Indonesia

For Vanessa Chaniago, a young transgender woman living in Jakarta, Indonesia, the first few months of the COVID-19 pandemic were filled with fear. “I was really struggling to make ends meet. I had been working for a civil society organization, which was a great place to learn and develop strong networks, but unfortunately the income was not sufficient to sustain me and my family. My income drastically declined,” she said.

According to a survey conducted by the Crisis Response Mechanism (CRM) Consortium of 300 lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Indonesia, the COVID-19 pandemic has caused most LGBTI people to have experienced layoffs or reductions in income or to close their businesses. Most LGBTI people work in sectors with a higher risk of COVID-19: 20.5% in the beauty industry, 19.5% in the health sector and 12.8% in the service industry. Unfortunately, most of the respondents do not have long-term savings—30% would only be able to survive for two to three months on their savings, and 64% are not able to access loans.

Reflecting back on more than a year of the pandemic, Ms Chaniago said that the situation didn’t rapidly improve and instead got more challenging as time went on. “I decided to start a small business, selling beef rendang and other Indonesian street food. Opening a business during the pandemic wasn’t ideal, and not long after the opening I had to close down my store. Now I continue my small business on the streets.”

Ms Chaniago is determined to survive these trying times and she recognizes that many of her fellow transgender women face bigger hurdles. Many transgender people in Indonesia do not have identity cards, leaving them unable to access social support from the government. The CRM survey found that 51% of respondents did not receive social support from the government and those that tried to receive it faced many challenges in accessing it.  

On top of the socioeconomic struggles they face, discrimination and violence towards the LGBTI community continues—transgender women in Jakarta have even been pranked with aid packages filled with garbage. The CRM survey also found that violence against LGBTI people increased.

Keeping in touch virtually among the community has been essential. Ms Chaniago said, “I want to tell my fellow LGBTI peers that they are not alone. As a community, we must continue to help each other out and fight for what is right.” Unfortunately, the CRM survey found that the community cannot always turn to peers for support, as many don’t have devices or enough Internet data to contact their friends.

Despite the huge hardships, there is a strong sense of optimism and hope for a better life after the pandemic. To get there, however, the LGBTI community needs support, including form the government and the public.

“Everyone has been affected by COVID-19. In Indonesia, many vulnerable groups have struggled to survive not only the pandemic but the devastating impact of loss of livelihoods and income. UNAIDS works with partners to strengthen the protection of vulnerable groups from stigma and discrimination in order to increase equitable access to support and services,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The CRM Consortium consists of UNAIDS Indonesia and four national civil society organizations—Arus Pelangi, the Community Legal Aid Institute, Sanggar Swara and GWL-Ina. In addition to the survey, the CRM Consortium has mobilized resources for LGBTI people affected by the pandemic through the distribution of food packages, sanitation packages and rent allowances.

The results of the survey are highlighted in a video here.

Many people have been able to work from home during the COVID-19 pandemic and continue to be paid, but low-income workers often haven’t had that opportunity.

In Indonesia, the latest labour force survey results show that 29 million workers have been affected by the pandemic, with 24 million workers suffering from cuts in hours of work and income. Average wages were depressed by 5.2% between 2019 and 2020. Surveys conducted by the Indonesia AIDS Coalition show that the situation is similar for people living with HIV and key populations—more than 80% of 529 respondents had experienced a reduction or loss of income due to the pandemic.

To address the rising income inequality, the United Nations allocated a US$ 1.7 million funding package to bolster the economic empowerment of women and vulnerable populations in Indonesia and to help protect their livelihoods from the devastating socioeconomic fallout of the COVID-19 pandemic. In 2020, the UNAIDS Country Office for Indonesia worked with the International Labour Organization, the United Nations Development Programme and the Office of the United Nations High Commissioner for Refugees to mobilize the funding.

A joint project launched earlier this month will directly benefit and empower vulnerable groups, including women, people living with HIV, key populations, refugees, migrant workers and people in disadvantaged regions.

The one-year project offers support through training on entrepreneurship and business development and facilitates access to skills development and jobs. UNAIDS will work closely with civil society organizations to identify the beneficiaries and ensure that people living with HIV and transgender people and other key populations are among the approximately 3650 people to be supported by the project.

