The sex trade in Indonesia - Videos

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Injecting Drug Use, Sexual Risk, HIV Knowledge & Harm Reduction Uptake in a Large Prison in Bali, Indonesia

Purpose
The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. Design/methodology/approach - A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. 

Findings
Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. 

Research limitations/implications
The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. 

Practical implications
The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. Originality/value - This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

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By:  Sawitri AA1, Hartawan AA, Craine N, Sari AK, Septarini NW, Wirawan DN.

• 1Department of Community and Preventive Medicine, Udayana University Bali, Denpasar, Indonesia. 
• Int J Prison Health. 2016 Mar 14;12(1):27-38. doi: 10.1108/IJPH-05-2014-0011.

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Toxoplasma & Viral Antibodies among HIV Patients & Inmates in Central Java, Indonesia

In Indonesia, Toxoplasma and its associations with blood-borne viruses have been poorly studied. In order to study the association between anti-Toxoplasma antibodies and blood-borne viral antibodies, blood samples from 497 participants (375 inmates from four prisons in Central Java, Indonesia and 122 HIV patients at a Voluntary Counseling and Testing Clinic in Surakarta, Indonesia) were tested for serological markers of Toxoplasma, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and human T-lymphotropic virus types I and II (HTLV-1/2). 

Anti-Toxoplasma IgG and IgM positivity rates were 41.6% and 3.6%, respectively. One point two percent of participants was positive for both anti-Toxoplasma IgG and IgM antibodies. Sixteen point five percent, 11.3%, 2.6% and 2.8% of participants were positive for anti- Toxoplasma IgG combined with anti-HCV antibodies, anti-Toxoplasma IgG combined with anti-HIV antibodies, anti-Toxoplasma IgM combined with anti-HIV antibodes and anti-Toxoplasma IgG combined with both anti-HIV and anti-HCV antibodies, respectively. Anti-Toxoplasma IgM seropositivity was associated with anti-HIV (aOR = 4.3; 95% CI: 1.112-16.204, p = 0.034). Anti-Toxoplasma IgG antibodies were associated with anti-HCV (aOR = 2.8; 95% CI: 1.749-4.538, p < 0.001) and history of injection drug use (aOR = 3.1; 95% CI: 1.905-5.093, p < 0.001). 

In conclusion, we recommend patients with HIV, HCV infection and injection drug users should be screened for Toxoplasma infection in Indonesia.

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By:  Sari Y, Haryati S, Raharjo I, Prasetyo AA.

Southeast Asian J Trop Med Public Health. 2015 Nov;46(6):977-85.

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Effect of HIV Prevention & Treatment Program on HIV & HCV Transmission & HIV Mortality at an Indonesian Narcotic Prison

Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. 

During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. 

During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. 

After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased.

Article via:   http://goo.gl/0abLLk

By:  Nelwan EJ, Indrati AK, Isa A, Triani N, Alam NN, Herlan MS, Husen W, Pohan HT, Alisjahbana B, Meheus A, Van Crevel R, van der Ven AJ.

Southeast Asian J Trop Med Public Health. 2015 Sep;46(5):880-91.

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Impacts of Stigma on HIV Risk for Women Who Inject Drugs in Java: A Qualitative Study

Highlights

• Javanese women who inject drugs felt stigmatized by health professionals and others.
• This stigma contributed to feelings of shame.
• Drug use was hidden by avoiding those who do not inject and harm reduction services.
• Trust in their small group of injecting friends contributed to sharing needles.

Background

People who inject drugs have experienced stigma around the world. Stigma has been found to have negative consequences for individuals in relation to health-service use, psychological wellbeing and physical health; and for populations in terms of health inequalities. Indonesia has experienced a rapid growth in injecting drug use and HIV and little is known about drivers of HIV risk among Indonesian women who inject drugs. The purpose of this paper is to describe and consider the multiple impacts of stigmatization of injecting drug use on injecting behaviors among women who inject drugs in Java.

Methods

In-depth interviews were conducted with 19 women who inject drugs in Java. Mean age was 25 years, all but one was employed or at college. The interviewers were Indonesian women.

Results

Significant stigma around women's drug use was reported from multiple sources in Java including family, friends and health services, resulting in feelings of shame. To avoid this stigma, most of the study participants hid their drug use. They lived away from family and had few friends outside their drug-injecting circle, resulting in isolation from mainstream society and harm-reduction services. Sharing of injecting equipment was restricted to a small, closed circle of trusted friends, thus limiting possible HIV transmission to a small number of injectors.

