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Indonesia cracks down on gays... and fuels its HIV epidemic
South China Morning Post - August 6, 2017
Often for 10-hour stretches, he would counsel, test, and, for the 17 per cent who were HIV positive, console upwards of 50 men. But after police raided and detained more than 140 men at a gay sauna in a red light district in the city's north, just days after one of those same mobile test units had wrapped up its work there, Prabowo shelved the programme, worried his NGO would be caught up in the dragnet.
"People are scared," says Prabowo, programme officer at Yayasan Suwitno, which operates and helps fund the mobile units and clinics with money from groups such as the Global Fund to Fight Aids, tuberculosis and malaria. "It's very hard to get people to come to the clinic. Now it's even harder to reach them," he said.
His nation's crackdown on its homosexual and transgendered citizens comes amid an explosion of HIV infections among gay men in Asia. In Indonesia, outreach and awareness campaigns have been shelved, limiting the ability of activists to reach gay men.
Unless official attitudes towards gay and transgendered citizens ease, activists say they will struggle to keep abreast of an epidemic that has already infected up to a third of young gay men in the region's biggest cities, including Jakarta and Bangkok.
"We could do more if it weren't for the sensitivities we're seeing now," says one HIV/Aids health activist, who, like many in Indonesia, spoke on condition of anonymity because of worries of unwanted government attention. "Young guys don't know that the guy they are having sex with has a 15 per cent to 30 per cent chance of being HIV positive."
Since early last year, government officials have made increasingly shrill and homophobic pronouncements, including one from Defence Minister Ryamizard Ryacudu that likened the spread of tolerance toward homosexuals to a proxy war waged by the West. The hysteria culminated in a series of arrests of gay men, including a young couple in Aceh who were publicly caned for having sex.
The knock-on effect has been to drive HIV treatment and outreach underground. Bizarrely, in some cases this means keeping the location of life-saving treatments a secret – albeit an open one.
Jakarta's main clinic, which Prabowo's organisation supports, declined repeated requests for interviews. It has no website and is known only by word of mouth. Its organisers asked that its identity be withheld out of fear it would be attacked by conservatives. In text messages, its chief medical officer seemed eager to distance the clinic from suggestions it was primarily for gay men.
"We like to keep [the clinic] known for only those who need it, no matter their sexual orientation," says the clinic's chief doctor, who also asked not to be identified.
If fear-induced subterfuge defines HIV activism in Jakarta, Rena Janamnuaysook employs the opposite approach to combating the epidemic in Thailand.
Standing 180cm, with long black hair, a crisp white blouse and impeccable make-up, the impassioned, media-trained transgendered woman is plain about her goal: the complete detoxification of HIV/Aids.
"Sensitivity is the frontline of our campaign," says the programme coordinator of the Thai Red Cross Aids Research Centre. "We are normalising HIV/Aids."
Part activist, part den mother, Janamnuaysook pauses to speak with a young man, who is relaying news that his recent HIV test was negative. "Next time don't wait so long," she admonishes the youth.
At the heart of the research centre is the Anonymous Clinic where some 35,000 pass through for testing and treatment each year. Roughly a third are men who have sex with men. About 3,500 a year come for the generic versions of a medication that prevents HIV, which the Thai government makes available for the equivalent of less than US$1 a day. This year the clinic opened a unit specifically tailored to transgendered people, who are particularly at risk of HIV because of a tendency for many to put gender reassignment before their health, Janamnuaysook explains.
"There are multiple layers of stigma that can make people vulnerable to HIV," she says. "As a citizen I am entitled to these services."
Regional access to such programmes has never been more important. In 2011, just over 6 per cent of Indonesian men who had sex with men were HIV positive; now, it is closer to 26 per cent, according to data from the Joint United Nations Programme on HIV/Aids (UNAids). In Jakarta and Bali, the figures can be as high as 36 per cent. In Bangkok, for gay men the prevalence is just under 30 per cent – up from 21 per cent at the beginning of the decade. By the end of the decade, half of all new infections within Southeast Asia will be among men who have sex with men.
The specific reasons for the widespread outbreaks are hard to quantify. The spread of recreational drugs such as methamphetamine, which prompts some to make poor choices, and the proliferation of online hook-up apps may be contributing factors.
But activist organisations, such as Apcom – a group that specialises in raising awareness of HIV/Aids among gay men in the region – say heavy-handed authorities are also accelerating the epidemic. "Gay men are increasingly vilified and oppressed," says Ryan Figueiredo, Apcom's deputy director. "It's disturbing that the authorities are denigrating the very community they need to be working with to address this epidemic."
Such sexual squeamishness, especially in Indonesia, is nothing new. But even amid heightened police scrutiny, progress is being made. Prabowo's organisation has provided staff training for treating gay men and has paid for additional operating hours at 36 government clinics across the country. Some facilities even dispense HIV medication without referring patients to hospitals – a key to preventing many from falling through the cracks.
For many young gay men living with HIV in Indonesia, however, a trip to the doctor is still like running the gauntlet. Once every two months, Jeremy, 30, sets aside his usual fitted polo shirts and mint-condition trainers and slaps on a loose T-shirt, flip-flops and heads to the same clinic in the centre of town which asked to remain unidentified. He goes there to pick up life-saving medication that has kept in check the HIV infection he has had since he was at least 25. A surgical mask, ostensibly to fend off street pollution, tops off the disguise, says Jeremy – not his real name.
"Normally I dress dapper, but when I go to the clinic I dress unlike myself so that no one recognises me," he says. "I live here. People talk."
But after two years of this ritual and a number of close calls seeing people who could reveal his identity, Jeremy is tiring of the routine. He says he can imagine a time when he will be more open about his status. "I think in the future I won't have to wear a disguise and I'll be able just go there and say 'hi' to everyone."
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