Ningsih [not her real name], 22, was taken aback when she was handed a pack of two female condoms in Jakarta, capital of Indonesia, but was even more surprised when she opened one. Measuring 17cm long and 7cm in diameter with a sponge attached inside, the female condom is indeed large compared to a male condom.
“My, it’s so huge. Will it be painful using it?” asked the self-professed freelance sex worker, who was hanging out at a sidewalk stall in the Pramuka area of East Jakarta, a well known pick-up spot.
She told IRIN/PlusNews she was not willing to try the female condom; she was fine with a tri-monthly contraceptive injection, which kept her from getting pregnant.
What about sexually transmitted infections (STIs)? “I heard condoms might prevent that, but most of the clients don’t want to use them, and I don’t dare to insist, although I sometimes provide them,” she said. “If a client ejaculates inside me I wash with Betadine,” she added, referring to a popular feminine hygiene product.
Indonesia has worked hard to increase condom use but, hampered by a strong patriarchal culture and a sporadic approach to promoting them, the results have been disappointing.
Data from the nonprofit public health organisation, Family Health International, puts Indonesia at the bottom of a list ranking condom usage in Asian countries.
According to official statistics from June 2007, the country’s HIV infection rate has reached around one percent, with 5,813 recorded cases of people living with HIV and another 9,689 people living with AIDS, but experts estimate that the real number of HIV-infected Indonesians is between 90,000 and 250,000 out of a population of 223 million.
While HIV infection rates are highest among injecting drug users (IDUs), sex workers and their clients, government officials estimate that 20 percent to 30 percent of infections occur during unprotected sex.
“We’ve done campaigns to increase [male] condom use and failed. We’re facing an alarming situation at the moment, with the general population becoming infected,” Sri Kusniyati, deputy secretary of the National AIDS Commission, told IRIN/PlusNews.
HIV infections have already become generalised in the easternmost province of Papua. In this remote mountainous area, where levels of awareness are low and condoms difficult to access, more than two percent of the 2.5 million population are estimated to be HIV-infected.
The government ran a trial of female condoms in selected areas of Papua in August 2006. According to Kusniyati, women who tried the condoms said they and their husbands enjoyed using them.
Encouraged by the positive feedback from the trial, the government launched a national female condom programme in February 2007. Six months later, however, the programme has been criticised for poor distribution and supply, the high price of the condoms (15,000 rupiahs, or US$1.60 for a pack of two), and even for discriminating against women.
“It has been a year since the female condom was distributed in Papua but, until today, not even one condom can be accessed by our group and we’re based in the provincial capital [Jayapura], not in a remote area,” said Robert Sihombing of the Jayapura Support Group, a local organisation that provides food packages, financial assistance and emotional support to local people living with HIV/AIDS.
Activists have slammed the programme for, once again, putting the burden on women. “The campaign against HIV/AIDS in this country is often discriminatory,” said activist Mukhotib MD from Magelang, a city in Central Java Province.
“In East Nusa Tenggara Province [in the eastern portion of the Lesser Sunda Islands, consisting of 550 islands], for instance, fishermen are called on not to have sex with sex workers without using a condom, but there’s no mention in the campaign of not having sex with their wives without using condoms,” he said.
“We’re afraid that 10 years from now, if HIV infections remain uncontrolled, then women will be blamed, when in fact it’s the whole problem of social construction which positions men with the rights to sex and women with the duty to serve them,” Mukhotib added.
Kusniyati, of the National AIDS Commission, said the female condom programme was launched to give women more options and to empower them, not to discriminate against them. The Commission was currently training campaigners in six provinces, not only to promote female condoms but also to increase knowledge of HIV/AIDS.
The price of female condoms remained relatively high because they had to be imported, Kusniyati admitted. “We need to push for cooperation with the state Family Planning Coordinating Body, which provides contraceptive products, including condoms, for poor people … [but it] will only launch a female condom programme some time in 2008.”