Conclusions

The stigmatization of drug use, particularly of drug use by women, in Indonesia appears to have contributed to significant shame, isolation from mainstream society and high rates of sharing injecting equipment with a small group of trusted friends (particularly the partner).

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By:  Catherine Spooner^a, , , Antonia Morita Iswari Saktiawati^b, , Elan Lazuardi^b, , Heather Worth^a, ,Yanri Wijayanti Subronto^b, , Retna Siwi Padmawati^b, 

^a UNSW Australia, Sydney, NSW 2052, Australia

^b Center for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Bulaksumur, Yogyakarta 55281, Indonesia

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Cardiac Effects of Antiretroviral-Naïve versus Antiretroviral-Exposed HIV Infection in Children

Background

Cardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment (ART) is unknown.

Methods

This cross sectional study involved 114 vertically-acquired HIV-infected (56 ART-naive, 58 ART-exposed) and 51 healthy children in Jakarta, Indonesia. Echocardiography was performed to measure dimensions of the left ventricle (LV) and systolic functions. We applied general linear modeling to evaluate the associations between HIV infection/treatment status and cardiac parameters with further adjustment for potential confounders or explanatory variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children, with 95% confidence intervals and p values.

Results

Compared to healthy children, ART-naïve HIV-infected children did not show significant differences in age-and-height adjusted cardiac dimensions apart from larger LV internal diameter (difference 2.0 mm, 95%CI 0.2 to 3.7), whereas ART exposed HIV infection showed thicker LV posterior walls (difference = 1.1 mm, 95%CI 0.5 to 1.6), larger LV internal diameter (difference = 1.7 mm, 95%CI 0.2 to 3.2) and higher LV mass (difference = 14.0 g, 7.4 to 20.5). With respect to systolic function, reduced LV ejection fraction was seen in both ART-naïve HIV infected (adjusted difference = -6.7%, -11.4 to -2.0) and, to a lesser extent, in ART-exposed HIV infected children (difference = -4.5%, -8.5 to -0.4). Inflammation level seemed to be involved in most associations in ART-exposed HIV-infected, but few, if any, for decreased function in the ART-naive ones, whereas lower hemoglobin appeared to partially mediate chamber dilation in both groups and reduced function, mainly in ART-exposed children.

Conclusions

ART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment.

Below: Influence of potential explanatory variables on cardiac structural estimates in ART-naive and ART-exposed HIV infected children.  Note: LVPWd = left ventricular posterior wall thickness at end-diastole; LVIDd = left ventricular internal diameter at end-diastole; LV mass = left ventricular mass; RWT = relative wall thickness; Hb = hemoglobin level; BP = systolic and diastolic blood pressure.

Below:  Influence of potential explanatory variables on cardiac functional estimates in ART-naive and ART-exposed HIV infected children.  Note: EF = ejection fraction; FS = fractional shortening; TAPSE = tricuspid annular plane systolic excursion; Hb = hemoglobin level; BP = systolic and diastolic blood pressure.

Full article at:   http://goo.gl/epfyuV

By:  

Nikmah S. Idris, Nia Kurniati

Department of Child Health, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Nikmah S. Idris, Diederick E. Grobbee, Cuno S. P. M. Uiterwaal

Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, Netherlands

Nikmah S. Idris, Michael M. H. Cheung, David Burgner

Department of Pediatrics, University of Melbourne; Heart Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia

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Testing the Woman Abuse Screening Tool to Identify Intimate Partner Violence in Indonesia

Intimate Partner Violence (IPV) is a global public health problem. IPV prevalence in Indonesia has been estimated to be less than 1%, based on reported cases. It is likely that IPV prevalence is underreported in Indonesia, as it is in many other countries. Screening for IPV has been found to increase IPV identification, but no screening tools are in use in Indonesia. 

The aim of this study was to test the translated Woman Abuse Screening Tool (WAST) for detecting IPV in Indonesia. The WAST was tested against a diagnostic interview by a trained psychologist on 240 women attending two Primary Health Centers in Jakarta. IPV prevalence and the reliability, sensitivity, and specificity of the WAST were estimated. 

Prevalence of IPV by diagnostic interview was 36.3%, much higher than published estimates. The most common forms of IPV identified were psychological (85%) and physical abuse (24%). Internal reliability of the WAST was high (α = .801). 

A WAST score of 13 (out of 24) is the recommended cutoff for identifying IPV, but only 17% of the Indonesian sample scored 13 or higher. Test sensitivity of the WAST with a cutoff score of 13 was only 41.9%, with a specificity of 96.8%. With a cutoff score of 10, the sensitivity improved to 84.9%, while the specificity decreased to 61.0%. 

