- Part 1: National and Urban Perspectives 533
- Basic Sexological Premises 534
- Religious, Ethnic, and Gender Factors Affecting Sexuality 535
- Knowledge and Education about Sexuality 536
- Autoerotic Behaviors and Patterns 536
- Interpersonal Heterosexual Behaviors 537
- Homoerotic, Homosexual, and Bisexual Behaviors 538
- Gender Diversity and Transgender Issues 539
- Significant Unconventional Sexual Behaviors 539
- Contraception, Abortion, and Population Planning 540
- Sexually Transmitted Diseases and HIV/AIDS 541
- Sexual Dysfunctions, Counseling, and Therapies 543
- Sex Research and Advanced Professional Education 543
- References and Suggested Readings 543
- Part 2: The Orang Rimba Indigenous Forest People 544
- Basic Sexological Premises 545
- Religious, Ethnic, and Gender Factors Affecting Sexuality 547
- Knowledge and Education about Sexuality 548
- Autoerotic Behaviors and Patterns 548
- Interpersonal Heterosexual Behaviors 548
- Homoerotic, Homosexual, and Bisexual Behaviors 551
- Gender Diversity and Transgender Issues 551
- Significant Unconventional Sexual Behaviors 551
- Contraception, Abortion, and Population Planning 552
- Sexually Transmitted Diseases and HIV/AIDS 552
- Sexual Dysfunctions, Counseling, and Therapies 552
- A Postscript on the Dugum Dani 552
- References and Suggested Readings 553
*A Note for Researchers: The numbers included in the section titles in the Contents above refer to the page numbers in the print edition of the CCIES. For the convenience of researchers, an Adobe Acrobat (PDF) file of this chapter is available for download above (click the PDF icon), which reflects the actual pagination of the book. This will allow scholarly writers to cite actual page numbers in the printed book for quoted material, as well as its availability on the Web and the URL if desired. See also How to Use This Encyclopedia.
Chapter URL: http://www.kinseyinstitute.org/ccies/id.php Retrieved:
[Note from the CCIES Website Editor: Please send any additions, corrections, or updated information to: Raymond J. Noonan, Ph.D.]
PART 1: NATIONAL AND URBAN PERSPECTIVES
Demographics and a Brief Historical Perspective
Located in the archipelago southeast of Asia along the equator, Indonesia comprises some 13,700 to 17,000 islands (depending on who does the counting). While only about 6,000 are inhabited, the island of Java is one of the most densely populated areas of the world. Besides Java, Indonesia includes four other major islands: Sumatra, the largest and most western of the Indonesian islands, Kalimantan (most of Borneo), Sulawesi (formerly Celebes), and the “Paradise Island” of Bali, as well as the western half of the island of New Guinea, formerly known as Irian Jaya. Indonesia’s total area covers 741,100 square miles (1,919,440 km2) and is roughly three times the size of the state of Texas.
The mountains and plateaus on the major islands have a cooler climate than the tropical lowlands. In the eastern island of New Guinea, the mountain peaks may be snow-covered. The Indonesian archipelago lies southeast of the Asian mainland. Straddling the equator, Indonesia’s neighbors are Malaysia to the north, Papua New Guinea to the east, Australia to the south of its western islands, and the Indian Ocean to the west. Situated in a part of the “ring of fire,” Indonesia has the largest number of active volcanoes in the world. Earthquakes are frequent. The “Wallace line,” a zoological demarcation, divides Indonesia, marking the separation of Asian and Australian flora and fauna.
In July 2002, Indonesia had an estimated population of 231.32 million. (All data are from The World Factbook 2002 (CIA 2002) unless otherwise stated.)
Age Distribution and Sex Ratios: 0-14 years: 30.26% with 1.05 male(s) per female (sex ratio); 15-64 years: 65.11% with 1 male(s) per female; 65 years and over: 4.63% with 0.78 male(s) per female (2000 est., The World Almanac and Book of Facts 2000)
Life Expectancy at Birth: Total Population: 68.63 years; male: 66.24 years; female: 71.13 years
Urban/Rural Distribution: 36% to 64%
Ethnic Distribution: Javanese: 45%; Sunsanese: 14%; Madurese: 7.5%; coastal Malays: 7.5%; Minahasans, Balinese, Bataks, Dayaks, Timorese, Papuans, Chinese, Arabs, Indians, Europeans, and other: 26%. Indonesia has more than 300 ethnic groups, most of which are very small minorities. Some very small ethnic groups still live in the jungles where they maintain their traditional cultures. Part 2 of this chapter examines the sexual culture of the indigenous hill tribe of the Orang Rimba. Each ethnic group has its own culture and language. Fortunately, there is one Indonesian language as a national language, so that people of the different ethnic groups, with the exception of small geographically isolated peoples, can usually communicate with each other.
Religious Distribution: Muslim: 88%; Protestant: 5%; Roman Catholic: 3%; Hindu: 2%; Buddhist: 1%; other: 1% (1998 est.)
Birth Rate: 21.87 births per 1,000 population
Death Rate: 6.28 per 1,000 population
Infant Mortality Rate: 39.4 deaths per 1,000 live births
Net Migration Rate: –0.21 migrant(s) per 1,000 population
Total Fertility Rate: 2.54 children born per woman
Population Growth Rate: 1.54%
HIV/AIDS (1999 est.): Adult prevalence: 0.05%; Persons living with HIV/AIDS: 52,000; Deaths: < 3,100. (For additional details from www.UNAIDS.org, see end of Section 10B.)
Literacy Rate (defined as those age 15 and over who can read and write): 83.8%; (male: 89.6%, female: 78%) (1995 est.); attendance for nine years of compulsory school: 95% (education is free and compulsory from age 6 to 15)
Per Capita Gross Domestic Product (purchasing power parity): $3,000 (2001 est.); Inflation: 9%; Unemployment: 15% to 20%; Living below the poverty line: 27% (1999 est.)
Indonesia is a developing country with major problems in the social, political, and economic areas. Most people still have a low-subsistence standard of living. However, the small middle- and upper-class populations have a very good standard of life. Some Indonesian businessmen even have their companies in some other countries. This means that there is a wide gap between the poor, as the majority, and the rich, as a very small part of the population. It is estimated that the country will join the developed countries in the near future.
B. A Brief Historical Perspective
It is generally believed that the earliest inhabitants of the Indonesian archipelago came from India or Burma (Myanmar). Later immigrants, known as Malays, came from southern China and Indochina. This later group is believed to have populated the archipelago gradually over several thousand years. Hindu and Buddhist civilizations reached Indonesia about 2,000 years ago, taking root mainly on the island of Java. In the 15th century, Islam was spread by Arab traders along the maritime trade routes and became dominant in the 16th century.
In the 17th century, the Dutch replaced the Portuguese as the dominant European power in the area. The Dutch gained control over Java by the mid-1700s, but the outer islands were not subdued until the early 1900s, when most of the current territory of Indonesia came under Dutch rule. On the other side, the Dutch and the Portuguese also brought Christianity to the Indonesian people.
After the Japanese occupation of 1942-1945, nationalists fought four years until the Dutch granted Indonesia its independence. Indonesia declared itself a republic in 1945. In 1957, Indonesia invaded Dutch-controlled West Irian (the western half of New Guinea); in 1969, tribal leaders voted to become part of Indonesia, a move sanctioned by the United Nations.
