Sara Schonhardt, Jakarta – The image of a giant condom draped in Indonesia's national red and white colors towered over the opening ceremonies of National Condom Week in Jakarta. To coincide with World AIDS Day, the National AIDS Commission crafted the message, "Use Condoms, Celebrate Life." But some hardline religious groups don't believe condom use should be promoted, let alone celebrated.
The Islamic group Hizbut Tahrir held banners during a demonstration on Sunday aimed at urging the government to end programs that provide free condoms to male and female sex workers, based on the argument that condoms encourage sex outside of marriage. Like many conservative opponents of the AIDS commission's plan to increase condom distribution, they say the way to stem HIV transmission is for people to stop engaging in risky behavior, such as drug use and commercial sex.
But the AIDS Commission, or KPA, argues that moral posturing should not triumph over the reality that HIV is quickly becoming one of Indonesia's biggest public health problems, with the number of reported cases nearly doubling between December 2006 and March 2009. "Now is not the time to pretend that all Indonesians are holy-holy," said Nafsiah Mboi, the tenacious head of the KPA. "Do we want to be hypocrites or do we want to see what's happening?"
Between eight and 10 million men annually visit female commercial sex workers, but only about 10% say they use condoms consistently, according to the National Coordinating Agency for Family Planning (BKKBN). That figure concerns HIV prevention workers, who say Indonesia is at a danger point in its epidemic, with as many as 19 million people prone to contracting HIV because of their risky sexual behavior or that of their partner.
Although Indonesia's 270,000 reported HIV/AIDS cases account for only a fraction of its 240 million population, the risk of the disease's spread is high as the main route of transmission shifts from intravenous drug use to unprotected sex.
Programs that discourage risky behavior and make condoms more widely available have successfully reduced the HIV rate in nearby Thailand. But a lack of political will coupled with backlash from conservative religious groups in Indonesia poses big barriers to prevention and treatment, with some of the worst forms of discrimination occurring at health centers.
"People here don't really care about HIV," said World Vision's Katarina Hardono. "They think people who contract the disease are being punished for engaging in risky behavior." The Christian humanitarian organization recently hosted an interactive HIV exhibit to reduce discrimination against HIV carriers in Indonesia. But Hardono and others working to curb the virus' spread say that their efforts need more government support.
KPA figures show positive results when the government puts its efforts into sex-related programs. The commission began mapping the prevalence of HIV/AIDS in Indonesia in 2006 to determine what populations were most at risk. It found that HIV was most highly concentrated among injecting drug users and geared its national action plan toward providing treatment, care support and prevention.
When the commission began drafting its budget for 2010, it found condom use among injecting drug users had soared while the number of new HIV cases had fallen. Condom use among the clients of female sex workers, however, had hardly increased at all.
In July, with an inflow of about $120 million from the Global Fund to fight HIV/AIDS, the KPA began a condom use campaign focused on expanding education and outreach to youth and men most likely to visit sex workers. Social stigmas that associate condoms with prostitution and homosexuality are a major barrier to their use, said the BKKBN's Nelly Nangoy at the launch of National Condom Week.
Although condoms are available in convenience stores and pharmacies around Indonesia, many people don't want to be seen purchasing them, partly from embarrassment, but also out of fear. Legislation that criminalizes people living with or vulnerable to HIV infection fuels stigma and discrimination in many countries.
In Indonesia, that criminalization extends to latex, said Robert Magnani, country director of the non-profit Family Health International. He explains that bylaws in some districts of Indonesia allow for a woman to be prosecuted on prostitution charges if she is caught carrying a condom.
"Indonesia's rapidly rising HIV rate is not a problem of finances, underdevelopment or low education levels among Indonesian citizens," said Michael Buehler, a postdoctoral fellow in Southeast Asian Studies at Columbia University in the United States. "The Indonesian government just does not have the political will to stand against conservative Islamic pressure groups that say condom distribution promotes premarital sex."
The fact that President Susilo Bambang Yudhoyono chose to address culturally sensitive subjects such as sex work and homosexuality during an August speech at the International Congress on AIDS in Asia and the Pacific was a positive sign that the government may support the KPA's condom promotion agenda. Yudhoyono created the AIDS commission in 2007 to help coordinate efforts by government and non-governmental entities, including the private sector, to tackle the spread of HIV.
Meanwhile, conservative Islamic parties have become more marginalized, garnering only 16% of the vote at April's national parliamentary election. Advocates have welcomed a changeover at the Ministry of Health from a leader who zeroed out money for condom promotion to a more reformist figure.
It is not only Islamic groups that have lashed out against condom use in Indonesia. The Catholic Church and even the US government under the former George W Bush administration, which steered funding toward prevention programs, have promoted abstinence over protection. The Catholic Church forbids the use of condoms as a family planning device, explained Mboi. "Does it also forbid the use of condoms to save lives?" Her challenge has drawn in Catholic universities, such as Atma Jaya, which is working with DKT, the largest condom distributor in Indonesia, to increase the use of contraceptives. Current figures show sales of 110 million condoms per year in Indonesia, a five-fold increase since 1996, but still far from where it needs to be, said the DKT country director, Todd Callahan.
Meanwhile, the KPA's current campaign actively focuses on Indonesian youth, raising concerns that public health messages are targeting politically safe populations. But Callahan disagrees that Indonesians are squeamish when talking about sex. The biggest challenge to selling condoms in Indonesia, he said, was the perception that sex with a condom was not pleasurable.
As part of this week's activities, DKT plans a concert and a "condom climb". The KPA has named sultry, hip-shaking singer Julia Perez as its condom ambassador, a decision that drew criticism from conservative groups who think her presentation is at symbolic odds the government's short-term goal of increasing condom use by 3%. "We have to change the message to say that with condoms you enjoy sex more... scare tactics just don't work," said Mboi.
[Sara Schonhardt is a freelance writer based in Jakarta, Indonesia. She has lived and worked in Southeast Asia for six years and has a master's degree in international affairs from Columbia University.]