Indonesian AIDS expert tries to change people's image of what a macho man should be as HIV infections soar among housewives
BANGKOK (AlertNet) – When Dr Nafsiah Mboi noticed that more and more Indonesian housewives were contracting HIV due to their husband’s reckless behaviour, she decided to reshape people’s perception of what a macho man should be.
It is not an easy task for Nafsiah who is secretary of Indonesia’s National AIDS Commission.
The archipelago, the world’s fourth largest by population, is made up of 17,000 islands and numerous ethnic groups with different languages and beliefs, and Nasfiah has limited resources. What is unlimited though is her desire for change.
“Last year, the largest number of people who needed treatment for HIV/AIDS were housewives. That’s really disconcerting,” Nafsiah told AlertNet this week on the sidelines of a high-level intergovernmental meeting on HIV/AIDS in Bangkok.
She said the big rise in HIV infections in a section of society traditionally considered low risk – housewives who are monogomous and not using drugs - showed the need to focus on men's behaviour.
“We decided to change the social image of men to say a strong and macho man is not selfish, but is responsible and caring,” she said.
The Commission embarked on several awareness campaigns in 2009, expanding its focus from drug users and sex workers to heterosexual men, with the message that being a real man means being responsible and safe and using a condom.
ADDRESSING GENDER ROLES
In Indonesia, like many other patriarchal societies, gender roles and expectations mean women, whether housewives or sex workers, do not have the bargaining power to negotiate safe sex or the use of condoms, Nafsiah said.
“In sexual relationships, men are supposed to be macho and they have to have their will and if they resort to violence, well, it’s ok because they’re men,” she said.
“If a housewife comes into the health centre with sexually transmitted diseases or infections, immediately everybody thinks she’s a whore, but if it’s a man, (people go) ‘poor dear’,” she added.
Nafsiah says research in 2009 identified there were 2 million women in Indonesia at risk of being infected with HIV/AIDS. Of these 1.6 million – or 75 percent – were housewives.
The Global AIDS Report in 2008 described the AIDS epidemic in Indonesia as “among the fastest growing in Asia,” and said the main cause was heterosexual sex.
By 2009, a quarter of the 300,000 or so people living with HIV/AIDS in Indonesia were women, which experts say “shows a feminisation of the epidemic”.
SLOW PROGRESS
Campaigns have included mobile clinics, video essays and a Condom Week. Nafsiah says they are seeing some changes, albeit at a slower pace than she’d like.
For example, condom sales increased from 75 million in 2008 to 300 million in 2011, a four-fold rise in three years, she said.
Research has also shown that the proportion of people saying they had used a condom when they last had sex has increased to 50 percent in places targeted by the Commission.
By comparison, national figures show consistent use of condoms is around 10 to 15 percent, Nafsiah said.
The sheer size of the country and the population are some of the biggest challenges in tackling HIV/AIDS, she added.
Nafsiah is also worried about young people, another group that is alarming experts because of growing infection rates.
“According to a survey, only 14 percent of young people aged 15-24 years can correctly identify how to prevent sexual transmission of HIV/AIDS,” she said.
“That (leaves) 64 million people. How do you reach 64 million people in 17,000 islands?”
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