Indonesia also invaded and annexed East Timor in 1975-1976, as Portuguese rule collapsed. However, this annexation brought many internal social, economic, political, and security problems and tensions in Indonesia’s international relations. After the fall of President General Soeharto in 1998, the transitional president, B. J. Habibie, proposed East Timorese vote on two options: independence or integration as a part of Indonesia. Through a self-determination vote under United Nations supervision in 1999, the East Timorese decided to be independent from Indonesia. The level of unrest and violence remains high in East Timor.
In the same year, the Indonesian people held the most democratic general election to that time to choose the people’s representatives in the Parliament and Assembly. Through the Assembly, Indonesian people now have a legitimate president, K. H. Abdurrahman Wahid, and vice president, Megawati Soekarnoputri, for the period 1999 to 2004. This, however, does not mean that the country has already been freed from its major problems. These economic, political, and security problems are the major problems faced by Indonesians under the new legitimated government.
A. Character of Gender Roles
In traditional Indonesian society, women clearly occupy a lower social status than men. This is still the dominant value in Indonesian culture. The idea that a female’s place is in the kitchen is still easy to find, especially in the villages. The husband-wife relationship is a chief-assistant relationship rather than a partnership.
Nevertheless, the role of women is improving in modern Indonesian society. Many women work outside the home, particularly in restaurants and in garment and cigarette factories, even though their wages are lower than those of males. Many female physicians, notaries, and lawyers are found in modern Indonesian cities. A few women have achieved high political positions as Cabinet and Parliament members. Vice President Megawati Soekarnoputri, elected in 1999 by the people’s representatives in the most democratic general election, is a female.
In modern Indonesian society, the husband-wife relationship is also improving, with a gradual shift to a partnership. Husbands increasingly treat their wife as a partner rather than as an assistant. It is no longer strange to see a husband taking care of his baby while his wife is working outside the home. Unfortunately, this improvement mostly occurs in well-educated couples, which are only a small part of the population. Furthermore, sometimes the change of the husband-wife relationship results in the disharmony of the relationship, mostly because of the negative response of the husband. For example, the husband will feel unhappy if his working wife’s salary is more than his, or he will get angry if his working wife does not prepare dinner for him (Blackburn 2000; Hancock 2000; Robinson 2000).
From the standpoint of national law, males and females enjoy the same rights in schooling and careers. However, in some areas, traditional and cultural laws discriminate against females. Only males, for instance, have a right to receive a legacy from their parents. This contributes to a higher status for males.
Another consequence of traditional values is that parents insist on having a son, even though the government has proclaimed a limit of only two children per family, regardless of sex. Many women come to clinics seeking male-sex preselection, even though there is no method that can give a 100% guarantee of having a male child.
In many families, parents give special treatment to the son over the daughter. For example, parents are more likely to support higher education for a son than they would for a daughter. This is based on the stereotype that females will ultimately end up working in the kitchen, while males, as the chief of the family, will work hard to gain money.
Another more serious consequence of the traditional law is that males feel they have a higher social status, and therefore feel more powerful than females. This effect appears in the relationship between a husband and wife where the husband feels he has power over the wife and acts as a chief in the family. Husbands also feel free to do what they want, including having sexual intercourse with other women.
However, among the Miharg Kabou of West Sumatra, females have a higher status than males. Unlike other regions of Indonesia where the male courts the female, Miharg women court the men (Blackburn 2000; Hancock 2000; Machali 2000; Robinson 2000).
Traditionally, Indonesian women connected sexuality with love and engaged in sexual activities only with the males they loved, specifically their husbands. A woman, it was believed, was not able to have sex with a male unless she loved him. In contrast, the traditional view fully accepted males as having sex with any female they liked. In essence, females were only sexual objects, designed for male pleasure.
This traditional view is changing in modern Indonesia. For many, sex and love are easy to separate and are frequently viewed as two different things. Many females, especially among the young, want to engage in sexual intercourse with anybody they like without the necessity of loving that person or without any interest in marriage. This concept, of course, is not well received by the older generation.
This concept change does not seem to occur only in the large cities, but also increasingly in the villages. Some studies performed of the young of the villages showed that there is no significant difference in sexual behavior between the young in the village and in the city. The difference is only in the physical environment and other circumstances that facilitate or permit sexual intercourse. Whether in the city or in the village, the young have the same perceptions about pregnancy, abortion, and family planning. The sexual knowledge and behavior of the young seem to be a new dimension, which is separated from the settings and culture of traditional social organization, family, and religion. The opinion that the village is a traditional and homogeneous community, which holds strongly the cultural and religious norms and is not easy to change, is no longer a reality.
A. Source and Character of Religious Values
During the first few centuries of the Christian era, most of the islands came under the influence of Hindu priests and traders, who spread their religion and culture. Muslim invasions began in the 13th century, and most of the area was Islamicized by the 15th century. Today, 88% of Indonesians are Muslim, with Hindu, Buddhist, and both Protestant and Catholic Christian minorities. There is a commendable degree of religious tolerance among the people.
Evidence of the Hindu influence can be found in some large ancient temples, like Borobudur, Prambanan, Mendut, and Kali Telon in Middle Java, and Jago temple in East Java. The temple in Borobudur is ranked by many as one of the seven miracles in the world. Many reliefs in the walls of these temples portray erotic themes. In the wall of the Kali Telon temple, for example, there are relief figures of males and females having sexual intercourse. In the Mendut temple, people can see in relief figures a scene of a male and female petting.
Christian Portuguese traders arrived early in the 16th century, but were ousted by the Dutch around 1595. In the early 1800s, the British seized the islands, but returned them to the Dutch in 1816. After the end of the Japanese occupation and World War II, Indonesia declared its independence from the Dutch.
In the past, conservative religious and cultural values had a strong influence on sexual attitudes and behaviors. For instance, it was taboo for male and female adolescents to walk together in public. A daughter who became pregnant before marriage created disastrous consequences for her whole family.
However, the influence of religious and traditional cultural values has decreased in recent decades, most noticeably since 1980. This decrease can be seen in the fantastic changes in the sexual attitudes and behaviors of the people, especially among the young. The widespread distribution of contraceptives, which the government initiated as a national program in 1970, brought many changes in the sexual attitudes and behaviors of the people.
The incidence of abortion among the young, which is estimated at around one million per year in the whole country, shows that the strength of religious values has decreased in today’s Indonesian society. On the other hand, attendance for all the different religious services is very high.
Each ethnic group has its own culture and sexual values. The Javanese, Sundanese, Minahasans, and Balinese, for instance, are more “modern” than the Dayaks and Papuans. In general, however, sex is considered something private and even secret. Sex is appropriate only between husband and wife. Women are like maids; they are only for their husbands’ benefit. Wives are subservient to their husbands in everything, including sexual contact.
In a certain Javanese art community of East Java, known as the Reog Ponorogo, some men engage regularly in homosexual behavior, because they believe that they have supernatural powers that will disappear if they have sexual contact with women. These men, known as waroks, take care of young males called gemblaks who are treated as females. Waroks engage in homosexual intercourse with gemblaks instead of with females.
