Made Efo Suarmiartha has developed a low-cost way to conduct effectual preventative education on HIV/AIDS and other sexually transmitted diseases in Indonesia. He has achieved this by organizing high-risk groups themselves to convey the "safe sex" message.
The New Idea
Made Efo Suarmiartha recognized that in order to begin to address the growing problem of AIDS in Indonesia, he had to approach the groups that were most vulnerable to the disease but had the least amount of access to practical information about safe sexual practices: sex workers, homosexuals, drug users. This is why he decided to undertake his initial interventions among sex workers in Bali, the group that, according to Efo, has the highest number of reported HIV-positive cases in Indonesia.His goal is to provide these individuals with knowledge of the effects and dangers of AIDS and other sexually transmitted diseases (STDs) and information on how to avoid contracting such diseases. He follows up the initial information he provides to people with peer counseling to ensure that they have understood what they have been taught. The distinctive aspect of Efo's initiative is to motivate the same individuals who have been counseled to become peer educators themselves. He believes that this is the only practical way to reach a section of the population that is most vulnerable, yet least likely to (be able to) heed the message calling for safe sexual practices. Reaching them through their peers will have more success than if the message comes from counselors who are perceived as having little or no understanding of the way of life in at-risk communities.Efo also offers sex workers access to medical testing and care, including reliable, confidential methods of determining whether or not they are already infected. For those who test positive for the virus, Efo has established the first counseling service in Bali to deal with the emotional and financial difficulties that come with HIV/AIDS, as well as to provide them with references for medical care.
According to an Indonesian Ministry of Health report at the end of 1992, 83 people in the country tested HIV-positive that year, a number that doubled the previous year's figure. Most of the officially reported cases came from Bali, Jakarta and Java, areas with large tourist trades. Experts feel that the number of reported cases is far lower than the reality due to a serious lack of testing and reporting, among other reasons. Accurate reporting is also hindered by the tendency of government and corporate interests to hide the extent of the problem, lest it dampen enthusiasm for tourism. Researchers and activists fear that as the tourist industry grows, so will the rate of HIV infection. If efforts are not made to educate the people who are most at risk, then the problem can only get worse. Most of the current HIV-positive individuals are from high-risk groups. Yet, despite the groups' vulnerability and the Indonesian media's increased attention to the issue, information simply does not always reach those who need it most. Information on HIV/AIDS and STDs and how to prevent contracting them has not been targeted specifically at these groups.
Efo has a two-track approach, prevention and testing/counseling. With respect to prevention, Efo established the Yayasan Citra Usada, a counseling, education and community outreach center located in the heart of one of the sex workers' districts in Bali. Efo's strategy rests upon first reaching high-risk sex workers in the streets and areas in which they congregate and then involving them personally and directly in the process of educating others. He has organized informal, daytime meetings and events for sex workers to discuss safe sexual practices and the dangers of AIDS and STDs. From these meetings he makes contacts with high-risk groups and gains acceptance by them through word of mouth. In this way, he learns where it might be possible for him to reach other high-risk groups.The contacts Efo makes in these meetings are critical to his plan. From this group he has recruited some of his first peer educators. Once they are taught about AIDS and STDs (from the basics of what the diseases are and how they are transmitted, to how to prevent transmission through safe sexual practices), they are equipped to go out into their own communities and spread the word on a one-to-one basis. With the message coming from someone with a social, economic and educational background similar to those whom it is intended to reach, the information comes across that much stronger. Efo's second track–providing testing and initial counseling–is led by Dr. Tuti Parwati, his cofounder at Citra Usada. Together they are developing a network of medical doctors who will perform blood tests and give initial counseling to HIV and STD carriers.
Efo's parents are both nurses, and their experiences made him very sensitive to health issues in his country from an early age. He obtained his degree in anthropology from Udayan University, following which he became involved in a research project on sexual behavior among Indonesian sex workers, homosexuals and transvestites.The experience of this research made such an impression on Efo that it set him on his present course. He first felt it imperative to address the alarming lack of knowledge of the respondents with regard to STDs, and to do so in a direct manner. He also recognized, on a human level, the need for a community outreach program that would truly be suited to the particular situations of these individuals.