Women with AIDS: Lessons from Indonesia and Singapore
By Tai Wei Lim
The AIDS situation amongst women in two neighbouring nations of Southeast Asia – Indonesia and Singapore – could not be more different. Indonesia is the biggest country in Southeast Asia, both in terms of size and population, and it is experiencing poverty, painful transition and change. Singapore, on the other hand, is the smallest state in Southeast Asia with one of the world’s highest GDP per capita income and a stable democratic regime. According to the CIA Factbook, the 2005 estimated GDP per capita (Purchasing Power Parity) of Singapore stands at US$29,700 (2005 est.) while that of Indonesia stands at US$3,700. [1]
Somewhere in the midst of this stark contrast is the reality of AIDS in Southeast Asia – a region with some of the fastest growing economies, disturbed by the 1997 crisis and now facing political transitions as well as keen economic competition from China and India.
Indonesia in trouble
Warning bells were already ringing in 2002, when it was reported that Indonesia could soon be witnessing an AIDS epidemic on the scale of some African countries if preventative measures were not implemented. [2] Indonesia’s commercial sex industry is believed to have become the largest in Southeast Asia with more than 500,000 prostitutes. [3] The cheapest prostitution services cost less than half a US dollar if one frequents railway lines where homeless people live, and this night work has spread to rural Java emanating outwards from Indonesian cities. [4] According to government data, only 13% of clients of female prostitutes have used a condom over the past year, ‘which compares very, very poorly with some of Indonesia’s ASEAN neighbours’. [5]
Indonesia ’s epidemic drug problem gives the nation a ‘double whammy’. Since 1997, when Asia’s financial crisis impoverished the nation, the number of young people injecting drugs has increased dramatically. [6] Poverty encourages the dangerous practice of sharing needles amongst addicts in Indonesia, catalysing the spread of HIV/AIDS. Shockingly, in one small Jakarta suburb where there are around 800 intravenous drug-users it is estimated that 70% have now been infected with HIV. [7] Based on government figures, there are about 130,000 Indonesians currently living with HIV/AIDS. [8] Unofficial estimates put the total number of people infected at half a million. [9]
1. An Indonesian AIDS information poster
Dr Syamsu Rizal, one of Indonesia’s leading experts on AIDS, says: “I’m afraid the situation is very serious, especially in the last three years … Increasing number of new HIV cases is very significant … Now each day we get 40 to 50 (new) cases admitted to hospital”. [ 10] In the doctor’s view, a significant proportion of the women selling sex at a shopping centre in Jakarta are doing so to buy their next shot of heroin. [11]
” Indonesia has one of the fastest growing epidemics in the world now,” says Elizabeth Pisani, an epidemiologist with Aksi Stop AIDS, an AIDS prevention and care group. [12] “Around one in two injectors in Jakarta is already infected with HIV and around 90% are sharing needles,” said Pisani, whose agency is a joint project of Indonesia’s Ministry of Health and USAID, implemented by Family Health International. [13]
Ostracised groups in Indonesia need more help. Unfortunately, Indonesia’s ethnic minority provinces have been hardest hit by AIDS. In Papua, Merauke has an infection rate of more than 8% and Sorong has the country’s highest level of infection at 16%. [14] Even in the capital, transvestite and transsexual prostitutes in Jakarta have an infection rate of 22%. [15]
The US Agency for International Development (USAID) is working with Indonesia to slow down the spread of HIV, providing US$45 million in HIV/AID assistance for five years starting from 2004. [16] These funds support a variety of campaigns including collaborations with MTV Indonesia to commemorate World AIDS Day 2004 in Indonesia, attracting young persons between the ages of 15 and 30, culminating in a live HIV/AIDS awareness concert at Ancol Carnival Beach on 4 December 2004 in Jakarta. [17]
Messages on drug abuse, safer sex practices and the empowerment of women and girls to protect themselves have proliferated in this campaign and MTV’s popular ‘ MTV Land’ program dedicated 13 episodes to interviews with HIV experts and discussions with local celebrities on a range of AIDS-related issues. [18] To reach the indigenous heartlands, USAID also collaborated with the newspaper group ‘Rakyat Merdeka’ to present a popular dangdut music concert entitled ‘Dangdut Queens’ on 5 December 2004 at Taman Mini Indonesia Indah Park featuring a friendly competition among Jakarta’s leading dangdut singers, who delivered HIV/AIDS awareness messages. [19]
