HIV cases among IDU had reportedly decreased.
HIV/AIDS cases started to affect heterosexuals, transmitting from husbands to wives; mothers to infants; as well as gay and transgender groups. The significant rise in HIV/AIDS cases among heterosexual couples has mainly been caused by the rapid growth of the sex business.
“More and more men are sexually involved with commercial sex workers. It is about supply and demand,” the professor said.
Limited work opportunities and poverty have also forced many women without education to plunge into the dark world of commercial sex.
“The HIV/AIDS epidemic among vulnerable groups of people in Bali and elsewhere in Indonesia has been pervasive, while at the same time, donor agencies and countries have pledged to stop financial assistance that funds research, prevention and medication programs,” he warned. Currently, Indonesia still receives funding from AusAID, the Global Fund and many other international donor agencies. Some HIV/AIDS prevention programs, media campaigns and advocacy, as well as outreach programs, are being funded by these agencies.
“Now, it is time for the central, provincial and regional governments to start allocating the funds for HIV/AIDS programs. Big corporations and communities are also encouraged to actively become involved and support the programs too.”
LUH DE SURIYANI