Use of the WAST with a cutoff score of 10 provides good sensitivity and reasonable specificity and would provide a much-needed screening tool for use in Indonesia. Although a lower cutoff would yield a greater proportion of false positives, most of the true cases would be identified, increasing the possibility that women experiencing abuse would receive needed assistance.

IPV Help-Seeking Behavior (N = 240).

Would report IPV
Would visit a PHC	26 (10.8%)
Would visit an Emergency Response Unit	3 (1.3%)
Would visit to service provider	20 (8.3%)
Would report to a policewoman’s desk	24 (10.0%)
Would call a hotline service	3 (1.3%)
Would report, but did not specify to whom	7 (2.9%)
Total	83 (34.6%)
Would not report
Would talk to family and friends	106 (44.2%)
Would remain quiet	32 (13.3%)
Would leave husband	4 (1.7%)
Would practice self defense	6 (2.5%)
Total	148 (61.7%)
Did not respond to question	9 (3.7%)

Note. IPV = Intimate Partner Violence; PHC = Primary Health Centers.

Full article at:   http://goo.gl/GDrHkM

By:  Livia Iskandar, MSc, DrPH,¹ Kathryn L. Braun, DrPH,¹ and Alan R. Katz, MD, MPH¹

¹University of Hawaii, Honolulu, USA

Corresponding Author: Kathryn L. Braun, Office of Public Health Studies, John A. Burns School of Medicine, University of Hawaii, 1960 East-West Road, Biomed D-204, Honolulu, HI 96822, USA. Email: ude.iiawah@nuarbk

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Women with HIV In Indonesia: Are They Bridging a Concentrated Epidemic to the Wider Community?

Background

Male injecting drug users drove the onset of the HIV epidemic in Indonesia but over time more women have been diagnosed. We examined the relative proportion of female patients in an HIV cohort and characterized their probable transmission route and reproductive profile.

Designs

Prospective cohort study in a referral hospital in West Java.

Methods

Interviews with standardized questionnaires, physical and laboratory examinations were done for 2622 individuals enrolled in HIV care between 2007 and 2012. The proportion of women in this cohort was compared with national estimates. The general characteristics of HIV-infected women and men as well as the sexual and reproductive health of HIV-infected women were described.

Results

The proportion of female patients enrolled in HIV care increased from 22.2 % in 2007 to 38.3 % in 2012, in line with national estimates. Women were younger than men, fewer reported a history of IDU (16.1 vs. 73.8 %, p < 0.001) and more were tested for HIV because of a positive partner (25.5 vs. 4.0 %, p < 0.001). The majority of women were in their reproductive age, had children, and were not using contraceptives at the time of enrolment.

Conclusion

HIV-infected women in Indonesia have specific characteristics that differ them from women in the general population. Further research to elucidate the characteristics of women exposed to HIV, their access to testing and care and sexual and reproductive needs can help reduce transmission to women and children in the context of concentrated HIV epidemic in Indonesia.

Below:  a Proportion of female adult patients entering HIV care at Hasan Sadikin Hospital between 2007 and 2012. b Proportion of female new HIV cases reported to the Ministry of Health between 2008 and 2013 [21]. Unfilled bar Number of women; striped bar Number of men; dotted bar Total number of new cases; Grey line % of women. Left y-axis refers to bar graphs. Right y-axis refers toline graphs

Full article at:   http://goo.gl/r0WESJ

By:   Annisa Rahmalia, Rudi Wisaksana, Hinta Meijerink, Agnes R. Indrati, Bachti Alisjahbana, Nel Roeleveld, Andre J. A. M. van der Ven, Marie Laga, and Reinout van Crevel

Tuberculosis and HIV Research Centre, Faculty of Medicine Universitas Padjadjaran, Jl. Dr. Eijkman No. 38, Bandung, 40161 Indonesia

Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia

Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia

Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands

Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

Annisa Rahmalia, Email: ln.cmuduobdar@ailamhaR.asinnA.

 

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A Survey on HIV-Related Health-Seeking Behaviors among Transgender Individuals in Jakarta, Based on the Theory of Planned Behavior

Male-to-female transgender (waria) individuals are at high risk for HIV. This study aims at mapping the psychological determinants of four HIV-related health-seeking behaviors. This knowledge can be used to develop effective interventions to prevent the spread of HIV/AIDS.

The study involved 209 waria from five districts in Jakarta, selected with a cluster sampling procedure. Cross-sectional data were gathered through structured interviews. The four examined behaviors are, visiting sexually transmitted infections (STIs) services regularly, adherence to STI treatment, taking an HIV test and picking up the result of HIV test. For all four behaviors, specific measures of the psychological determinants as defined by the Theory of Planned Behavior were developed: attitudes, subjective norms and perceived behavioral control (PBC). Logistic regression analyses were conducted with these three psychological measures as independent variables and the behaviors as dependent variables.