The Indonesia Positive Network is among the organizations that will be involved in the project. Meirinda Sebayang, the National Coordinator of the Indonesia Positive Network, appreciates the support of the project. “COVID-19 has amplified existing disparities, especially for the livelihoods of people living with HIV and key populations in Indonesia. In this difficult time, we learned that it is important to build trust and strong collaboration between communities, government, health services and United Nations partners, not only to ensure that essential services remain available but to ensure that our community is not left behind in the response and recovery from the socioeconomic impact of COVID-19,” she said.

The project also includes advocacy for policies that promote inclusion and respond to discrimination in the government, the private sector and trade unions. Through this sensitization and advocacy work, these sectors will be required to protect vulnerable groups from discrimination and exclusion from the job market, even beyond the COVID-19 recovery.

One year into the pandemic, it is crucial that United Nations agencies join forces to support vulnerable groups, which have been disproportionately impacted by COVID-19, in the recovery process.

“Many key populations affected by HIV work in informal settings and were seriously hit by the pandemic. While we may not be able to respond to every single need of the community, we aim to provide an example of how to support vulnerable communities in these stressful and critical times. We believe that through this project many people will receive the direct support and opportunities that are vital for the recovery of their livelihoods,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

After the 2018 earthquake struck Lombok, in West Nusa Tenggara, Indonesia, the destruction it caused closed most health facilities. Among those affected were people living with HIV, who could no longer access their HIV treatment. Then, Yayasan InSET, a civil society organization in the province, stepped in, teaming up with health facilities in the area and taking on the role of delivering antiretroviral therapy to people in need. Today, the COVID-19 pandemic is threatening to do what the earthquake did to access to HIV treatment, and Yayasan InSET is ready to step in again.

Many people living with HIV in West Nusa Tenggara and in the rest of the country are acutely concerned about the possibility of disruption to HIV services and not being able to access antiretroviral therapy, owing to overburdened health facilities or the possibility of lockdowns. A recent rapid survey of 1000 people living with HIV conducted by the Positive Indonesia Network found that more than 41% were extremely anxious about COVID-19, with more than 36% worrying about their ability to obtain their HIV treatment.

“In West Nusa Tenggara, there are more than 500 people living with HIV on treatment who are worried about being unable to go to a clinic to access antiretroviral therapy,” said Himawan Afrian, the head of Yayasan InSET.

Yayasan InSET’s experience of working with hospitals and health centres after the earthquake has left it ready to help out in the COVID-19 outbreak. “Some health facilities actually contacted us a couple of weeks ago to ask for our help. The concern did not just come from the community, but also the health workers. Initially they asked us to raise awareness about COVID-19 prevention to our communities. Now we are working out the arrangements for us to take over the delivery of antiretroviral therapy should the situation worsen,” said Mr Afrian.

Having a close collaboration with the health services has been a big help for Yayasan InSET ensuring that people living with HIV are not left behind during the COVID-19 pandemic. Its direct advocacy has ensured that people living with HIV in the province receive a two-month supply of antiretroviral therapy. The organization has also successfully lobbied the authorities to move the HIV clinic away from the hospital, so people can swiftly pick up their medicines without entering the overcrowded clinics in the hospital, and has successfully advocated to the authorities in Mataram for the provision of food packages for sex workers and people living with HIV for six months.

During emergencies, whether pandemics or earthquakes, collaboration and local solutions are key to ensuring that there is as little disruption as possible to services for people living with HIV. 

Although difficult for everyone, the COVID-19 pandemic has had severe impacts on key populations, many of whom are experiencing economic hardship and anxiety about their health and safety.

Rito Hermawan (also known as Wawan), the Advocacy Coordinator of the Network of Sex Workers of Indonesia (OPSI), explained that the places that sex workers work in Indonesia have been closed down. Since, for their own safety, sex workers are avoiding working on the streets, many have been left without an income, unable to make ends meet.

It’s been about a month since Indonesia enacted a set of preventive measures against COVID-19. With the uncertainty of when life may return to normal, OPSI is supporting the urgent needs of the sex worker community.

