PAPER:Sexual tensions, HIV-positive women in Papua

Leslie Butt, 2015, Sexual tensions, HIV-positive women in Papua, in Sex and Sexualities in Contemporary Indonesia (Linda R Bennett and Sharyn Graham Davies), Routledge

Authors	Setting	Research Paradigm	Methodology	Result 1	Result 2	Result 3	Summary
Butt, Leslie, 2015	Two highland in Papua	-	Interview Of 13 men, 17 women, 11 healthcare workers	Internalised-self stigma Women is more likely to self-stigmatise than men:blame themselves, feel ashamed, dirty, unworthy, not respected/needed	HIV vulnerability among women: Mobility, transactional sex to punish their parent, from their husband Pretend to be ‘normal’ and still have sex with their husband- minimise husband’s infidelity or take additional wife	Disclosure of HIV status: fear of ostracism at the level of the indigenous tribal community, fears of exarcerbated discrimination at level of broader urban milieu (like health setting)	There is interplay of gender normativity, sexual choice as public contests and value, negative judgement and morality on mobility and racialised difference in Papua towards women’s vulnerability to HIV.

DIRECT QUOTATION FROM LESLIE BUTT

Introduction

HIV prevention is no the norms, but HIV treatment is related to the norms

Despite the alarms sounded in the late 1990s around skewed patterns of infection, which find more Papuans infected than migrants to the province, it is unusual for HIV prevention and intervention to be geared to indigenous Papuans, and it is virtually unheard of for health researchers to involve Papuans in documenting and disseminating results on infection rates and strategies for prevention (Munro and Butt, 2012)

Culturally focused prevention has been done successfully (Simonin et al, 2011), but it is not the norms.

Interview, 31 HIV-positive men (13) and women (17), 11 healthcare, highlands Papua with Indonesian and local language

Respondents: 31 HIV-positive men and women and 11 healthcare staff in two towns in the highlands district. All respondents were diagnosed as being HIV-positive at least six months prior to being interviewed. All had some experience with medications available for HIV-positive persons, although their commitment to drug regiments varied widely. The ages of the respondents ranged from 15-52 years, with an average age of 25 years.

Methodology: Interview in Indonesian or in the appropriate language indigenous language

The study aimed to explore experiences of stigma of HIV-positive Papuan persons in response to the Indonesian state’s refusal to recognize the differential impact of HIV infection along the lines of ethnicity.

Chapter Section: discourses of responsibility with regards to HIV and discrimination, internalized in self-stigmatising, and 3 lived stories of women of living with HIV

This chapter draws upon the experiences of the 17 women who were interviewed, exploring the challenges they faced when trying to take responsibility for their HIV status and conform to treatment regimens. I discuss how women associate their status with a negative sexuality and fear strong discrimination and stigma if their status is exposed. There is a discrepancy between idealized discourses around responsibility with regards to HIV and the experiences of these women, for whom sexuality is too often associated with violence, betrayal, discrimination and stigma. This paper focuses on how women talk about their sexuality and social roles in the context of their HIV status. I suggest discourses around HIV provide fodder for local ethnic politics, exacerbating differences and that these negative inscriptions are internalized in self-stigmatising ways by HIV-positive women. Papuans and Indonesians tend to racialize each other, transforming differences in skin colour and cultural practice into innate, essentialised differences that make discrimination and inequality seem unsurprising (Munro, 2012, see also chapter 14). This has important consequences for how politics and access to health services play out in Papua.

Honing in on three cases studies, I show how stigma is paramount for all three women, despite their social positioning and life experiences.

I first describe the trauma one woman faced when her story was made public by a healthcare worker, and the impact of disclosure by others on her quality of life.

The second case focuses on forms of discrimination experienced by a young woman who was known as a street sex worker. Her story illustrates how the stigma of being a sex worker was exacerbated by challenges around access to healthcare.

The last case gives voice to a monogamous housewife infected by her well-known politician husband. normally silenced because of the powerful networks supporting her husband, she describes here a sexually violent marriage and a sterile, post-sexual life as a widow.