Of the 209 waria, 20.6 % had never visited STI services in the last 6 months, while 56.5 % had visited the services once or twice, and 23 % had visited the service three or more times. A HIV test had been taken by 90.4 % of the waria, and of those, 64.6 % had picked up the results. About 85 % of the waria who did a HIV test had been tested for HIV one or two times in the last 6 months and 10 % had been tested three to four times. The variance in behaviors that was explained by the concepts defined in the Theory of Planned Behavior ranged from 15 to 70 %; PBC was the most powerful predictor. Furthermore, the results showed that in several cases the relationships of attitudes or subjective norms with the dependent variable were mediated by one or both other independent variables.

The results regarding the prominent role of PBC suggest that interventions should increase waria’s control over the behavior: Engaging in specific desired behaviors should be made easier for them. Besides, waria’s attitudes and subjective norms should be addressed, by education, but possibly also by providing waria with a positive experience with the behavior, for example, by designing a professional and friendly health care system.

Full article at: http://goo.gl/7X00Af

By:  Ciptasari Prabawanti^1*, Arie Dijkstra¹, Pandu Riono² and Gagan Hartana³

¹Social Psychology Department, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1 9712 TS, Groningen, The Netherlands

²Population Studies and Biostatistic Department, Faculty of Public Health, University of Indonesia, Kampus UI, Depok 16424, West Java, Indonesia

³Faculty of Psychology, University of Indonesia, Kampus UI, Depok 16424, West Java, Indonesia

 

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Estimation of Cancer Burden Attributable to Infection in Asia

Some infectious agents have been shown to be human carcinogens. The current study focused on estimation of cancer burden attributable to infection in different regions of Asia.

By systematically reviewing previous studies of the infection prevalence data of 13 countries in Asia and relative risks of specific cancers, we calculated the population attributable fraction of carcinogenic infections. Using data from GLOBOCAN 2012, the overall country-specific and gender-specific number of new cancer cases and deaths resulting from infection were estimated.

Across 13 principal Asian countries, the average prevalence and range was 6.6% (0.5% in Japanese women to 15.0% in Vietnamese men) for hepatitis B virus (HBV), 2.6% (0.3% in Iran to 5.1% in Saudi Arabia) for hepatitis C virus (HCV), 7.9% (2.8% in Pakistan to 17.7% in China) for human papillomavirus (HPV), and 61.8% (12.8% in Indonesia to 91.7% in Bangladesh) for Helicobacter pylori (HP). 

The estimated total number of cancer cases and deaths caused by infection in these 13 countries were 1 212 026 (19.6% of all new cancer cases) and 908 549 (22.0% of all deaths from cancer). The fractions of cancer incidence attributable to infection were 19.7% and 19.5% in men and women, respectively. 

The percentages of cancer deaths attributable to infection were 21.9% and 22.1% in men and women, respectively. Among the main infectious agents, HP was responsible for 31.5% of infection-related cancer cases and 32.8% of infection-related cancer deaths, followed by HBV (28.6% of new cases and 23.8% of deaths), HPV (22.0% of new cases and 27.3% of deaths), and HCV (12.2% of new cases and 10.6% of deaths).

Approximately one quarter of all cancer cases and deaths were infection-associated in Asia, which could be effectively prevented if appropriate long-term controls of infectious agents were applied.

Below: Proportion of estimated new cancer cases and deaths attributable to different infectious agents in men and women

Full article at:  http://goo.gl/HTZsxV

By: He Huang,1,2 Xiao-Feng Hu,3 Fang-Hui Zhao,1 Suzanne M. Garland,4 Neerja Bhatla,5 and You-Lin Qiao1

¹Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

²Department of Prevention and Control of Communicable Disease, Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou, China

³Shijingshan District Center for Disease Control and Prevention, Beijing, China

⁴The Microbiology and Infectious Diseases Department, Royal Women’s Hospital, and the Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia

⁵Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Address for correspondence. Fang-Hui Zhao, Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, P.O. Box 2258, Beijing 100021, China (e-mail: nc.ca.smacic@hgnafoahz).

 

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Somadril and Edgework in South Sulawesi

The use of psychoactive prescription drugs (PPDs) by young people is part of a broader worldwide trend towards the consumption of pharmaceuticals to improve social, emotional, and sexual performance. Few studies have examined how young people use PPDs in developing countries, where off-label use is likely to be greater due to weaker market controls. 