Many sex workers are increasingly needing mental health support to combat the stress and anxiety they are currently experiencing. In a rapid survey conducted by the Indonesian Positive Network to review the needs of people living with HIV and key populations, more than 800 out of 1000 people surveyed expressed a need to access mental health and psychosocial support.

In order to address this, OPSI uses social media to provide virtual mental health support. “Through our social media, we are able to reach sex workers and empower them with information, motivation and support. They need to know that they are not alone, even though we may not be physically close,” said Mr Wawan.

A video teaching meditation and breathing techniques was recently launched to help sex workers cope with stress and to improve their general well-being. OPSI is also highlighting innovative work, such as making masks for sex workers during the COVID-19 pandemic. For those who need one-on-one support, OPSI has also established a counselling hotline.

In addition to supporting the sex worker community in Indonesia, OPSI is also exploring ways for outreach efforts to be continued despite the current conditions. The essential work of outreach workers should not come to an abrupt halt because of COVID-19, but it will need to move to a virtual form.

With technical assistance from the United Nations Population Fund Indonesia, OPSI developed a module on virtual outreach. The module outlines how outreach workers can adapt their work online, such as by using WhatsApp. The outreach workers are provided with lists of HIV counselling and testing services that are still open in 88 districts in Indonesia, which they can use to refer sex workers.

Sex workers, like others, are facing incredible hardships during the COVID-19 pandemic, whether it be struggles with their mental health, difficulty in continuing their work and loss of income. The role of networks and organizations of sex workers like OPSI is incredibly important in ensuring that the needs of sex workers are supported at this vital time.

The COVID-19 pandemic has disrupted people’s lives around the world, including those of many marginalized people, who suddenly face additional burdens and vulnerabilities.

Many areas in Indonesia, which as of 6 April had 2491 confirmed cases of COVID-19 and 209 deaths, have put in place measures, such as physical distancing, to curb the spread of COVID-19. While effective in responding to the disease, many people have been impacted by the effects of physical distancing on the economy.

Out of 1000 people living with HIV and members of key populations surveyed by the Indonesian Positive Network, more than 50% are experiencing severe impacts on their livelihoods, including many transgender women. Sanggar Swara, a civil society organization of young transgender women in Jakarta, conducted a rapid assessment that found that more than 640 transgender people in greater Jakarta have lost their jobs, leaving them unable to support themselves. “On several occasions when the distribution of basic food staples took place, many of them could not access it as they do not have their identity cards on hand or simply due to their gender identity,” said Kanzha Vinaa, the head of Sanggar Swara.

Seeing the critical need for support, the Crisis Response Mechanism (CRM) Coalition, fronted by the civil society organizations LBH Masyarakat, Arus Pelangi, Sanggar Swara and GWL Ina, with support from UNAIDS Indonesia, decided to raise funds for the transgender community. “Since 28 March, we spread the information about the fundraising to communities and partners. Our plan was to collect the funds and distribute them to transgender women in need, with support from focal points in the areas,” said Kanzha Vinaa.

In less than a week, the CRM Coalition had collected more than IDR 67 000 000—around US$ 4100—and distributed food and hygiene packages to more than 530 transgender women in greater Jakarta. The packages cover the basic needs for one week. Ryan Kobarri, the head of Arus Pelangi, said, “Initially we only expected our close networks to respond to this call for donations. We were elated to see that the support and enthusiasm was much more than we expected. Not just from local networks, but even international networks gave their support. Someone even donated 100 kg of rice!”

Although there is uncertainty over how long the current COVID-19 situation will last, it is very likely that the need will persist in the coming weeks and months. The CRM Coalition continues to welcome donations from all around the world in order to keep the community afloat during these difficult times.

Since its establishment in 2018, the CRM Coalition has worked to coordinate and mobilize resources to respond to the persecution and discrimination faced by lesbian, gay, bisexual, transgender and intersex people in Indonesia, one of the most vulnerable communities in the country.

Donations to help keep this vital work going can be made by PayPal at paypal.me/kanzha or through Ryan Kobarri at ryan@aruspelangi.or.id.

