FHI - Lottery Tickets Promote Condom Use in Malang, Indonesia.

MAY 2008 — FHI's ASA Project is aiming for 100 percent condom use among the large female sex worker population in Malang, East Java, to help ensure that HIV infection does not spread to Indonesia's general population from those engaging in high-risk behaviors. One strategy the project adopted to encourage condom use is to provide brothel-based sex workers with one lottery ticket for every 20 wrappers that they turn in to a brothel owner. These tickets offer the sex workers the chance to win TVs, DVD players, and other prizes that they value.

Draws held every few months are sponsored by ASA and DKT, a condom social marketing organization that provides a reliable supply of good quality condoms at low cost. The draws are big occasions, with live entertainment and a speech by a senior official, such as the deputy head of the district or the chief of the local health service.

This is one aspect of a strategy that has achieved dramatic increases in consistent condom use among sex workers in Malang. Corresponding declines have also been achieved in the prevalence of sexually transmitted infections (STIs), partly due to agreements made between local authorities, brothel owners, sex workers, and pimps requiring brothel-based sex workers to undergo monthly STI screenings at the local community health center, Sumber Pucung, or its mobile clinic.

How It Happened
Funded by USAID and DFID through the Indonesian Partnership Fund for HIV/AIDS, FHI's ASA Project has developed an innovative, comprehensive strategy to contain the HIV/AIDS epidemic in Indonesia, working with local government and civil society. At the core of the strategy is ASA's work with the District AIDS Commission to improve its capacity to map the local response and identify the most at-risk groups, including sex workers, injecting drug users, and the transgender population.

At the same time, ASA helped local NGOs to develop targeted interventions by strengthening their capacities in program and financial management, planning, monitoring, and behavior change strategies. Technical assistance and training has also been provided for local health services—and, in particular, community health centers—to foster high-quality STI screening and treatment services as well as voluntary counseling and testing for HIV.

Throughout, the District AIDS Commission networked regularly with the health services, local NGOs, and ASA's provincial office, and strong linkages were developed between all these partners. To maximize impact, however, high-level support was needed, so the commission advocated to the local government and the district parliament. Military and religious leaders who supported the program at the provincial level were brought to Malang from Surabaya, East Java's capital, to defuse local concerns about highly sensitive aspects of the program, such as condom promotion and cooperation with brothel operators.

Screening for STIs and Raising Awareness
The campaign resulted in a guarantee from the district parliament that brothel complexes would not be closed down—as has been occurring elsewhere in the country—but on condition that each one develop and enforce a strong mechanism to prevent the spread of STI and HIV.

The commission then facilitated the coming together of key stakeholders in neighborhoods where brothels operate, which resulted in an extraordinary collaboration to develop local agreements on regular health screening for sex workers and 100-percent condom use in the brothels. Paramitra, a local NGO, acts as the liaison between the brothels and the clinic for the STI screenings, providing advice and information and accompanying the sex workers to the clinic.

By September 2007, more than 750 of the estimated 1,070 sex workers in the four neighborhoods covered by Sumber Pucung had been contacted by outreach workers and just under 600 had been screened. Paramitra also interacts regularly with clients of the sex workers to raise awareness about HIV risks and reinforce the condom-use message. More than 13,300 clients have been reached in this way.

These data clearly demonstrate the value of ASA's intensive work with the District AIDS Commission to bolster its commitment and comprehensive understanding of the epidemic, as well as its capacity building and collaborations with NGOs and local health services. Taken together, these efforts have been crowned with success: building on the innovative, comprehensive strategy of the ASA Project, they have facilitated the convergence of constructive policy and good program implementation.

PHOTO: An attendee at a lottery drawing event in East Java demonstrates the correct way to use a condom. (FHI/Indonesia)