Commentary: The Cost of Popular Policy for HIV/AIDS Prevention

Police officers clash with residents during the closure of the Dolly red-light district in Surabaya, East Java, in this July 28, 2014 file photo. (Antara Photo/Suryanto)

By : Shela Putri Sundawa | on 11:34 PM December 07, 2016
Category : Opinion, Commentary

If people had to pick a disease that will take their lives, most will probably choose cancer over HIV/AIDS, knowing that there is more of a moral issue attached to the latter.

People with AIDS are the most stigmatized group. Even before becoming infected with HIV, society would have rejected most of them already. Prostitutes, drug users, prison inmates and homosexuals are classified as high-risk groups, which means that they have a greater risk of contracting HIV than other people. So once people in these high-risk groups become infected with HIV, or develop AIDS, it is no surprise that society will condemn them to being punished by God.

Health care is a popular campaign tool for politicians as it wins votes. If we were to ask about their commitment, each one would say they are committed to limit the spread of HIV. However, many health policies are made without really understanding the problems or without any evidence. We know that this disease is spreading widely among inmates, but there are no policies that try to limit the spread of the disease in prison. We also know that the transmission of the disease can be prevented with the use of condoms, but when condom use is promoted, it is suddenly considered unethical and disgraceful.

There is unlikely to be a bigger harm being done by the closing of brothels. This policy has lately become a way to measure the success of every mayor in Indonesia. Surabaya Mayor Tri Rismaharini popularized it by closing the Dolly red-light district, which was the biggest brothel complex in Southeast Asia. This policy has quickly gained popularity and started to be duplicated in many other cities in the country.

Brothel complexes, or lokalisasi, have long been effective places for health promotion. Lokalisasi, which means "to localize," served as an important way to limit the spread of sexually transmitted infections among a major high-risk group. Brothel complexes act like reservoirs of STIs and they keep the disease inside, which makes health promotion and early detection easier. Health professionals can visit these areas on a regular basis to provide cures for STIs and increase specific protection of this group by delivering condoms and lubricants. Once a brothel complex is destroyed, there is no longer an easy way to detect infections and no longer an effective way for health promotion and early treatment of STIs. This is a nightmare scenario for the spread of HIV/AIDS, as untreated STIs make HIV more likely, while the unavailability of condoms make STIs more common. It becomes a vicious cycle.

Many people believe that by closing brothels, prostitution ceases to exist. Pimps and prostitutes are converted to become entirely new people who continue their lives by doing productive work. The government means well by providing occupational training to help them develop new skills so that they do not resort back to prostitution. But how many of them stay on the right track is a question the government rarely asks.

Prostitutes are thought to be outcasts and even after they leave the sex trade, they are still thought of as sinful people and face rejection. Even when they are victims of human trafficking, who did not voluntarily choose prostitution, society still casts them out. How can someone start a business with zero acceptance from those around them? This makes them vulnerable to going back to prostitution, even when they aim to lead new lives.

If the only thing they have mastered to make a living is selling their bodies, and the only people that accept them are their clients, there is nothing that will stop them from returning to the sex trade.

This is a bad news for public health. The sex trade is driven underground, which make it more difficult for them to be "rescued" again. It can happen anywhere and there is no more reservoir that can act to limit the spread of STIs. It will be harder to monitor and it can only delay case detection and treatment of infections, whereas the viral load in those that are HIV-positive decreases once antiviral treatment starts. Therefore, treating it early also serves as an important tool to limit the spread of the dreaded disease.

Much research has been conducted to promote better handling of HIV/AIDS in populations but implementing those measures in society still seems like it is in the distant future. The government still prefers to make policies that are popular with voters, rather than those that prove to work, but which may be unpopular. High-risk groups are already cast out anyway, so excluding them when making policy will not hurt politicians' popularity and future chances for re-election. Then one should really ask if HIV/AIDS is truly God's punishment – not for its stigmatized victims – but for our ignorance.

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