Nining Ivana, the local coordinator of the Indonesia Positive Women Network (IPPI), Jakarta, was shocked when she received a voice message from one of the network’s new members.

In the message, Mutiara Ayu (not her real name) said that she had been beaten by her husband and abused by her husband’s family when they discovered that both her and her son were living with HIV. Research by IPPI in 2011 found that, like Ms Ayu, more than 28% of its members across Indonesia had experienced violence from their partners and family members because of their HIV status. It is known that women who are victims of sexual abuse are also at a higher risk of contracting HIV.

To address the linkages between HIV and violence against women, IPPI is holding a series of workshops to better integrate services for HIV care, support and treatment and against violence against women across eight cities in Indonesia. IPPI members who are survivors of violence, local HIV service workers from public health clinics and managers of women’s shelters have been attending the workshops, at which the results of the IPPI’s research are disseminated, needs are discussed, experiences are shared and a local action plan to better integrate both services is decided upon.

“I heard stories from HIV service providers at public health clinics. They couldn’t understand how a woman living with HIV had such a low CD4 level despite routinely visiting the clinic. Apparently, her husband banned her from taking her antiretroviral medicine. They know that these women are more likely to be victims of violence, but they do not know where to refer them to, since there is no standard operating procedure beyond their health care,” said Chintya Novemi, the person in charge of integrating services for HIV and violence against women at IPPI.

In addition to HIV care, support and treatment services, women living with HIV who are victims of violence may need counselling for trauma and legal aid should they decide to pursue litigation. Through its HIV & Violence against Women Services Integration Project, IPPI aims to bridge this gap. When there is not a formal relationship or mechanism, or it is not clear, informal referral mechanisms made by local stakeholders could save a woman’s life.

“After meeting with workers from services for HIV and violence against women at the workshop, it became clearer to me where I should refer IPPI members who encountered violence and how we should handle their cases,” said Ms Ivana, who joined the workshop in Jakarta.

Upon finishing the series of workshops, IPPI hopes to disseminate the results to national stakeholders, including the National Commission on the Elimination of Violence against Women, the Ministry of Health, the Ministry of Law and Human Rights and others. The ultimate goals are to gather evidence regarding these interlinked issues and advocate for a national standardized mechanism to protect women living with HIV from all forms of gender-based violence. 

“I was walking to work, like I do every morning. There was a man on a motorbike at the end of the street. As I walked pass him, he grabbed my breasts and sped off.” This is a quote from one of the many stories featured on Hollaback! Jakarta’s website.

Sexual harassment and other forms of gender-based violence remain a serious issue for women in Indonesia. According to the National Commission on Violence Against Women’s Annual Report, there were more than 400 000 reported cases of violence against women in 2019, of which 28% were in public spaces. Public facilities, public transport and streets have become places where women do not feel safe and secure.

Hollaback! Jakarta is part of the global movement to end harassment in public spaces. In its quest to create safer spaces for women in the city, Hollaback! Jakarta works with ride-hailing app companies, public transport services, schools and campuses to provide training on gender-based violence.

“By training motorbike taxi drivers, they are not only able to understand forms of harassment, but also take an active part in intervening against harassment they see in public spaces,” said Noval Auliady, Co-Director of Hollaback! Jakarta. In Jakarta, where streets are filled with motorbike taxis, this is incredibly important.

Currently, women do not have full legal protection from gender-based violence. While there are laws that exist, gaps still remain. The Draft Bill on the Elimination of Sexual Violence was set to fill the gap, with an expanded definition of sexual violence and a focus on protection and victim restitution.

For several weeks in September 2019, students, activists and young people took to the streets of major cities in Indonesia to demand the passing of the draft bill. Hollaback! Jakarta was part of the core team for the campaign, creating a social media buzz, mobilizing people and meeting with parliamentarians.

Unfortunately, the draft bill was not passed in the last parliamentary sitting as conservative groups strongly argued against the clauses on the criminalization of marital rape. It is notable that the bill is still included in this year’s priority list of the national legislation programme. The massive support from civil society groups for the bill does increase its likelihood of passing and brings hope to the fight for ending gender-based violence in Indonesia.

