How do you reach illiterate young people at risk from HIV/AIDS? These volunteers take them camping.
Ingrid Hering
Vickram Amiri knows the ways of the streets. At 19, this Manadonese youth is the youngest outreach worker in an HIV/AIDS prevention project for marginalised youth run by a local non-government organisation.
His earlier years mirrored the lifestyle of the project's target group in the North Sulawesi capital - drinking, drug use, numerous partners who were also sex workers, hanging around with friends, and sleeping on the streets. He first came into contact with the non-government organisation Yayasan Mitra Masyarakat (YMM) two years ago when he participated in one of the monthly three-day camping sessions aimed at distributing information about sexually transmitted diseases (STD) and HIV/AIDS. The sessions convey the message through role plays, small group discussions, case studies, information sessions, and question and answer time with a HIV/AIDS specialist. Camping as a tool to reach marginalised youth is unique in Indonesia. Before camping, Vickram had never heard about HIV/AIDS.
He was subsequently trained as a peer educator. Although not instantly, his lifestyle slowly changed and he believed many of his friends were at high risk of infection by STDs, which is one of the channels of HIV /AIDS infection. The girls often had four to five partners in one night, encouraged by their boyfriends who acted as pimps and who were themselves often drunk or used drugs.
Early last year Vickram became an outreach worker. Despite finding it initially daunting he has come to view his youth as an advantage. 'They (the target group) receive me as a friend, which makes it easier to give them information and for them to receive it,' he explained.
Some of his friends are reducing their intake or using drugs in a safer manner. Others who are sexually active but have never used condoms have become aware of the dangers. 'Camping is very effective to give information because it appeals to youth,' Vickram said.
His work is sometimes made difficult by his age, or because discussing sex is still taboo. He has to overcome myths such as that lemon juice on the genitals will kill infection, that only foreigners get HIV/AIDS, or that only transvestites (bancis) use condoms. The project has led to behaviour change, but this can be difficult to sustain if the youth have no regular activities. 'Their environment does not support them to change. It can influence them to return to their former behaviours,' Vickram said.
Indonesia's official figure of 1080 HIV/AIDS cases is greatly underestimated, mainly due to a poor surveillance system. According to Dr James Sinaya, one of about 20 HIV/AIDS specialists in the country, HIV/AIDS here is a time bomb in the face of globalisation and a growing illicit drug trade.
Manado in particular is at high risk. Youth unemployment is high, a large maritime and unskilled labour force work overseas, and the town shares a reputation with West Java for its beautiful women.
The government supports the distribution of information, but Dr Sinaya wants to see more funds for testing kits, which had been dropped as a policy priority, and more recreational activities for young people.
Much of the question and answer sessions are spent dispelling popular myths such as the use of beads, needles and horsehair around or in the penis to increase sexual pleasure. Dr Sinaya believes the greatest obstacles for disseminating information are the diversity of ethnic languages, illiteracy and religious objections to discussing of sex.
YMM's prevention project is funded by USAID and has been running since 1997. It has reached more than 3600 youths to date. According to project manager Umar Mato, written material is not enough to be effective for this target group, due to their limited attention span, minimal education and transient lifestyle. The use of peer educators to reach them, outreach workers to give follow-up information, and activities such as World AIDS Day expos and small group discussions help reinforce information given during camping.
Pak Umar believes the biggest hurdles to be overcome are the resistance to condom use and the increasing prevalence of injecting drug use, particularly heroin. 'The Department of Religion here is not brave enough yet to talk about condom use or promote it,' he said. 'They still hope HIV/AIDS is not a big problem because in North Sulawesi there are only three (official) cases.'
Government prevention strategies are in place, as they were in Thailand 10 years ago, but Pak Umar believes it has not translated into action, partly because 100% condom use is not being pushed. Attention also needs to be focused on injecting drug use. 'Otherwise we will be late, like Thailand and Malaysia,' he added.
Ingrid Hering (ingrid_1010@hotmail.com) is an Australian Volunteers International volunteer, working with Yayasan Mitra Masyarakat in Manado, North Sulawesi.