However, the USAID program faces major obstacles, beginning with the geography of the Indonesian archipelago. The far-reaching scattered 13,000 islands of Indonesia makes It hard for USAID or its local partners to comprehensively reach the far-flung islands. In practice, the reach of USAID’s activities is limited to the metropolitan center, barely even diffusing to the periphery. The other great limitation factor is geopolitics. Indonesian politics limits access to areas where the AIDS plague has the greatest potential to proliferate, such as Papua. There were 1,263 recorded HIV/AIDS cases in Papua against 3,782 nationally with the rate of HIV infection there possibly at 5%, according to Gunawan Ingkokusumo, head of the USAID-funded AksiStopAIDS network in Papua. [20]
2. Jakarta rally in support of AIDS victims
While USAID has helped raise the profile of AIDS to the Jakarta elite as well as Indonesia’s mass media and ruling elites and metropole generally, it has barely reached the island peripheries, and particularly indigenous groups. Efforts are, however, being made beyond USAID. For example, David Gordon and his wife Joyce who manage YAKITA, an Indonesian NGO and rehabilitation centre, are moving beyond raising awareness to outreach beyond Jakarta. They train youths from the greater Jakarta region and three outer provinces of Bandung, Makassar, and Bali to be roving peer group educators and ambassadors for matters that are AIDS-related.
On 5 April 2005, the Indonesian government defended its record in AIDS prevention before the UN General Assembly. According to Mr. Siswanto Agus Wilopo (Indonesian Deputy for Family Planning and Reproductive Health, National Family Planning Coordinating Board), Indonesia’s National HIV/AIDS Strategic Plans for the year 2003-2007 will highlight a multi-sectoral partnership approach for working with the family unit. The Indonesian government has inked a family planning programme to promote the use of condoms for high-risk groups, provide free Anti-AIDS drugs for the indigent and sex education for Indonesia’s youths. The government admits that it is challenged in such tasks as it takes on poverty alleviation at the same time.
Singapore tackles HIV/AIDS
Singapore has achieved some success in combating the scourge of AIDS amongst women. Such progress came against a general backdrop of advancement for women in Singapore society – politically, economically and socially. The new Prime Minister in August 2004 appointed three women to his team in positions such as Finance and Transport, Community Development, and Youth and Sports Economically, trade unions like National Trades Union Congress (NTUC) and the Singapore National Employers Federation (SNEF) on 6 November 2002 endorsed a Tripartite Declaration on Equal Remuneration for Men and Women Performing Work of Equal Value. The Singapore Parliament passed a bill to amend the Constitution of the Republic of Singapore to allow children born overseas to Singaporean mothers to acquire Singapore citizenship by descent.
Against this backdrop of progressive policies and developments for women in Singapore society, in area of AIDS initiatives, the government on 16 December, 2005 launched the HIV Women & Children’s Fund under Dr Balaji Sadasivan, Senior Minister of State for Information, Communications & the Arts & Health. KK Women’s & Children’s Hospital led the charge in this project to help HIV-infected women and children. Those who have contracted the disease receive the same level of access as other patients to the public healthcare system. For example HIV/AIDS patients have access to subsidised outpatient and inpatient medical treatment and drugs. [21]
What is impressive about Singapore’s effort is the extension of HIV/AIDS care to the psychosocial and economic dimensions. Here the community plays an important support role. The Singapore state is in general keen to integrate state and community through the Singapore21 initiative, national blueprint that aims to foster state-community relations. One aspect of Singapore21 is the encouragement of the formation of Community Development Councils (CDCs). CDC’s Patient Care Centre set up in 1997 is operated by volunteers who provide counselling, therapeutic and home care services. Action for AIDS runs programs for high-risk groups. [22] Women’s organisations like the Association for Women & Research (AWARE) and UNIFEM Singapore also contribute to HIV campaigns in Singapore.