The Internet has become a great ally for the movement. Not only was social media vital in mobilizing people to support the draft bill, it has also been a powerful platform to spread the important message of ending violence against women.

On its website, Hollaback! Jakarta encourages people to share their stories, showing how widespread, serious and familiar experiences of violence are for women. Like the quote above, people share personal experiences and some share cases they have witnessed as bystanders.

The Hollaback! Jakarta website has posted more than 300 stories of women experiencing various forms of gender-based violence, from catcalling to abuse. With each story posted, others can show their solidarity by clicking “I’ve got your back”. With its website and social media presence, Hollaback! Jakarta recognizes the potential to create a virtual safe space for women experiencing such issues.

“The more stories there are, the more people are willing to speak up and show their support. More bystanders are willing to intervene when seeing it first-hand. This is what we hope to achieve,” said Mr Auliady.

Indonesia has decided to pilot pre-exposure prophylaxis (PrEP) in four cities with high levels of HIV prevalence. PrEP is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. It is hoped that the pilot project will pave the way for a wider roll-out across the country.

The commitment to piloting PrEP came during the 1st Indonesian Symposium on PrEP, which was organized by UNAIDS at the end of June. The two-day event brought together around 150 clinicians, public health officials and representatives of key populations, who shared their experiences of PrEP research and implementation strategies across the Asia-Pacific region. The pilot in Indonesia will be conducted in close collaboration with the Ministry of Health. 

PrEP is a highly effective prevention choice for people who are at high risk of HIV infection such as sex workers, people who use drugs and gay men and other men who have sex with men. It is having a big impact in reducing new HIV infections in Australia and its availability is increasing in New Zealand, Thailand and Viet Nam. China, India, Malaysia and Philippines have also initiated pilot projects.      

Prevention efforts are vital to strengthening the HIV response in Indonesia and PrEP would be a significant addition to the country’s combination prevention approach. Indonesia had 46000 new HIV infections in 2018 and has one of the fastest growing epidemics in the Asia Pacific region. In 2018 there were 640000 people living with HIV in the country and only 17% had access to treatment.

The discussions at the symposium helped to disperse some of the common misconceptions regarding PrEP, both among communities and services working to reduce new HIV infections.     Civil society activists expressed their strong support for PrEP roll-out.

“PrEP will become a necessity for sex workers,” said Rito Hermawan of the Indonesian Sex Workers Network, “As well as using condoms, they can get additional protection by using PrEP. We must educate people about PrEP to stop any misconceptions.”        

Other civil society activists echoed their support.

“The more I learn about the benefits of PrEP, the more I wonder why it is not available here,” said Mr. Riunaldi from Intermedika Prana Foundation, “I am hopeful that more people will understand how important PrEP is for our country.”

Participants in the symposium said that many people were already accessing PrEP online, indicating a growing demand in Indonesia.

“It is incumbent on policy makers, health professionals, researchers and civil society organizations to ensure that those at risk of HIV infection have access to the information and resources needed to make informed decisions regarding their health” said Tina Boonto, UNAIDS Country Director for Indonesia. 

Discussions about sex and HIV in Indonesia remain highly taboo, while the limited information that exists is often unclear, not easy to digest or contradictory. That’s why many young people are turning towards new technology platforms to seek answers to questions that affect their health and well-being. 

In an attempt to improve the quality of information provided to young people, the UNAIDS Country Office in Indonesia has developed Tanya Marlo, or Ask Marlo, a chatbot powered by artificial intelligence and designed to be the go-to source for all things HIV-related.

Marlo is a cute character who provides basic information about HIV through user-friendly content such as infographics, quizzes and FAQs (frequently asked questions). In just a few taps, Ask Marlo users can also book HIV testing appointments at health centres across Jakarta, Indonesia. Young people looking for a more in-depth chat are connected to real counsellors, who are on standby to talk, provide guidance and make referrals to specialized services.

The counsellors receive many questions on how to access HIV services and HIV treatment.

“Many people, particularly young people, in Jakarta still do not know basic information about HIV. I hope that as a counsellor on Marlo, I can change that,” one of the counsellors said.