In relation to supernatural belief or culture, in a certain community sexual intercourse is practiced as a part of ritual. Many people, hoping to receive a blessing, visit a cemetery on Mount Kemukus in Central Java. However, to receive the blessing the visitors must fulfill one erotic condition. The condition is that the visiting petitioners have to engage in sexual intercourse with each other. They are forbidden to have sex with their own partners during the visit to the sacred cemetery. The other condition is that the sexual intercourse must be done in seven visits with the same partner. It is hard to imagine hundreds of couples having intercourse in the open air under the trees covered with clothes. This cemetery is still visited today by many people from different places, and the free sex among the sacred cemetery visitors continues to the present.
In certain isolated ethnic groups living in remote areas, there is a custom whereby a man may borrow another’s wife. This custom is based on the fact that the number of females in the group is very limited and out of balance with the number of adult males. This custom allows a man to enjoy the other man’s wife for a few days, but after that, he has to bring her back to her husband.
In today’s globalization trends, sexual attitudes and behaviors are changing rapidly in all the cultures of Indonesia. Premarital sex, for example, is now common among adolescents. Even premarital pregnancy is easy to find and, for many parents, it no longer has the disastrous consequences it did only a generation or two ago.
There is a homogenous tendency in sexual perception, knowledge, and behavior, especially among the young, which crosses the ethnic and religious boundaries.
A. Government Policies and Programs
Sex education is not a priority in the government’s program. Until the year 1999, school curricula did not offer students any education on sexual topics or issues. However, the Department of Education and Culture has recommended a book, About the Sexual Problems in the Family, by Wimpie Pangkahila, as a source of sexual information for high school students. This 152-page text, published in 1988, discusses many sexual problems that occur in Indonesian families as a result of misinformation, misunderstanding, and myths, such as the belief in the harmful consequences of self-pleasuring or the impossibility of pregnancy if sexual intercourse occurs only once a month.
The Indonesian Health Department and the National Coordinating Board of Family Planning have a program for Reproductive Health Education. This program, designed for young people, provides seminars on topics of reproductive and sexual health.
In recent years, some secondary high schools have introduced a small segment of sex education as part of their extracurricular offerings. Outside experts are invited to talk about sexuality in these seminars. The era of reformation in Indonesia has also changed the policy of the government on sex education. The new government, through the Department of Education and Culture, has legalized sex education for students under the title of “healthy reproductive education.” Now sex education is formally a part of school curricula.
Despite public reticence about sexuality, the Indonesian people are eager for and need more information about the subject—hence, the popularity of public and semi-private seminars on sexual topics. Many social organizations for young people and women sponsor seminars for their members, with outside experts invited to speak about sexuality. The seminars are not only held in the big cities, but also in the small cities and suburbs.
Some magazines, newspapers, radio broadcasts, and TV stations also have columns or programs in which sexuality and sexual problems are discussed. Readers, listeners, and viewers write or call in asking about some sexual issue or problem they are facing or they want to know about. Television viewers can watch advertisements for condoms every day in the context of HIV/AIDS prevention.
With the advent of cyberspace, some Indonesian Web sites now offer popular sites for dialog about sexuality. The popularity of these sites among Indonesians makes it hard to believe the view of some people that sex is still a taboo topic among the Indonesian people.
A. Children and Adolescents
Autoeroticism is common among children in the phallic stage of their psychosexual development. Although some parents report that they watch their children pleasuring themselves to orgasm, many parents are afraid when they discover their children self-pleasuring because they believe this to be an abnormal act.
Autoeroticism is also common among adolescents as a way of tension release. One unpublished study by Wimpie Pangkahila found that 81% of male adolescents and 18% of female adolescents aged 15 to 20 years old engaged in self-pleasuring. Most reported using their fingers, sometimes lubricated with a liquid. Some rubbed against a pillow or mattress. Only a few females reported using a vibrator.
However, there is still considerable misinformation and misunderstanding about autoeroticism. Many adolescents still believe that autoeroticism or masturbation may result in various health problems, like decreased memory, erectile dysfunction, infertility, and decreased bone marrow.
On the moral side, many adolescents feel that autoeroticism is sinful. But they continue to practice this sexual activity. Questions about autoeroticism appear very often in many informal sources of information about sexuality, such as seminars, interactive Internet chat groups, newspapers, and radio programs. The questions are usually related to the consequences of autoeroticism for the practitioner’s health.
Autoeroticism is very common among adults, especially single adults. The pattern is the same as among adolescents. The use of sexual accessories, like various kinds of vibrators and doll partners, are becoming common even though these materials are still illegal. No legal sex shop can be found anywhere in the country, even in the larger cities. One sex shop did open early in 2000 in Surabaya (East Java), Indonesia’s second largest city, but the police quickly closed it on the grounds that the sex shop did not have a license from the government and that such shops are contrary to Indonesian culture and morality. It is really difficult to understand such reasoning, especially when this episode triggered a flood of questions in various media—questions, such as “Why close a sex shop? Why don’t the police shut down the prostitution?” However, some drug shops still sell those sex accessories illegally, and people can buy from them.
Masturbation among married men or women is practiced in certain situations, like when they stay apart from their partners, if they cannot reach orgasm by sexual intercourse, or if the partner is not able to engage in sexual intercourse for some legitimate reason. Some wives practice masturbation directly in front of their husbands after they have had sexual intercourse without reaching orgasm. A few of them use vibrators or other sexual accessories, whereas others do not want to do it in front of their husbands. The result is that the husbands often do not know that their wives are not reaching orgasm by intercourse and are relying on masturbation for this.
Even though autoeroticism is very commonly practiced among both adolescents and adults, many people still believe that autoeroticism is morally wrong and will result in harmful physical and mental consequences.
Sexual exploration and sex rehearsal play are common among children as a natural part of their psychosexual development. However, many parents are afraid of such behaviors, believing that the child is suffering from some sexual abnormality or that this behavior will result later in life in some sexual abnormality. Some parents bring their children to psychologists to find out whether their child has had actual sexual intercourse.
Many adolescents are afraid of not being virgins because they had sex rehearsal play a long time ago during their childhood. Some of them even come to the clinic to make sure that they are still virgins. Others seek answers to their questions about childhood sexual rehearsal play and virginity from the dialog columns on sexuality in the newspapers.
Some ethnic groups, especially in the remote areas and among tribal people, have ritual ceremonies for adolescents. These ceremonies differ greatly from one ethnic culture to another.
In certain areas, there is a ritual ceremony for the female on the occasion of her first menstruation. This ceremony is actually a way to inform the community that this young female now has become an adolescent and is ready to marry. In one area in East Nusa Tenggara province, male adolescents have to practice sexual intercourse after they are traditionally circumcised. For practical reasons, these male adolescents tend to practice with sex workers. With the unhealed penile cut, this practice, of course, can result in transmission of STDs. This practice also poses a high risk factor for the transmission of HIV/AIDS. However, these ceremonies are no longer practiced in most modern areas of Indonesian society.
Premarital Sexual Activities and Relationships
Premarital sexual activities are still generally considered taboo. In general, older persons and parents oppose all sexual activities engaged in before marriage. However, during the past decade, there has been a change in sexual attitudes and behaviors among adolescents. Some small studies in a few Indonesian cities reveal a growing trend among adolescents to engage in premarital sexual activities, such as necking, petting, and even intercourse.
These sexual activities are also becoming common among adolescents in the villages and suburbs. Today, there is no significant difference in sexual perception and behavior between the young in the big cities and the villages.
