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Indonesia has a relatively fast growing HIV epidemic. According to UNAIDS 2013 data, of the 640,000 people living with HIV throughout Indonesia, 240,000 were women, aged 15 years and older. While women represent just over a third of people living with HIV in Indonesia, they encounter particular challenges, including violence and discrimination, when it comes to accessing HIV and sexual and reproductive health care, as well as in exercising their rights. 

It is to address these challenges that the Indonesian Positive Women’s Network was established in 2006. The network brings together women living with HIV from across 23 provinces from different islands and regions of the country. Together, they work to enhance the knowledge and skills of women living with HIV related to sexual and reproductive rights and health (SRHR); improve access to HIV, SRHR and gender-based violence related health services; and undertaking studies to inform policy and advocacy efforts, while also increasing the meaningful participation of women living with HIV in these spaces.

As part of their efforts to document and create greater awareness of the particular issues faced by women living with HIV in Indonesia, the Network undertook a survey across eight provinces, engaging 110 women living with HIV, along with 12 women affected by HIV, to identify and document the types of violence they have experienced. Conducted in2012, the survey findings showed that 29% of women experienced sexual violence, 25% of respondents experienced physical violence, 29% experienced economic discrimination, and 14% had undergone forced or coerced sterilization.[1] The accounts shared by respondents exemplify the brutality with which women living with HIV are treated. As one respondent stated, “While my husband was using drugs, I was forced to have sex for six hours and I was haemorrhaging while being beaten and pulling out my hair… He couldn’t enter with his penis so instead, before he entered, he put the broom handle in my vagina and in my anus before he put his cock in, to tear me.”

In addition to severe physical and sexual violence, the survey found that women living with HIV in Indonesia are also subjected to forced and coerced sterilization, upon the urging of health care providers. [2] The findings also revealed that women living with HIV were not aware that they had the right to decline sterilization when they were asked to undergo the procedure. They generally were not aware that they had rights over their bodies. In some cases, husbands and family members made the decision for the women, following the advice of health care workers to undertake the procedure.

The survey findings were reinforced by those of a 2012 regional study on access to reproductive and maternal health care for women living with HIV. This study found that women living with HIV in Indonesia, reported the highest rate of being asked to undergo sterilization (over 35%), along with Cambodia and India. Furthermore, the study, in which 109 Indonesian women living with HIV participated, found that of the 44 women asked to undergo sterilization, 13% did not have the option to decline the procedure. This supports the findings of Indonesian Positive Women’s Network survey, which revealed that 14% of women were coerced or forced into sterilization.

Following these alarming findings, in the Network began to raise the issue of women’s rights and forced sterilization as a major issue for the HIV response, partnering with the National Violence against Women Commission and also linking their advocacy to the Committee on the Elimination of Discrimination against Women (CEDAW).

In addition to raising awareness about forced and coerced sterilization as a form of gender based violence and a fundamental human rights violation, the Network advocates for the integration of HIV services with those that prevent and respond to violence against women and advocating for health services to be held accountable to providing quality care for the women they serve with services that effectively meet their needs. Their membership highlights the growing need for a one-stop service that would include a safe house, mental health professionals, doctors and medication such as post-exposure prophylaxis and emergency contraception for all victims and survivors of sexual violence. While some efforts have been made with the Ministry of Health, more remains to be done. As Baby Rivona has highlighted:

“This integrated service would ensure that women living with HIV would have a deeper understanding of the linkage of violence and HIV. In Indonesia, recognising violence against Women (VAW) as an influencing factor of the AIDS epidemic has not been considered a main factor of concern. From the governments and AIDS related Non-Governmental Organization’s perspectives, VAW is a separate issue and disassociated to AIDS problems.”

Moving forward, there are promising examples of action being taken. With the support of the UN Trust Fund, IPPI works collaboratively with ResultsinHealth (RiH), an international public health advisory agency, to create greater awareness of the rights and the need for better health outcomes for women and girls living with HIV, including in regards to gender based violence from November 2013 till November 2015 with two pilot projects in provinces . Working with women living with HIV in DKI Jakarta and North Sumatera, IPPI and RiH are working towards integrating services for GBV and HIV, which would provide quality of care, including reduction of discrimination towards women living with HIV and violence survivors. IPPI believes the full implementation of the project will create positive changes to the epidemics of HIV and violence against women. This project will establish significant collaboration with relevant providers in the field of GBV and HIV, will ensure better monitoring of quality of care, bring around attitudinal changes among health care providers and policy makers to reduce discrimination against women living with HIV and survivors of GBV as well as changes in practices at the health care level, community level providing a systemic approach to the two epidemics.

Through initiatives such as the above, the HIV-related linkages to GBV and SRHR can contribute to women becoming empowered to exercise their rights and zero tolerance to GBV and violation of SRHR being achieved. To do so, women living with HIV must be supported in breaking the silence on the violence and stigma they experience, with their experiences and expertise valued.

Forced and coerced sterilisation is a continued human rights violation against women living with HIV that needs our continued efforts to end. The GCWA stands with women living with HIV, joining them in the call to stop all forms of violence against women, particularly women living with HIV, and to uphold their rights at all times.

For more information, go to http://www.ippi.or.id/

[1] http://www.ippi.or.id/pendokumentasian-kekerasan-terhadap-perempuan-deng...

[2] APN+. Positive and Pregnant: How Dare You. A Study on access to reproductive and maternal health care for women living with HIV in Asia. 2012