Condom use still low by Bali sex workers

BALI - The Bali Health Agency is reaching out to sex workers to boost the rate of condom use to 80 per cent from a current 39 per cent to prevent the spread of HIV.

"Ideally, there should be at least 80 per cent of sex workers who use condoms regularly for HIV/AIDS prevention. That is our target," Gede Agus Suryadinatha, the head of the Bali Health Agency's HIV/AIDS and sexually transmitted disease programme, said.

Suryadinatha said that it was difficult to reach out to sex workers and their customers, which he said was a common obstacle in a society that demonizes and criminalizes sex workers.

Since prostitution is illegal in Indonesia, sex workers go underground and offer their services through various legal business, such as beauty parlours, spas and cafes, making it difficult for public health officials to identify them or to provide information on safe sex and condom use.

"We can't recognise sex workers or their customers, and they don't want to be recognised. It's difficult to reach out to those groups and give them healthcare," Agus said.

"We will work together with the residents of villages to provide public health services to the customers of sex workers.

Ten outreach workers will be deployed at puskesmas (local community health centers) in each village, comprising five volunteers from local villages and five employees from puskesmas.

The agency wants to implement its condom outreach programme in community health centers in Denpasar and Badung this year before expanding it to all 115 puskesmas on the island.

Under the programme, called "Simultaneous and Comprehensive Service", local residents will identify people who are at risk of contracting HIV/AIDS, including the customers of sex workers, their spouses and children, who will be given healthcare services and counseling.

"We hope these volunteers will be able to diminish the stigma and discrimination against HIV/AIDS, which makes people reluctant to undergo a test and receive treatment once they test positive for the infection," he said.

People with HIV/AIDS still face discrimination, as do their family members. Based on the experience of several local NGOs, members of some communities in Bali have refused to carry out traditional Balinese Hindu cleansing rituals for the corpse of a person who has died from AIDS.

According to one survey cited by Tri Indarti, the secretary of AIDS Treatment Commission in Denpasar, most of the customers of sex workers said that did not want to use condoms, which they described as uncomfortable.

Many respondents said that they regularly refused to use the condoms offered to them by sex workers and would threaten to walk out if the sex worker insisted on its use, according to the survey. Five per cent of respondents said they did not use condoms because they were drunk.

"This shows that the use of condoms by these groups is still low because most refuse it," Indarti said.

A similar survey on condom use among sex workers and their clients will be conducted this year.

Denpasar has chosen as the centre for the surveys a representative area where most of the sex workers and prostitution areas on the island are located.

Although condoms are readily available to sex workers - 30 per cent of the condoms circulated in red-light districts are provided by NGOs for free - condom use remains low. Only around 40 per cent of the customers of sex workers were willing to use condoms, according to a report issued last year, Tri said.

NGOs offer counselling to sex workers every two months, where them women are taught about the importance of using condoms to prevent HIV/AIDS, and are given health check ups every three months at puskesmas or clinics.

"Even though they already have the knowledge, it's not enough to change their behaviour," Tri said.