However, knowing that parents and the older generation oppose premarital sexual activities, young people hide their activities from them. On the other hand, parents frequently give their children more opportunities to be alone with their boy- or girlfriends, and many adolescents take advantage of these opportunities for sexual activities.
In their sexual activities, oral sex is becoming popular among adolescents. There are at least two reasons why adolescents prefer oral sex. First, with oral sex they can avoid the risk of premarital pregnancy. Second, the female feels secure, because oral sex leaves her hymen, a mark of her virginity, intact. A few adolescents engage in anal sex for the same reasons.
Unfortunately, the changes in sexual behavior, which tend to be freer today than in the past, are not accompanied by any increase in sexual knowledge. Most adolescents have many questions about their sexual lives and experiences, which, if expressed, bring negative responses from the older generation, who still believe that such questions are not appropriate for adolescents to inquire about. However, it seems that the general public tends to be more permissive of these changes. Of course, the lack of sexual knowledge results in some negative personal consequences for adolescent life: feelings of guilt and anxiety, unwanted pregnancy, abortion, and STD transmission.
[Update 2003: Alarmed by increasing teenage pregnancies in the 1990s, the Indonesian government started planning to incorporate sexuality education into courses such as biology. Similar concerns prompted NGOs, supported by the United Nations Population Fund (UNFPA), to train peers to provide reproductive health information and services to reduce the rate of unwanted teen pregnancies. UNFPA expanded its information and education materials to reach parents, policymakers, and community leaders, as well as teenagers. Under the theme “Having sex before marriage is not appropriate among youth,” specific messages stress such issues as: “Responsible relationships between boys and girls,” “The world of youth is free, but there are limitations,” and “Youth must get correct and clear information about sexuality.” The UNFPA and its cosponsors program use regional newspaper columns, a question-and-answer book on the 100 most-asked questions about adolescent reproductive health, leaflets, posters, stickers, calendars, and T-shirts, as well as radio and television talks for youth (UNFPA 2000). (End of update by R. T. Francoeur)]
Premarital Courtship, Dating, and Relationships
Dating and premarital sexual relations among adults are very common in modern Indonesian society. The culture requires a particular kind of courtship when a couple wants to marry. In this courtship, the parents and family of the male approach the parents of the female to make the arrangements.
In some ethnic groups, a courtship document is signed when presents, such as cows, buffaloes, gold, and jewelry, are given. For many people in these groups, this custom is very expensive, because they need to save enough money to buy the presents for courtship. Presently, this custom is still practiced among certain ethnic groups, particularly those who live in the areas where they have little contact with outsiders. This custom actually implies that the male has bought and now owns the female.
However, traditional courtship customs are no longer practiced by people who live a modern lifestyle, especially those who live in big cities far from their original area. It is much more practical for them to abandon the traditional customs of courtship, which are both expensive and impractical. The simpler courtship custom of modern Indonesians calls for the parents of the young man to visit the parents of the young woman and agree to their children courting, but without expensive presents.
Sexual Behavior and Relationships of Single Adults
Self-pleasuring is a common sexual behavior among single adults, even though it is not allowed by religious and moral values. Sexual relationships among male and female single adults are also taboo. However, some data show that many couples engage in sexual relations before they marry. A 1991 study by Wimpie Pangkahila suggested a rate of 53% for urban couples. Another unpublished study of rural, pregnant women found a premarital intercourse incidence of 27%.
This incidence is now believed to be much higher because of more-liberal relationships, between single adults and adolescents as well. The term “the other man or woman” has become very popular in the last few years. It is no longer a surprise if somebody is said to have a relationship with an extramarital partner.
Many single adult males have sexual contact with prostitutes. Prostitution exists in many places in Indonesia, whether it is legal or illegal. The range of services comes in various classes from low/cheap to high/expensive (see Section 8B, Unconventional Sexual Behaviors, Prostitution, below).
Marriage and Family
Indonesia has had a marital code to regulate marriages since 1974. The law requires that a marriage be performed in a religious ceremony and then be registered in the civil act office for Christians, Buddhists, and Hindus. The marriages of Muslims are registered in the Muslim Religion Affairs Office.
Generally, marriage in Indonesia involves the families of both partners. It is uncommon for a marriage to be conducted without involvement of the families of both spouses. In case the families cannot agree for whatever reason, there are two choices for the couple. Adult couples who insist on marrying can arrange their own marriage. The other choice is to delay or cancel the wedding. Couples who insist on marrying, even though their families do not agree, usually attempt to repair their relationships with their families.
Divorce is prohibited in Christianity. However, Christian couples who want a divorce may apply to a state court for a civil divorce. In Islam, Hinduism, and Buddhism, divorce is allowed for certain reasons, mainly infertility and adultery on the part of the wife.
In some areas, the incidence of divorce is very high because of financial problems, family conflict, and infidelity. For example, in Lombok Island (West Nusa Tenggara Province) there are many young widows with or without children. Of course, this becomes a serious social problem in the society.
Extramarital intercourse is common, especially among males. Many married men seek prostitutes or have sexual relations with single or married women. Extramarital intercourse is also found among married women, but at a lower incidence than among husbands. Although married women do have sexual relations with single and married men, most people consider this as very bad and unacceptable behavior. In a typical, double moral standard, extramarital sex by males is considered something usual, even though it is forbidden by religion, local morality, and law.
Sexuality and the Physically Disabled and Aged
Most Indonesians believe that sex is only for physically normal and young people. Most feel uncomfortable when a disabled or aged person still thinks about or expresses an interest in sexual activities. A disabled young woman wrote her complaint and protest in a newspaper because she was discriminated against by a dating and marriage service. The manager of the organization had refused her membership because she was a disabled person. The male manager mentioned that nobody would be attracted to a disabled female.
Even though there is discrimination against disabled persons, marriages do occur between disabled persons, or between disabled and able-bodied persons. Some disabled and many aged people do come to sexual clinics with their sexual problems for counseling and treatment.
The misinformation that sexual intercourse should not be performed after menopause may lead a male with a postmenopausal wife to seek sex with another woman—prostitutes included. Erectile dysfunction is the most common sexual complaint of older males. On the other hand, pain during sexual intercourse is the most common sexual complaint of older females.
Incidence of Oral and Anal Sex
Generally, Indonesians do not accept fellatio, cunnilingus, and anal sex as foreplay or sexual outlets. Most people consider these behaviors as abnormal or sinful. On the other hand, many people do engage in fellatio and cunnilingus, but not with their own spouses.
Many men seek out prostitutes only for fellatio, because their wives refuse to engage in it. Some women do like to have cunnilingus, but refuse to perform fellatio for their husbands. Still, many couples enjoy both fellatio and cunnilingus as a part of their normal sexual activities.
Fellatio and cunnilingus are becoming popular among the new generation as a sexual alternative to vaginal intercourse, and as foreplay as well. Generally, they decide to practice fellatio and cunnilingus after watching this behavior on pornographic cable television or on videocassettes. Very few couples engage in anal sex.
A. Children and Adolescents
Homoerotic and homosexual activities are not common among Indonesian children, although some sexual exploration involving exhibiting the genitals is known to occur. Some children who experience homosexual experience with adults may be drawn into long-term homosexual behavior, but no data are available on the various outcomes of child-adult same-sex experiences.