The Ask Marlo chatbot is integrated into the LINE chat messaging application. Users looking to chat to Marlo can simply add @tanyamarlo on LINE and begin chatting. Indonesia is one of LINE’s top markets, with around 90 million users. Around 80% of its users are young people, many of whom use LINE Today to get news and information and to shop.

Since launching on 1 December 2018, Ask Marlo has increased the number of its users, reaching almost 3000 followers at the end of March. Reviews of Ask Marlo bear witness to how important and necessary the service is for young people.  

Upon seeing Ask Marlo for the first time, a psychology graduate from the University of Indonesia said, “It is so youth-friendly! My friends and I use LINE a lot, so this is the perfect platform for Ask Marlo. I am surprised that a chatbot can be used to teach about things as complex as HIV.”

A university student at the Atma Jaya University likes the anonymity provided by the application. “With Ask Marlo, we don’t have to be ashamed to ask anything related to HIV.”

University students, young professionals, communities, civil society activists and the Ministry of Health have endorsed Ask Marlo. Besides students and young professionals, several social media influencers and YouTube personalities have also given their stamp of approval. Their endorsement of Ask Marlo has helped to promote the chatbot to wider audiences. The idea is to eventually expand to offer testing in other major cities across Indonesia.

On 28 September, Central Sulawesi, Indonesia, was struck by a powerful earthquake and a subsequent tsunami. Thousands of people are known to have died and tens of thousands of people have been displaced. In the event of a major humanitarian disaster, the basic needs of people are always difficult to fulfil—this is especially true for people living with HIV in Central Sulawesi.

The hospitals in the town of Palu are heavily damaged but remain operational. There are still stocks of antiretroviral therapy in those hospitals, but there are concerns about how long those stocks will last. Before the disaster, according to government data, there were an estimated 1913 people living with HIV in Central Sulawesi, with 334 people, including three children, on antiretroviral therapy.

People in the region have been rallying as champions for people living with HIV. Yuli works for the Indonesia AIDS Coalition, a civil society organization monitoring support for antiretroviral therapy, in Makassar in South Sulawesi, Indonesia. On 2 October, while on her way to Donggala, a region affected by the earthquake, to check on her family, she heard from her employer about severe disruptions in the supply of antiretroviral medicines in Palu.

Yuli and her colleagues headed to Palu to provide help, contacting hospitals and other service providers to gather the remaining stocks of antiretroviral medicines to distribute to those in need. Her mission quickly became a commitment to support the HIV response in Palu, including helping in contact tracing and providing social support for people living with HIV in the region.

“The reason I’m still here more than two weeks after the disaster is because it is impossible to see the conditions and not lend a helping hand,” Yuli said, explaining that, in addition to antiretroviral medicine, people in Central Sulawesi need support for their basic needs and psychosocial support.

By 16 October, 92 out of the 344 people previously on antiretroviral therapy had accessed a one-month supply of antiretroviral medicines, either from Yuli and her team or directly from clinics.

“My main concern is that I want to make sure that even though the disaster happened, people living with HIV still get access to antiretroviral therapy and not stop their treatment,” Yuli said.  

UNAIDS and partners in the region have joined together as the National Core Team for HIV Response in Humanitarian Settings. The team is actively working to support the HIV response in the affected areas, trying to find out the status of the people living with HIV yet to be found and ensuring the distribution of antiretroviral medicines to those who need them. A command post for HIV has been established in Palu, with a team monitoring the availability of antiretroviral medicines in the affected region.  

“HIV is often overlooked in emergency situations. We must work hard to ensure that people living with HIV are not forgotten in times of need. We applaud the quick initiative and commitment of Yuli and her fellow outreach workers and will continue to provide them with support,” said Krittayawan Tina Boonto, UNAIDS Country Director for Indonesia.

The UNAIDS office in Indonesia has mobilized resources to fund six field visits by peer supporters for people living with HIV to Palu to provide immediate assistance. UNAIDS will also conduct a full needs assessment for HIV, tuberculosis and malaria in Central Sulawesi to develop funding requests for medium- and long-term assistance and will establish contingency plans for use in the event of future disasters in Indonesia.