3. Singapore AIDS conference poster
Women make up only 10% of new HIV infections in Singapore. However, women are bear much of the social burden of the disease when either spouse is infected. [23] It is usually women who care for the sick, manage the household and meet financial needs. When a woman falls ill, there is often no one to care for her or the children and, if she dies, the children frequently become orphans. [24] Women also tend to outlive an infected spouse and have less financial resources. [25]
In many ways, efforts to prevent AIDS also promote women’s rights. In Singapore, women account for more than 12% of the total number of HIV/AIDS cases (271 out of 2213 cases as of June 2004) and some 40% of these (112 cases) are housewives. [26] Women are often infected by male partners who have contracted the disease from other sexual partners or from injecting drugs. Fear of abandonment or eviction from their home puts those women who lack economic means at greater risk for HIV infection . [27] In such cases, promoting women’s economic security and empowerment can reduce women’s vulnerability to domestic violence, unsafe sex and other AIDS-related risk factors. [28] According to Singapore’s Ministry of Health (MOH), in 2004, there were 311 new cases of HIV infection and, for the first 10 months of 2005, there were 198 cases with a projection of 250 for 2005 , implying a reduction of 20% of AIDS in Singapore overall and the total infection rate remains low at 0.2%. [29]
UNIFEM’s efforts to combat the spread of HIV/AIDS have gone regional. In Singapore and across the region, UNIFEM Singapore strives to ensure that women facing AIDS are protected and cared for. Of notable significance is the UNIFEM Singapore’s ‘Empowerment of Migrant Industrial & Sex Workers in Batam” program, extending AIDS work to a large Indonesian island near Singapore, and the current anti-trafficking campaign. [30] Working with Yayasan Mitra Kesehatan dan Kemanusiaan (in Batam), UNIFEM Singapore aims to educate women on their reproductive health rights and raise awareness through the ‘Stop Trafficking of Women & Children for Sex’ program. [31] Batam’s industrial ‘development’ has seen its migrant population rise from 39,000 in 1980 to 438,000 in 2000 and, with an annual population growth rate of 12%, the island’s population is now estimated at well over 600,000. [32] With its exponential growth and boom town atmosphere, many women and children have turned to work in the sex industry. The UNIFEM Singapore-YMKK program aims to invest in projects to create employment that would provide women and children alternatives to trafficking.
Singapore enjoys important advances in addressing problems of AIDS, above all strong financial foundations for managing Its social problems. It also helps that Singapore is a city-state in contrast with the far-flung archipelago of Indonesia. There are, nevertheless, some elements of Singapore’s initiatives against the AIDS that may be applicable to the region.
One is the state’s increasingly successful partnership with community groups like the CDCs and the overall blueprint Singapore21, which is probably the first of its kind in Southeast Asia. Self-reliance is rarely detected in other Southeast Asian state initiatives like Malaysia’s Wawasan 2020 or Indonesia’s Visi 2020 which tend to focus more on economic development and perhaps pay less attention to social community group integration and encouragement.
Singapore ‘s progressive policies on women’s rights stand out in the Southeast Asian setting. AIDS prevention policies for women are important not only in addressing problems related to the epidemic but also have implications for addressing issues of exploitation in the sex industry. By raising the social profile of women through legislation, economic mobility and governmental appointments, and by establishing government-community partnerships, it sends a signal to the rest of society about the determination of the tripartite roles of society, government and the employment sector in combating the root causes of the AIDS epidemic.
Tai Wei Lim is a Japan Foundation Fellow based in Kyushu University, Overseas Research Associate Singapore Institute of International Affairs and Cornell CV Starr Fellow. His recent articles have appeared in The Stanford Journal of East Asian Affairs, Japan-China Economic Association (JCEA)’s monthly J+C Economic Journal and the Australian National University (ANU) Asian Studies WWW Monitor.
This is a revised and expanded version of an article that appeared at UNIFEM Affairs, the Singapore website of the United Nations Fund for Women in February 8, 2006. Posted at Japan Focus, on February 25, 2006.
Notes
[1] CIA,” Indonesia” in the CIA Factbook website [downloaded on 20 Feb 2006, available here ]and CIA,” Singapore” in the CIA Factbook website [downloaded on 20 Feb 2006, available here].
[2] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[3] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[4] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[5] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available at here.
[6] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[7] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[8] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available here.
[9] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[10] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[11] Galpin, Richard, “ Indonesia’s Aids alert – Poverty lies at the root of the problem” dated Tuesday, 2 July, 2002 [downloaded on 24 Jan 2006], available here.
[12] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available here.
[13] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available here.
[14] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available here.
[15] Timberlake, Ian, “Health-AIDS-Indonesia: Indonesia’s HIV epidemic one of the fastest growing, expert says” published in Agence France-Presse dated November 30, 2003 in the Aegis website [downloaded on 24 Jan 2006], available here.