Some adolescents engage in homosexual activities as a sexual outlet, while others engage in this activity for material gain as homosexual male prostitutes. In one Javanese society of traditional artists, known as Reog Ponorogo, some adolescents engage in homosexual activities to serve adult males who are believed to have supernatural powers (see Section 2B, Character of Ethnic Values).
In general, Indonesians consider homosexuality and bisexuality as abnormal acts forbidden by morality and religion. Despite this taboo, thousands of adults engage in homosexual and bisexual relationships. An organization called the Functional Group for Gays and Lesbians exists, with branches in some of the larger cities. This organization also publishes a newsletter/bulletin to help homosexual persons keep in touch and build support.
Most gays and lesbians, however, hide their orientation and activities, because they know that most people oppose homosexual behavior. Only very few male homosexuals want to be open and frank about their sexual behavior. Some homosexual males hide their sexual orientation by marrying a woman for social status and conformity. Their wives only learn that their husbands are homosexual after the marriage occurs. Some of these marriages end in divorce, but some others remain intact for social or religious reasons.
Some men gradually discover their homosexual orientation during adolescence or early adulthood. Others may be drawn into a homosexual lifestyle, because they had homosexual experience during their childhood. Some engage in homosexual behavior strictly for profit as male prostitutes, and then discover that they have a homosexual orientation.
Since same-sex marriage is illegal, homosexual persons are limited to living-together arrangements and cohabitation without legal sanction. In terms of socializing, some of the larger cities offer places where homosexual persons can gather and meet each other. Sexual outlets among homosexual, lesbian, and bisexual-oriented adults include oral sex, anal sex, and mutual self-pleasuring. Some lesbians use vibrators or other sexual accessories. But, unlike male homosexuals, lesbians are much less obvious in this society.
[Note from the CCIES Website Editor: See Last-Minute Developments for updates related to this topic that were added after this chapter had been typeset.]
There are no precise statistics on the incidence or sexual lives of gender-conflicted persons. It is commonly assumed by professionals in the field that there are thousands of male transsexuals in Indonesia. Banci, a slang term, and waria, an abbreviated combination of wanita (female) and pria (male), are popular terms for gender-conflicted persons in Indonesia. In Surabaya, the capital city of East Java, Perkumpulan Waria Kotamadya Surabaya, the Association of Waria in Surabaya, provides members with support, education, and career training as beauticians, artists, or dancers. These skills, they hope, will allow waria to support themselves and avoid a life of prostitution. Support groups also provide information about HIV/AIDS prevention.
In modern-day Indonesia, people can see many transsexuals working as beauticians, dancers, or entertainers. However, on the other hand, many of them also work as low-class prostitutes. This gives all transsexuals a negative image in the eyes of the wider Indonesian society.
Only a few male transsexuals, usually well-known artists, can afford to have surgery to change their sexual anatomy. The average cost for such surgery is the equivalent of 30 to 40 times a lower-class worker’s monthly income, about US$2,000 to US$3,000.
A. Coercive Sex
Child Sexual Abuse, Incest, and Pedophilia
There is no research on child sexual abuse, incest, or pedophilia in Indonesia. What is known about these issues comes from reports in the newspapers detailing some incidents of coercive sex involving children. Legal penalties exist for persons convicted of child sexual abuse, incest, and pedophilia. The social response to these acts is very negative, and the perpetrators are viewed as criminals.
Many street children, whether female or male, experience child sexual abuse. Many male street children are sexually abused by female lower-class prostitutes, who believe the myth that anyone who has sexual intercourse with children or adolescents will remain young.
Incest usually occurs among poor and uneducated families, although this may be a myth. The housing situation of poor families with a single bedroom facilitates the occurrence of incest. Some cases of incest come to public attention when the victims become pregnant and the perpetrators cannot hide the incident. Neighbors and family normally become angry and physically abuse the perpetrator when they learn of such incest.
In the last few years, as the terms pedophilia and sex tourism have become common in Indonesia, knowledge of the incidence of sex with children is increasing. The victims are children of poor families in the villages, while the perpetrators are foreign tourists from other countries. Parents of the children do not object to the foreign tourists who visit their family and offer to help their children. Frequently, the parents agree when the tourists want to bring the children to the city.
It is reported that the organizers are members of an international syndicate of promoters of pedophilia. A video of pedophilia involving Indonesian children is reported to be widely available in many countries.
However, it is necessary to study whether the tragedy inflicted on the children of poverty-stricken families is really the result of paraphilic pedophilia or whether it occurs more because of the belief that sexual intercourse is safer with children who are assumed to be “clean,” free from STDs including HIV/AIDS.
Even though there are no significant data about sexual harassment, it is believed that it is a common occurrence in Indonesia. Many women who work in factories or offices, or walk along the street, suffer from a variety of sexual harassments, although few women realize they are victims of sexual harassment. Conviction on a charge of sexual harassment may result in three to six months in prison.
Fortunately, in recent years, some women leaders have been trying to educate women, teaching them that sexual harassment is illegal and that women have the right to prosecute those who engage in it.
As with other forms of sexual coercion, there are no significant data on the incidence of rape in Indonesia. Rape incidents perpetrated by an acquaintance, boyfriend, or stranger, and rapes that end in murder are sometimes reported. However, most rapes reported to the police do not end up in a court trial. One of the reasons for this is to protect the victim from public embarrassment in the mass media. Another reason is that the punishment for rapists is considered to be very light.
Marital rape is not reported in the news media, although some wives in counseling or therapy do report being raped by their husbands when they refuse to have sexual intercourse. However, none of the wives want to report this to the police, because they never realize that it is a rape if done by a husband to his own wife. Some wives, however, resist their husbands and threaten to divorce them when forced to have sex against their will. [Update 2003: Indonesia has no law on marital rape, despite considerable debate between religious and legal experts on the subject (Idrus 2000). (End of update by R. T. Francoeur)]
Some taxi passengers are raped by the drivers, and have ended up being murdered. According to the confessions of the taxi drivers, at the beginning they only wanted to rob the passengers, but this in the end resulted in sexual arousal, assault, and murder. Some wives and their daughters become the victims of gang rapes perpetrated by robbers when they are discovered at home during a robbery.
Prostitution is widespread and occurs in many locations from small to large cities, even though it is often illegal. In some jurisdictions and cities, where prostitution is illegal, the law may prosecute either the prostitutes or those who manage the business of prostitution.
In a few large cities, prostitution is legal. Many prostitutes (“sex workers”) of different ages, from adolescence to middle-aged, can be seen. The sex workers are not only local or Indonesian females. There are also some foreigners working as prostitutes. They are divided into different groups based on their appearance, with low-, middle-, and high-class categories. The price of sexual services offered by the sex workers varies, depending on the class determined by their managers. It varies from only 25,000 Rupia (Rp.) (US$3) to Rp. 3,000,000 (US$400) for a short time and one coitus.
Beside legal and illegal prostitution, there is also a hidden prostitution. This is a form of prostitution concealed in another business, such as a massage parlor, beauty parlor, or karaoke place. In terms of STD transmission, this sort of prostitution is worse because the masseuses, the beauticians, or the karaoke escorts do not feel that they are prostitutes; on the other hand, the male customers do not feel that they have had sexual intercourse with sex workers. As a result, many males are unknowingly infected with STDs after they have intercourse with masseuses, beauticians, or karaoke escorts.
