June 15, 2023
JAKARTA – A disproportionate number of housewives and pregnant women contract sexually transmitted diseases (STDs) such as HIV and syphilis each year, according to recent data from the Health Ministry, which attributed the problems to poor awareness of sexual health and their partners’ unsafe sexual behavior.
Sexual and reproductive health activists say that the lack of a comprehensive approach and preventative measures from the government, as well as stigma and prejudice from society at large have prevented women living with STDs from being tested or seeking medical treatment, increasing the risk of STD transmission to thousands of infants each year.
According to data from the Health Ministry, about 35 percent of all new HIV cases in Indonesia are found in housewives, greater than in other vulnerable demographics such as the spouses of sex workers or men who have sex with men.
Roughly 5,100 housewives contract HIV in the country each year, with around 33 percent catching the disease from their husbands.
Syphilis cases have also increased by a staggering 70 percent in the past five years, from around 12,000 incidents in 2016 to 21,000 last year. Out of 17,000-20,000 new syphilis patients each year, around 5,500 are pregnant women.
Health Ministry spokesperson Muhammad Syahril said recently that the main reasons for the high STD transmissions among housewives and pregnant women were the lack of knowledge about STDs and how to prevent them, as well as having partners who engage in high-risk sexual behavior.
Babies at risk
The high incidence of pregnant women contracting HIV and syphilis is putting thousands of infants at risk, with pregnant women with HIV having a 20-45 percent chance of transmitting the virus to their babies at birth and during breastfeeding.
Meanwhile, pregnant women with syphilis have a 60-80 percent risk of transmitting the disease to their babies.
Syphilis in pregnant women can also cause miscarriage, stillbirth or death shortly after birth, with approximately 40 percent of babies born to women with untreated syphilis being stillborn or dying from the infection as a newborn.
Another spokesperson at the ministry, Siti Nadia Tarmizi, said that since 2017 health authorities had been providing free HIV, syphilis and hepatitis B tests for pregnant women, a program dubbed triple elimination.
“Health workers [in community health centers] always offer pregnant women syphilis, HIV and hepatitis B tests and if the results are positive they will be offered free treatment to prevent transmission to their infants,” she told The Jakarta Post recently.
“The ministry also continues to educate the public, both homosexuals and heterosexuals, not to engage in high-risk sexual behaviors,” he said.
Despite free STD tests and treatment being largely available in community health centers (Puskesmas) across the archipelago, Syahril said that the number of pregnant women who undergo tests and receive treatment for STDs remained low as a result of stigma and shame.
Out of roughly 5 million pregnancies per year only 55 percent of expectant mothers are willing to undergo HIV tests and only 25 percent take syphilis tests, for various reasons including not getting their husbands’ permission.
Syahril said that only 24 percent of pregnant women who tested positive for HIV received treatment and only 40 percent of pregnant women with syphilis were treated.
Comprehensive measures
Ayu Oktariani of the Indonesian Positive Women Network (IPPI) said that gender inequality was the biggest obstacle in preventing and treating STDs in women.
“The government has been working to combat HIV for more than four decades but only in the last five years or so have women been recognized as among the vulnerable and at-risk groups,” she said. “Even then the government only provides free screening for pregnant women, which could prevent transmission to their babies but it is practically too late for the mothers.”
Ayu said that health authorities also failed to realize that gender-based violence increased women’s risks of HIV infection and that for women living with HIV, their well-being is not just about access and adherence to treatment.
Evidence, she said, showed that it was also dependent on how social norms and patriarchal settings might leave them at higher risk of gender-based violence that in turn would create barriers to accessing medical treatment, thus affecting their overall quality of life.
Ayu stressed that holistic and comprehensive approaches were crucial to reducing and preventing HIV transmission in women and to ensure their access to treatment.
“The government needs to approach the problem as a social issue, not just a health issue. A joint effort between ministries is crucial to educate the public on STDs, women’s reproductive health rights and to fight the stigma against women living with HIV-AIDS,” she said.