T

he number of HIV/AIDS cases in Indonesia continues to rise ahead of World AIDS Day commemorated every Dec. 1. In last year’s Joint United Nations Program on HIV/AIDS (UNAIDS) meeting, Indonesia joined other countries in a declaration to end the global epidemic by 2030. This includes zero infection, zero deaths and zero discrimination.

In 2016, the number of people living with the human immunodeficiency virus in Indonesia reached more than 690,000 people, with the highest risk coming from unprotected sexual intercourse with multiple partners. Home to at least 40,000 sex workers, Indonesia’s sex trade greatly contributes to the country’s HIV/AIDS epidemic.

Poverty remains a key driver that forces individuals and even families into the sex trade. When I first conducted my study on sex workers at the Boker red-light district in Ciracas, East Jakarta, I was shocked to learn that many had turned to the trade after given permission by their own husbands.

“We feel like we have no choice. We were not able to meet our financial needs,” one of the women said.

In a bid to eradicate prostitution in the world’s most populous Muslim-majority nation, Social Affairs Minister Khofifah Indar Parawansa rolled out an ambitious plan to close down all 168 red-light districts in the country by 2019.

The idea to permanently shut down red-light districts is not new in Indonesia. It might be possible to turn all the brothels into parks, but expecting zero prostitution in the next two years seems like a false hope.

Although some red-light districts — like Dolly in Surabaya, East Java, or Kalijodo in Jakarta — were officially shut down by their respective local governments, it did not seem to have put the brakes on the sex industry. These centers merely scattered into smaller prostitution sites elsewhere.

A few kilometers from the hospital where I work in Lombok, West Nusa Tenggara, I found several sex workers near the Senggigi red-light district who used to work at Dolly.

Former Jakarta governor Basuki “Ahok” Tjahaja Purnama earlier acknowledged that demolishing red-light districts did not solve prostitution.

As a trade, it simply depends on supply and demand; as long as clients exist, prostitutes also exist, making it almost impossible to eradicate.

In addition, as escaping or overcoming poverty is a main driver into sex work, it is no surprise that prostitutes would return to the streets the minute their places of business are “closed.”

The criminalization of sex work is believed to have a huge role in the worldwide epidemic of HIV/AIDS. Experts at the 2016 International AIDS Conference in Melbourne found that making any part of prostitution illegal makes prostitutes less able to seek treatment when they become infected.

Stigmatization of sex work also forces prostitutes to hide their involvement in sex work from family, friends and their home communities, and acts as a major barrier to accessing health care services. When they are scattered and hiding, it becomes more difficult for health workers to deliver mobile services.

“Where criminal laws toward prostitution have actually been removed, rates of HIV and sexual transmitted infections are very, very low,” said Sandra Ka Hon Chu of the Canadian HIV/AIDS Legal Network.

As stated in the law on HIV/AIDS prevention, employers of any place of business in which workers could potentially contract HIV are obligated to check their employees’ health every three months.

If prostitution was legalized and centered, pimps would likely comply with the regulations, and the city administrations could effectively supervise the workers, hence minimizing the spread of HIV through prostitution.

However, this legalization would most definitely be controversial, including among Muslim health workers.

Thus, sex workers also face stigma in health care facilities. According to the International Journal of Equity in Health in 2015, stigmatization by health care providers sadly remains the highest barrier for care among prostitutes. While the Ciracas community health center (puskesmas), the nearest health care facility to Jakarta’s Boker red-light district, provides services that are friendly to sex workers, we would be hard-pressed to find others.

Take my hospital in Lombok, famously known as the Island of 1,000 Mosques. Here, the stigma against prostitutes, including in health facilities, is strong, as in many other areas in Indonesia.

“I have been to hospitals where I have felt dirty and felt these people just look at me like I am a stupid prostitute. I did not want to go to the hospital because of the judgment,” said one sex worker at the popular Senggigi beach.

It is crucial to constantly remind ourselves that sex workers are still humans who deserve to be treated equally. We must not forget that health workers are sworn not to discriminate against patients regardless of their backgrounds or occupations. In fact, health care facilities should be the safest place for the high-risk population.

As mentioned in the newest guideline of HIV testing and counseling issued by the World Health Organization (WHO), it is pivotal for health workers to provide HIV examinations with a non-judgmental attitude and assurance of confidentiality.

Compulsory regular health checks in a calm and non-reactive way seem to be the most simple and effective step toward early diagnosis and treatment of HIV for all sex workers or other high-risk populations.

In Bali, several clinics have committed to providing friendly HIV examinations for sex workers, transgenders and homosexuals. It is proven successful, as Bali was recently heralded as having shown the greatest progress in reducing cases of HIV. This kind of approach should be implemented in many more health care facilities to produce a greater impact.

So, should we continue to close down Indonesia’s red-light districts? Should we legalize prostitution?

These are crucial questions that should be considered very wisely.
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The writer is a physician practicing in Lombok, West Nusa Tenggara, who has also conducted several studies on HIV/AIDS in Indonesia.