Childhood prostitution is often supported by wealthy tourists from the Middle East, Europe, Japan, and other countries, but it is not the extensive problem it is in neighboring nations, like Thailand, Cambodia, Myanmar, and Vietnam. The increase of childhood prostitution is related to the myth that children are “clean” and free from STD infections.
In a few large cities, male sex workers also operate. Their customers are widows, women of middle age or older, and female visitors from foreign countries. Some of them operate quietly as masseurs providing special services for women.
In certain tourist areas, such as Bali, some foreign tourists end up marrying a sex worker whose services they originally sought for pay.
In keeping with our conservative Indonesian tradition, pornography is illegal throughout Indonesia. However, it is not difficult to find “blue” or hardcore video material. Some people sell pornographic books, magazines, and pictures, despite their being illegal. People, including adolescents, can easily rent pornographic videos and videodisks in many rental places for a low price because so many of them are illegal copies.
Police have caught some criminals who illegally produce or import copies of pornographic video material. However, the illegal business never stops, and people can always rent or buy such hardcore video materials. There is no protection for adolescents from pornographic materials, so they can rent or buy it easily. The video renters/sellers do not feel a moral responsibility to protect adolescents from the effects of the hardcore materials they sell.
In the era of cyberspace, it is much more difficult to protect adolescents from pornography, because it is very easy to access pornographic Web sites. In big cities, there are many places where people can gain access to the Internet and no one can control this access to pornographic Web sites on the Internet.
Indonesia has a national program promoting contraception to help married couples plan their families. This program addresses only married people, and not adolescents or unmarried adults. Information on contraception is provided through women’s social organizations, newspapers, and radio and television broadcasts.
In 1970, the government began providing free contraceptives at public health centers. In 1988, with an improving economic situation and people recognizing the need for family planning, the government gradually began reducing its support, encouraging people who could afford them to obtain contraceptives from physicians in private practice or midwives with reasonable fees. The poor can still obtain free contraceptive services at public health centers where the only charge is for an inexpensive admission ticket.
The most popular contraceptives are the oral hormonal pill, hormonal injections, and IUDs. Women have to be examined by a physician before they can obtain a prescription for oral hormonal pills, but renewal of such prescriptions is not limited. Hormonal injections and IUDs are administered by doctors or by midwives. The other contraceptives are hormonal implants and tubectomy. As for males, acceptance of contraception is very limited. There are at least two reasons for this resistance. First, perceived male social superiority results in males not accepting their responsibility for contraceptive decisions and use. Second, there are only two alternatives in choosing male contraceptives, condoms or vasectomy. Condom users account for only about 5% of the total number of contracepting men and women.
Despite the limiting of contraceptive information to married women, some adolescents and unmarried women also use contraceptives. They are available in pharmacies (apothecaries or chemists), and include the condom and vaginal film (tissue). Often the hormonal pill can be obtained without a physician’s prescription.
In general, the people do not agree that unmarried people should have access to and use contraceptives. Thus, there is no formal education in the schools about contraceptives for adolescents. Sexually active adolescents and single adults have only informal sources of information about contraceptives: newspapers, television, radio programs, and seminars sponsored by interested social groups. As a result, not many adolescents understand how to prevent unwanted pregnancies. They do not even understand how to estimate their fertile period. However, with the government agreement on sexual education as a part of the curriculum in the schools, adolescents will have access to complete information about sexuality, including contraceptives.
Unmarried pregnancies are not uncommon, but data are nonexistent. What little information is available from routine clinical statistics simply documents the number of unmarried pregnancies in different years. Unpublished data from one urban clinic, for instance, reported 473 unmarried pregnant women seeking aid in 1985-1986, a second clinic served 418 pregnant unmarried women in 1983-1986, and a third clinic reported 693 unmarried pregnancies in 1984-1990.
These reports provide only raw data with no perspective, and the frequency and incidence of unmarried pregnancies are much higher than these few studies indicate. Likewise, there are no data that would allow one to compare the incidence of unmarried pregnancies in the cities and rural areas. However, the incidence of abortions performed illegally by medical doctors or traditional healers suggests that unwanted pregnancies are not uncommon, either in the cities or in the rural areas.
Of course, not all unwanted pregnancies result in abortion. Some pregnant adolescents are forced to marry even though they do not want to. The unwanted babies born by unmarried adolescents or young adults that are taken care of in orphanages also indicate that unmarried pregnancies are not uncommon. Some unwanted babies are left by their mothers in the clinic after delivery. Others are simply left in front of somebody’s house to be rescued.
Based on an estimated one million teenage abortions a year, and the fact that not all unmarried pregnancies result in abortion, it is believed that the actual number of teenage unmarried pregnancies is well over a million a year.
Abortion is illegal throughout Indonesia, except in rare medical cases to save a mother’s life. It is impossible to obtain any realistic number of abortions performed in Indonesia, simply because it is illegal. However, many abortions are performed. In addition to abortions performed illegally by medical doctors, abortions are also performed by native or traditional healers, who use traditional methods that are often unsafe and result in complications. One such method uses the stem of a coconut tree leaf, which is inserted into the uterus through the vagina and cervix. This method, of course, is very risky, because it is not sterile and the healers do not understand the sexual anatomy. Some deaths are reported after abortions by native healers because of uterine rupture, bleeding, or infection.
Some doctors are caught by the police because they perform abortions in their clinics. A few of these cases were reported in the news media when police found many dead fetuses buried in the yard of a clinic or in plastic bags thrown into the garbage bins or dumps.
It is estimated that around 2.5 million abortions are performed each year throughout Indonesia, for both married and unmarried women. Of these, around one million are abortions performed on teenagers.
The success of Indonesia’s national program of family planning was recognized in 1989 when the United Nations gave its Population Award to the president of Indonesia. Efforts are being made to achieve zero population growth in the near future.
These efforts are particularly important considering that the island of Java is one of the most densely populated areas of the world with 2,100 persons per square mile (2.6 km2) and over 100 million people on the island of 51,023 square miles (132,149 km2). By comparison, the states of New York, North Carolina, and Mississippi are each roughly the same size as Java, but have only 18, 6.6, and 2.5 million people, respectively.
One important effort is to increase the participation of males in family planning. Up to now, their participation is very low. The involvement of males in family planning is only 6% of the contraceptors because of various factors. The male superiority is one of important factors that inhibit males accepting responsibility in family planning. Most males are not interested in using either condoms or vasectomy.
A. Sexually Transmitted Diseases
Although no survey and reliable clinical reports are available, it is the clinical experience of the authors and their colleagues that sexually transmitted diseases are common among Indonesian adolescents and young adults, indicating that the taboos against premarital sex are not observed. The incidence is highest among those between ages 20 to 24, and lower among the 25- to 29-year-olds and 15- to 19-year olds. As would be expected given the social customs, the incidence among males is higher than it is among females. The most commonly reported STDs are nonspecific urethritis, gonorrhea, ulcus molle, and genital herpes. Syphilis is no longer common, although it appears to be increasing in recent years.
Transmission of STDs is caused by unsafe and high-risk sexual behavior, including intercourse with sex workers. The use of condoms is not popular among males who are involved in high-risk sexual behavior.
Treatment for STDs is available at all health clinics throughout the country. Some years ago, the government sponsored a program to reduce the spread of STDs by providing prostitutes with penicillin injections. Unfortunately, the program is no longer available.