This study presents our findings on PPD use among sex workers in Makassar, Indonesia. We focus on one potent painkiller, Somadril, which is freely available over the counter in pharmacies. The sex workers we studied used most of their earnings to purchase Somadril pills, which they used to feel more confident and to make their work more palatable. 

This paper also traces the history of the active component in Somadril, carisoprodol. This was developed in the United States, where it was soon used recreationally. We found that knowledge of its effects seeped from health professionals into youth networks, where it was spread by word of mouth. The flow of information on carisoprodol's harmful effects, however, was less evident...

In Makassar's Losari Beach, the sex workers whom we interviewed work freelance, finding customers through referrals from bellboys and becak drivers. They live in a nocturnal peer group that shares everything – food, lodging, and earnings from customers. They help each other to find customers and then use the proceeds to buy food and drugs for everybody. As we joined in their gatherings, especially on Wednesday and Saturday evenings (the former is ladies’ night, the latter a popular evening for young people to go out), it became clear to us that the priority in their lives was Somadril. The sex workers in Makassar craved the drug. Whereas the young women in Isidro got drunk on beer, sex workers in Makassar used Somadril to get high.

The sex workers at Losari Beach consumed Somadril in different ways. Some chewed it; others took it with Sprite (a soft drink commonly used as a solvent for drugs in Indonesia). Others mixed it with red label whiskey or Topi Roja, a local brand of vodka. As Rina told us: ‘If you mix it with an alcoholic drink, the effect is sure to be great.’ Others mixed Somadril with other PPDs such as Calmlet (alprazolam) or the painkiller Tramadol. Hasan, reflecting on his mixing of Tramadol and Somadril, said it made him ‘act like a mad man’. When they had enough money, they bought pedas (hot) food, which they said makes them sweat and enhances the high. They also wore warm jackets, and avoided the wind and cold drinks, which they said weakened the effect of Somadril.

When they could not get enough Somadril, our informants mixed or substituted it with cheaper PPDs such as ‘LL’ (also called ‘DoubleL’; chemical content unknown), which was bought from street vendors in sachets of around 10 pills and ‘Dextro’ (dextromethorphan, a cough medicine sold in generic containers in pharmacies). To get high, they swallowed 20–30 Dextro or several LL pills. Neither are very strong, they said. Mira was one of the sex workers who kept a diary for us:

May 13 (2012): Last night I took only three pills of Somadril. For me, only taking three pills gives me a bad headache, it feels like my head will break into pieces.

May 14: I took five pills of Somad, and I added DoubleL, and I felt like a fool. DoubleL makes us uncommunicative, and not friendly to people. But, I like mixing Somad with DoubleL.

May 15: We didn’t have a supply of Somad, because we have a debt with the seller. I took 15 pills of Dextro and added three pills of DoubleL, and I felt like I had nothing … no worries, no debt, no sins…. But I am worried that if I take too much, it won’t work. It will kill me.

May 16: I took five pills of Somad, and it gave me a headache and I became sleepy…. Dextro makes me sweat like shabu-shabu [methamphetamine], because the heat comes from inside [panas dalam]. It makes me feel weak … but it can also make me feel confident if someone asks me for a date.

May 17: I have taken 10 pills of DoubleL, because I am in a bad mood, and I have nothing to do. DoubleL made me feel crazy, we laughed about everything, even things that are not funny.

May 18: I have taken 9 pills of Somad and I also drank 2 bottles of beer, so it feels really good. It's balanced with beer. It makes me sleepy, but I enjoy it because it makes me feel confident.

Dextro and LL are second-choice drugs among sex workers. Dextro, our informants say, is used a lot among high school-aged young people (below age 18, and not included in our study) who lack the money to buy more expensive PPDs.

We were struck by the uniformity in the reported beneficial effects of Somadril. All of the sex workers to whom we talked said using it made them feel more pede (confident) and/or less malu (shy). These are important qualities in attracting customers; the drug makes the sex workers talkative and feel less inner resistance to their work. As Samsul notes in his diary: ‘I took four pills of Somad and five pills of DoubleL because if I am not taking Somad I have no confidence to accompany my clients, and no desire to look for them.’ Another entry in his diary stresses the uselessness of DoubleL for his work: ‘I didn’t have money to buy Somad, so finally a friend gave me DoubleL, but my eyes blurred and I looked like a fool…. I just kept on laughing, acting like a madman...

  

Full article at: http://goo.gl/SGXX0n

By:  Anita P. Hardon⁎ and Amelia Ihsan

Amsterdam Institute for Social Science Research, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands

Anita P. Hardon: ln.avu@nodraH.P.A

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