These case illustrate the particular importance of political conditions, and the impact of thise conditions on encounters with the healthcare system, for understanding the intimate sexualities of vulnerable HIV-positive women

Pp 115

HIV, culture and sexuality

Mode of HIV transmission in Papua

1.     Mobility, being young, not under parents’ surveillance, and sexuality shifts

Most women followed a common pathway to HIV infection. It has become the norm in the past decade for young Papuan women to leave remote rural communities and travel to regional towns to get an education. Spurred on by their parents who want their children to benefit from the province’s rapid development, girls leave the village and live in dormitories, or with family or kin in town, and attend high school away from home. Away from the protective mantle of close kin, women’s sexuality shifts from a set of values primarily created and enacted within rural, class-based systems of descent and inheritance that strongly value women’s role as the source of brideprice. Exposed to young men with guitars, mopeds and other exciting commodities or to devout Christian men who offer the appearance of being an ideal suitor, young women take advantage of opportunities and have sex.

2.     Transactional sex due to economic needs or a punishment for their parents

Another pathway to HIV is for a young girl to go to town for an education, only to have her parents stop paying school fees for a range of reasons. A young girl may interpret this response by her parents as proof they do not love her. Young girls sometimes engage in transactional sex due to need and other times deliberately begin to have sex with many partners as a way to punish their parents (Butt and Munro, 2008)

3.     From their husbands

Only three of the respondents in our study described being in a monogamous sexual relationship with their husbands

Non-disclosure due to double fears at level of the indigenous tribal community and at level of the broader urban milieu

I suggest there are two places of potential discrimination that strongly discourage disclosure: fears of ostracism at the level of the indigenous tribal community and fears of exacerbated discrimination at the level of the broader urban milieu. Pp 117

1.     Non-disclosure to an influential person (health workers and religious leader) and of ostracism by close family, including to their husband

2.     Women is more likely to self-stigmatise and negatively internalize their serostatus in emotional ways. Women were significantly more likely to blame themselves, to feel ashamed, but especially to feel dirty or unworthy, and to feel they are not respected or needed

Self-stigmatization statements	Men (n-13)	Women (n-17)
Very afraid to disclose status	11	12
Feel strongly their status is their fault	9	12
Feel strongly ashamed of themselves	8	14
Feel strongly dirty or unworthy	4	14
Strongly do not feel respected or needed	3	11

Pretend to be ‘normal’

For women, social withdrawal is especially fraught with danger. Women are more afraid to disclose than men, with heightened fears of abandonment and ostracism following disclosure. Many gruesome worst-case scenario stories circulate, in which women are accused of witchcraft and of infecting their husbands, and are killed. Other women fear being banished by their husbands and expelled from kin-based exchange networks. Women remain focused on their ability to remain respected and needed, where their contributions that matter the most are the ability to contribute to food production and preparation by working sweet potato gardens and by cooking. They are also concerned about their ability to remain sexually active with their husbands and thereby minimize the high risk of their husband’s and thereby minimize the high risk of their husband’s infidelity or of him taking on an additional wife in a traditional polygamous marriage system. These gendered responsibilities are cemented by a bride price payment system, where a woman’s family received agreed-upon payments of gifts at her marriage.  Pp 118

There is a strong social imperative to behave and appear ‘normal’ for women to avoid judgement. Pp 119

Non-discriminatory practice: not subjective and moral internalisations in health settings

For respondents who are unable to control disclosure and marriage their status successfully, being HIV-positive can lead to total social ostracism pp 119

In sum, highland Papuan women typically articulate a subjective understanding of their HIV status that is grounded in cultural values and responds to community norms. They avoid stigma and discrimination in ways that are culturally recognized and allow social and sexual relations to remain strong.  However rich this analytic vein, it does not fully acknowledge the impact of wider political conditions and the quality of local healthcare on how women view their status with regards to their sexuality. The stigma-driven responses of our interviewees are not just a product of local cultural logics, and they should not be examined only in ways that emphasise subjective and moral internalisations. Responses are also formed out of wider interlinked systems in which discrimination and racism coalesce to create a situation where women’s sexuality in response to their HIV status is strongly conditioned by the healthcare they receive. Pp 120

HIV vulnerability: Fear of judgement and Faitful to a Fault

Safira: fear of judgement: As long as an HIV-positive women does not have to go to hospital herself, Safira is content to stay on the drugs in a Papuan-run hospice service pp 122

Bunga: faithful to a fault. “ everyday, I wake up I regret things, I regret marrying my husband, I regret all that he did to me, because it was not my fault”