Currently, sex workers have taken the initiative in preventing STD transmission. However, their effort is often medically unsound because it is only based on misinformation from friends or other lay people. The most popular method employed by sex workers is consuming an oral antibiotic after sexual activity. The other is irrigating the vagina with antiseptic. These methods, they believe, can prevent STD transmission, including HIV/AIDS. On the other hand, the customers also believe that if the sex workers do not have any visible signs of an STD, they are not at risk of being infected even though they do not use a condom.
The prevention efforts by the government and nongovernmental organizations (NGOs) focus on providing information in seminars and the mass media, including the newspaper, radio, and television.
Some informal studies of STD prevention have found that most Indonesians do not understand well the nature and character of STDs. The obvious question, then, is whether the strategy and/or technique of prevention efforts have to be reevaluated, and probably even changed.
The first case of AIDS found in 1987 in Denpasar (in Bali) was a Dutch visitor. This incident scared many people, including the hotel staff where he stayed and the hospital staff where he was treated a few days before he died. Fortunately, in revealing that HIV/AIDS was indeed present and active in Indonesia, this incident raised the awareness of many Indonesians, including doctors and government officials.
Until the end of 1987, there were only 6 cases of HIV/AIDS reported in Indonesia. Thereafter, this incidence has increased rapidly as reported by the Indonesian Department of Health (see Table 1). In the first two months of the year 2000, 103 new cases were reported, suggesting the start of an exponential increase, with perhaps a tripling of cases to about 600 for 2000. The cumulative number of HIV/AIDS cases until February 2000 was 1,146, consisting of 853 cases of HIV positives and 293 cases of AIDS. However, it is believed that the real number of HIV/AIDS cases is much higher than the reported number. The real number of HIV/AIDS cases is estimated around 100 to 200 times greater than the reported number (Indonesian Department of Health 2000).
Incidence of AIDS in Indonesia, 1988-1999
The 1,146 cases of HIV/AIDS reported as of February 2000 are spread throughout Indonesia’s 23 provinces. These involve 679 males and 412 females, with the sex of 55 patients unidentified. Most of the HIV/AIDS cases in Indonesia resulted from heterosexual contact. Most of those infected are between 15 and 39 years of age (Indonesian Department of Health).
Sex workers are believed to be one source of infection transmission, but the freer sexual behavior among today’s people has also become a prominent factor. In the early years of HIV/AIDS transmission in Indonesia, it is estimated that some HIV-positive foreign tourists who came to popular tourist centers like Bali introduced the virus through sexual contact with sex workers or local people.
Prevention efforts have been provided for some groups of people, such as sex workers, both female and male, people who work in the tourism industry, university and high school students, long-distance truck and bus drivers, women leaders, and religious leaders. These efforts involve providing information, education, and training on how to reduce the spread of AIDS, and include blood tests for HIV infection. Campaigns to popularize the use of condoms are now conducted through the mass media, including newspaper, radio, and television. However, it is not easy to make people aware and encourage condom use if they engage in high-risk sexual intercourse.
The classical belief that using condoms inhibits the joy of sex is still fixed in the mind of almost all Indonesian males, as well as females. The simple distribution of condoms to sex workers does not solve the problem. Most males seeking sex workers do not want to use condoms because of the classic myth of inhibiting pleasure. Sex workers are in a very weak bargaining position, so they do not have enough power to refuse the customers who do not want to use condoms. If they insist and refuse the customer who does not want to use a condom, they will have to answer to their manager, and this could lead to further difficulties. No one seems to know what policy could best convince those who have sex with sex workers that condoms are a must in today’s world. Indonesia very much needs a national policy to encourage men frequenting sex workers to use condoms, or to press sex workers not to do their job if the customer does not want to use a condom. If such a policy is not found and implemented effectively, Indonesia faces the distinct likelihood of an explosion of cases of HIV/AIDS in the near future.
[Update 2003: Indonesia faces a national health disaster, which belies its reputation as the world’s largest, and quite conservative, Muslim community—an epidemic of IV-drug use that suggests needle sharing will soon surpass unsafe sex as the most common method of contracting HIV (The Age 2003).
[According to Henry Yosodiningrat, a Jakarta lawyer and member of the government’s National Narcotics Agency, “This is an extremely serious issue for us. It’s a threat that could kill an entire generation. There’s not a school or district anywhere across the country where drugs are not used.” In January 2003, Broto Wasisto, head of the Health Ministry’s committee on drug control, and a member of the national HIV/AIDS control board, agreed that IV-drug use “is a national emergency as far as controlling the spread of HIV/AIDS is concerned.” In February 2002, a report by Melbourne’s Macfarlane Burnet Institute for Medical Research and Public Health estimated that there were between 1.3 million and two million IV-drug users in Indonesia, with up to one million of these injecting. Some local estimates put the number of users at four million—about one in every 50 Indonesians.
[In 1996, Jakarta’s RSKO hospital, which specializes in treating drug addicts, dealt with 2,000 patients; three years later, the number had risen to 9,000. In the process, users are getting younger, with most now between the ages of 16 to 25. The full range of drugs available in the West, and more, is used here. Premium-quality marijuana from Sumatra, ecstasy, heroin, and methamphetamines are offered for sale. Shabu-shabu, a potent new form of methamphetamine that is injected, inhaled, or taken orally, increases the duration and intensity of sex and reduces inhibitions, making users fearless and prone to risk-taking. It is popular among prostitutes and their clients in Indonesia’s massive sex industry and is cheaply produced in backyard factories. There is a caste system among Indonesian drug users. The middle class use ecstasy; poorer people use shabu.
[Despite the growing awareness of the problem, Indonesia faces unique obstacles and some reluctance in dealing with it. “Although the use of illicit drugs is increasing, political conflict, power struggles, and widespread corruption are influencing how the drug-related HIV/AIDS crisis should be tackled,” the Macfarlane Burnet report concluded. A major obstacle in the anti-drug war is a mind-boggling array of other social, economic, and security crises competing for the government’s attention. Then there are too many other pressing health problems: high maternal and infant-mortality rates, malaria, tuberculosis, and a multitude of diseases because of the lack of clean drinking water. All these obstacles are complicated by the free flow of money from the drug syndicates to buy officials, police, and the army. There is also evidence that elements of the underfunded police and military are themselves involved in the drug trade and are willing to fight public turf wars for their share of it. In October 2002, at Binjai in north Sumatra, soldiers in an army airborne unit tied up their officers and attacked police stations using rocket-propelled grenades, mortars, and automatic weapons, killing eight police and civilians. The soldiers were upset after the police arrested a drug dealer and seized 1.5 tons of cannabis.
[Meanwhile, the East Timor government and the UN have launched an AIDS-awareness campaign on television, radio, and print media, hoping the country can avoid the explosion in HIV/AIDS seen elsewhere in the region. East Timor, newly independent from Indonesia on May 20, 2002, has so far avoided an HIV/AIDS epidemic, but social dislocation, cross-border migration, high unemployment, illiteracy among the rural population, and low awareness about HIV indicate a significant risk. In 2002, preliminary estimates from the Ministry for Health showed the rate of HIV infection at 0.64% of people of reproductive age. Cambodia, Thailand, and Myanmar have HIV rates of more than 1%, according to UNAIDS (Reuters Health, 2002). (End of update by R. T. Francoeur)]
[Update 2002: UNAIDS Epidemiological Assessment: Until the end of 1998, all HIV/AIDS data collected in Indonesia from all sources indicated that HIV-seroprevalence rates were very low (below 0.1%), even in the highest heterosexual risk groups, such as female sex workers. The exception to this very low HIV prevalence was in Merauke (in West Irian) where relatively high HIV-prevalence rates were reported among female sex workers several years ago.