[16] US Embassy in Jakarta, “U.S. EMBASSY – PRESS RELEASE – PUBLIC AFFAIRS SECTION The U.S. Commemorates World AIDS Day with Indonesia” dated December 1, 2004 [downloaded on 24 Jan 2006], available here.
[17] US Embassy in Jakarta, “U.S. EMBASSY – PRESS RELEASE – PUBLIC AFFAIRS SECTION The U.S. Commemorates World AIDS Day with Indonesia” dated December 1, 2004 [downloaded on 24 Jan 2006], available here.
[18] US Embassy in Jakarta, “U.S. EMBASSY – PRESS RELEASE – PUBLIC AFFAIRS SECTION The U.S. Commemorates World AIDS Day with Indonesia” dated December 1, 2004 [downloaded on 24 Jan 2006], available here.
[19] US Embassy in Jakarta, “U.S. EMBASSY – PRESS RELEASE – PUBLIC AFFAIRS SECTION The U.S. Commemorates World AIDS Day with Indonesia” dated December 1, 2004 [downloaded on 24 Jan 2006], available here.
[20] China Daily, “AIDS nightmare looms in Indonesia’s Papua” in the China Daily website [downloaded on 20 Feb 2006], available at here.
[21] Sadasivan, Balaji (Senior Minister of State for Information, Communications and the Arts and Health), “2005 Speeches – The Launch of HIV Women and Children’s Fund” dated 16 Dec 2005 [downloaded on 24 Jan 2006], available here.
[22] Sadasivan, Balaji (Senior Minister of State for Information, Communications and the Arts and Health), “2005 Speeches – The Launch of HIV Women and Children’s Fund” dated 16 Dec 2005 [downloaded on 24 Jan 2006], available here.
[23] Sadasivan, Balaji (Senior Minister of State for Information, Communications and the Arts and Health), “2005 Speeches – The Launch of HIV Women and Children’s Fund” dated 16 Dec 2005 [downloaded on 24 Jan 2006], available here.
[24] Sadasivan, Balaji (Senior Minister of State for Information, Communications and the Arts and Health), “2005 Speeches – The Launch of HIV Women and Children’s Fund” dated 16 Dec 2005 [downloaded on 24 Jan 2006], available here.
[25] AWARE, “Facts About HIV/AIDS in Singapore- About Women” in the AWARE website [downloaded on 24 Jan 2006], available here.
[26] UNIFEM, “Violence against Women – Not A Minute More – UNIFEM Singapore and Action for AIDS join forces to commemorate – International Day to Eliminate Violence Against Women, 25 Nov 2004” in the UNIFEM website [downloaded on 24 Jan 2006], available here.
[27] UNIFEM, “Violence against Women – Not A Minute More – UNIFEM Singapore and Action for AIDS join forces to commemorate – International Day to Eliminate Violence Against Women, 25 Nov 2004” in the UNIFEM website [downloaded on 24 Jan 2006], available here.
[28] UNIFEM, “Violence against Women – Not A Minute More – UNIFEM Singapore and Action for AIDS join forces to commemorate – International Day to Eliminate Violence Against Women, 25 Nov 2004” in the UNIFEM website [downloaded on 24 Jan 2006], available here.
[29] Sadasivan, Balaji, “Forum on Gender Issues and HIV/AIDS in Southeast Asia: “Trends and Challenges for the 21st Century”” dated 5 Dev 2005 in the Ministry of Health Singapore website [downloaded on 20 Feb 2006], available here.
[30] UNIFEM, “Violence against Women – Not A Minute More – UNIFEM Singapore and Action for AIDS join forces to commemorate – International Day to Eliminate Violence Against Women, 25 Nov 2004” in the UNIFEM website [downloaded on 24 Jan 2006], available here.
[31] UNIFEM, “Violence against Women – Not A Minute More – UNIFEM Singapore and Action for AIDS join forces to commemorate – International Day to Eliminate Violence Against Women, 25 Nov 2004” in the UNIFEM website [downloaded on 24 Jan 2006], available here.
[32] Ismael, Saleemah, “Empowering Migrant, Sex and Industrial Workers in Batam” in the UNIFEM Singapore website [downloaded on 20 Feb 2006], available here.
