While women account for less than ten per cent of injecting drug users, the rate of HIV infection among them is higher than for men. Research focussing on women has just begun and it is revealing the part that social and sexual politics play. It is hoped this new work will provide some guidance for future policy settings.
Presenter: Karon Snowdon
Speaker: Heather Worth, International HIV Research Group, University of New South Wales, Australia
SNOWDON: HIV prevalence is on the rise in Indonesia.
Even so, the statistics are vague, anywhere between 290,000 and 400,000 people are living with HIV.
And while the prevalence is highest in Papua, 50 per cent of total HIV infections are to be found in the main island of Java.
WORTH: We do know that injecting drug use transmission of HIV is on the increase.
SNOWDON: Heather Worth is an associate professor with the International HIV Research Group at the University of New South Wales.
Around half the injecting drug users in Indonesia are infected with HIV.
And while women make up a small proportion of drug users - less than ten per cent - they are more likely than male drug users to become infected.
The figures are 56 per cent for women, compared to 52 per cent for men who inject.
Heather Worth's recent study focussed on women heroin users in three cities in Java with the help of local researchers.
They found women face more stigma, are more socially isolated as a result, and access fewer health and preventative services than men.
And research and education about needle sharing and safe sex have more often targeted men.
WORTH: In Indonesian culture women are expected to be submissive, to be self controlled, to be gentle and kind and some very positive aspects. But it also means that it makes it very hard for women who inject drugs to be able to talk about that or to be able to admit that they do inject drugs.
SNOWDON: What are some of the reasons for women taking up the practice?
WORTH: Most of the women we talked to had been initiated into injecting by their boyfriends or their husbands. And most of the women in the study were in a really great dependency. They were dependent on men for drugs supply, they were dependent on men for economic things, to live, and they were very much dependent on their partners for emotional support and social support. Most of them had given up their own friends, their networks had become very narrow.
SNOWDON: And are they concerned about or aware of HIV infection?
WORTH: Yes, I think the women are concerned about HIV. But I think in some cases they have a fatalistic approach to their lives now. They feel they are 'just a junkie', so they're beyond the pale, and I think in those circumstances maybe women don't care as much about becoming infected with HIV and feel they have little control over whether that actually happens.
SNOWDON: The delivery of health and social services is made more difficult by the the size of the country and the high level of decentralisation. But Heather Worth says the Indonesian government is taking the issue of drug use and HIV seriously.
WORTH: It's begun to implement really good programmes, some of which are funded by the Australian government through AUSAID. Women injecting drug users and the reach of those programmes is really increasing every year. It's really important. I know that women only make up a small proportion of those who inject drugs but the issues for women are important and different from men, so it's really important that those programmes begin to think about the women who also inject drugs.