[Starting in 1999 and continuing in 2000, several HIV Sentinel Surveillance sites for female sex workers began to detect increasing numbers of HIV infections, and prevalence rates from 1% to 5% were found in several areas. Although injecting-drug-user populations were not included as a routine sentinel surveillance group, several ad hoc serosurveys throughout Indonesia, especially in Jakarta, detected sharply increasing HIV prevalence (up to over 35% in Jakarta) among injecting drug users in late 2000. This increasing trend of HIV prevalence can be seen in blood-donor data from the Indonesian Red Cross from 1992 to 2000. In recent years, approximately 750,000 to 1,000,000 blood donors have been screened annually for HIV; a marked increase was seen in 1999 and 2000, probably reflecting the large increase among injecting-drug-user populations noted during the same time period.
[Indonesia is classified as a country with a concentrated HIV epidemic, primarily among its injecting-drug-user population. At the end of 2001, an estimated 120,000 people were living with HIV/AIDS. The estimated number of AIDS deaths for the year 2001 is about 4,600. Most of these AIDS deaths occurred in or around Jakarta, where the majority of the HIV-infected injecting-drug-user populations live.
[The estimated number of adults and children living with HIV/AIDS on January 1, 2002, were:
|Adults ages 15-49:||120,000||(rate: 0.1%)|
|Women ages 15-49:||27,000|
|Children ages 0-15:||1,300|
[An estimated 4,600 adults and children died of AIDS during 2001.
[At the end of 2001, an estimated 18,000 Indonesian children under age 15 were living without one or both parents who had died of AIDS. (End of update by the Editors)]
The diagnostic paradigm used by Indonesian sexologists is basically that of William Masters and Virginia Johnson, with presenting cases of inhibited penile erection (erectile dysfunction), early (premature) ejaculation, inhibited (retarded) ejaculation, male and female dyspareunia, inhibited female orgasm, and vaginal spasms (vaginismus).
However, the development in diagnostic tools has changed both the results of the diagnosis and the strategy of case management. With some diagnostic tools, like the erectiometer, Doppler pen, and Rigiscan, a more accurate diagnosis can be achieved. For example, before the new diagnostic tools were developed, most erectile dysfunction was considered to be psychological in origin. But after the development of new diagnostic tools, it is found that most erectile dysfunctions are organic. This finding, supported by the new medicines like sildenafil, has changed the strategy in the management of erectile dysfunction. Now the treatment of erectile dysfunction is divided into three steps: first-, second-, and third-line therapies. First-line therapy consists of sexual or psychosexual therapy, oral erectogenic agents (primarily Viagra), and a vacuum constriction device. Second-line therapy includes intracavernosal injection and intraurethral application. Third-line therapy is the surgical procedure of penile implant. These advanced treatments are available only to a small minority of Indonesians living in urban centers who can afford them.
A common psychological sequel for males with a sexual dysfunction is a feeling of inferiority with regard to their partner. This feeling is often what brings the male to seek treatment.
Many women, on the other hand, tend to hide their sexual problems and feel shy about seeking treatment. Many married women never have orgasm and never tell their husbands. At the same time, many husbands are unaware or do not even suspect that their wives never have orgasms. Many of them are simply unaware of their wife’s sexual dysfunction even after the wife complains to a sexologist.
Out of 4,135 women who came for consultation at the authors’ clinics for their own or their husband’s sexual problem, 2,302, or 55.7%, have never had an orgasm, and 527, or one in six (12.7%), have experienced orgasm only rarely. Among those who never reached orgasm, 60 (2.6%) experienced dyspareunia, 67 (2.9%) experienced hypoactive sexual desire, and 27 (1.2%) suffered from vaginismus.
The high incidence of sexual dysfunction among Indonesian females is caused by poor communication between husbands and wives, poor sexual knowledge, and male sexual dysfunction. However, good diagnosis and treatment for sexual dysfunctions are available in only a few urban clinics, and are available only to those who can afford it.
A few Indonesian sexologists have finished their education and training in the United States, Belgium, and Australia. Some informal unpublished clinical studies of sexuality in Indonesia have focused on sildenafil and alprostadil for the treatment of erectile dysfunction, on sexual perception and behavior among the youth in cities and villages, and sexual knowledge, perception, and behavior of STD patients. Some studies are currently in progress, including management of erectile dysfunction using the new medications, and high-risk sexual behavior in relation to HIV/AIDS transmission.
Advanced education on sexuality is available only in the Master Program in Reproductive Medicine at Udayana University in Denpasar, Bali. This program offers sexology lectures and study as a part of the curriculum. As a postgraduate program, it requires a two-year study course in sexology, spermatology, experimental reproductive biology, reproductive endocrinology, embryology, family planning, and infertility management. Instruction in sexology includes perspectives on sexuality, gender and sexual behavior, childhood, adolescence, and adulthood sexuality, sexual fantasy, sexual variation, sexual dysfunction, sexual deviation, and premarital and marital counseling.
The mailing address of this center is: The Master Program in Reproductive Medicine, Udayana University Medical School, Attention: Prof. Wimpie I. Pangkahila, M.D., Ph.D., Jl. Panglima Sudirman, Denpasar, Bali, Indonesia.
References and Suggested Readings
CIA. 2002 (January). The world factbook 2002. Washington, DC: Central Intelligence Agency. Available: http://www.cia.gov/cia/publications/factbook/index.html.
Idrus, N. L. 2000. Marriage, sex and violence in Bugis ciety. In: S. Blackburn, ed., Love, sex and power: Women in Southeast Asia. Clayton, Australia: Monash Asia Institute.
Hancock, P. 2000. Gender empowerment issues from West Java. In: S. Blackburn, ed., Love, sex and power: Women in Southeast Asia. Clayton, Australia: Monash Asia Institute.
Machali, R. 2000. Women and the concept of power in Indonesia. In: S. Blackburn, ed., Love, sex and power: Women in Southeast Asia. Clayton, Australia: Monash Asia Institute.
Pangkahila, W. 1981. Changes in sexual perception and behavior in adolescence. Presented at the National Congress of Sexology, Denpasar, Indonesia.
Pangkahila, W. 1988. Sexual problems in the family [in Indonesian]. Jakarta: PT Gaya Favorit Press.
Pangkahila, W. 1991. Premarital sex in married couples: A survey [in Indonesian]. Presented in many public and professional seminars.
Reuters Health. 2002 (April 4).
Robinson, K. 2000. Gender, Islam and culture in Indonesia. In: S. Blackburn, ed., Love, sex and power: Women in Southeast Asia. Clayton, Australia: Monash Asia Institute.
The Age [Australia]. 2003 (January 4). Indonesia is dancing with death. Available: www.theage.com.au.
UNAIDS. 2002. Epidemiological fact sheets by country. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS/WHO). Available: http://www.unaids.org/hivaidsinfo/statistics/ fact_sheets/index_en.htm.
UNFPA. 2000 (June 22). Sex before marriage not appropriate for youth, messages tell Indonesian adolescents. UNFPA at work.