Intersections: Say No to <i>Seks Bebas</i>! Transnational Women Migrants and Indonesia's Strategies for HIV Prevention

Intersections: Gender and Sexuality in Asia and the Pacific
Issue 26, August 2011

Say No to Seks Bebas!
Transnational Women Migrants and Indonesia's Strategies for HIV Prevention

Theresa W. Devasahayam^[*]

Introduction

In Indonesia, the HIV epidemic consists of several epidemics in different districts, provinces, cities/towns and regions, including a variety of levels between different subgroups.[1] Some scholars argue that an epidemic is imminent in the general population although prevalence rates are said to be relatively low,[2] except for the provinces of Papua and Irian Jaya Barat.[3] In 2010, it was estimated that up to 400,000 people in Indonesia were living with HIV out of a total population of 237.6 million.[4] The projected estimate for 2015 is one million people living with HIV.[5]
Given these trends, there has been a push towards generating urgent policy responses to address HIV. Fully aware of the threat of the spread of HIV because 'all the ingredients' are said to be present, the Indonesian government has strengthened and intensified its HIV sentinel and surveillance system.[6] As a result of increased population mobility and ever-increasing numbers of people leaving the country for employment abroad, the Indonesian government has also recognised migration as a potential factor for the transmission of HIV.[7]
For this reason, the Indonesian labour law made it mandatory for all prospective documented migrants deployed to work abroad to attend a government-sponsored pre-departure orientation programme,[8] which includes an HIV component.[9] The programme is conducted in accordance with Article 34 of the Placement and Protection of Indonesian Manpower in Foreign Countries (PPIMFC) Bill, passed in 2003, implementation of which is the responsibility of the Ministry of Labour and Transmigration. Since 2007, the programme was implemented by the National Authority for the Placement and Protection of Indonesian Overseas Workers (BPN2TKI – Badan Nasional Penampatan dan Perlindungan Tenaga Kerja Indonesia), which works directly under the supervision of the President and is tasked with integrating services and sharing responsibilities related to the placement and protection of overseas workers.[10] Migrants leaving Indonesia attend the programme in the town or city through which they depart the country as documented workers. As of 2007, there were a total of fifteen established centres across the country with each centre being managed by fifteen instructors, except for the Jakarta centre which has more than one hundred and thirty instructors.[11]
This paper challenges the notion that the HIV/AIDS component of the pre-departure orientation programme helps to create awareness and thereby protects prospective migrants against an HIV infection through educational efforts. Specifically, the paper critiques the basic assumption that the individual migrant is responsible for his/her health outcome in the migration process. The assertion here is that, while the programme generally increases awareness about HIV/AIDS in spite of its flaws, the orientation actually does little to protect prospective women migrants because it overlooks the structural and institutional factors responsible for their vulnerability to HIV in the migration process. Arguments have been put forth for the success of Individualist Health Promotion Programmes (IHPPs) wherein the individual is held responsible for his/her health outcome. In response, many criticisms have been levelled against IHPPs, particularly as they do not show positive results and are considered to be relatively unsuccessful.[12] This health model has been criticised for being simplistic in approach and lacking understanding of human behaviour because increased health knowledge does not necessarily translate into behaviour modification.[13] Others assert that health behaviour points to a complex 'interlocking' between the personal and social and, as such, disease preventive measures encompass a confluence of self-centred and social variables.[14] Among women migrants, their limited capacity to avoid certain contexts may increase their vulnerability to HIV. Since the pre-departure programme does little to take into account the social situations that frame a person's decision about their health outcomes, the programme tends to be victim blaming as it puts pressure on migrant women to determine their own health outcomes.
In Indonesia, the export of labour has been explicitly outlined in the country's economic plans since the 1970s.[15] It was in the 1980s under the Third Five-Year Plan (1979–1984) that Indonesia saw a dramatic increase in women leaving for employment abroad. During that period, there was a total of 55,000 women migrants compared with 41,410 men migrants.[16] From 1990 to 2005, however, there was a jump from 90,000 to around half a million Indonesians leaving the country for work abroad through official channels [17] Estimates from BNP2TKI in 2007 show that women formed the majority of migrants seeking employment abroad (78%), and mostly in the domestic work sector (see Table 1). Destination economies in which women migrants can find employment include Saudi Arabia, Malaysia, Singapore, Taiwan, and Hong Kong.

Year 2000 2001 2002 2003 2004 2005 2006 2007
Number 297273 239942 363614 213824 296615 325045 542000 543859
Percentage 68.3 81.3 75.7 72.8 77.9 68.5 79.7 78.0

Table 1. Number and Percentage of Women Migrants from Indonesia in International Labour Flows

Sources. Penemptan Tenaga Kerja Indonesia 1994–2007, "Menurut Jenis Kelamin dan Negara Tujuan", (BNP2TKI-Badan Nasional Penempatan dan Perlindungan Tenaga Kerja Indonesia (Indonesian National Authority for the Placement and Protection of Indonesian Overseas Workers), online: http://www.bnp2tki.go.id/content/view/180/87/>, accessed 25 July 2010.

Data collection
The bulk of the data for this paper was gathered in Jakarta, in August 2008. In-depth interviews were conducted with officials and staff members from the National AIDS Commission (KPA), Indonesian National Authority for the Placement and Protection of Indonesian Overseas Workers (BPN2TKI), the Ministry of Health, and an instructor trained in implementing the pre-departure programme. Interviews were also carried out with labour-recruitment agencies, and various commercial enterprises, international and local non-governmental organisations. Since 2008, I have maintained ongoing contact with key respondents in order to keep abreast of new developments on issues related to public health, HIV and migration.
During fieldwork in Jakarta, I was able to observe the implementation of the pre-departure orientation programme. But as I only had the opportunity to observe one class, the findings presented in this paper are provisional. Nevertheless, it was an opportunity to observe how information on HIV and STIs was conveyed to programme participants and the responses of prospective migrant women to the programme.

Preparing for work abroad: the pre-departure orientation programme
Prospective women migrants who receive travel documents and are given clearance to work must attend the pre-departure orientation programme prior to departure. The programme aims to increase protection among migrant workers,[18] and includes the provision of information about recruitment procedures, documentation requirements, their rights and responsibilities, the conditions and risks of working in the destination country, and the system of protection for migrant workers in the destination country.[19]
Held over a day, the pre-departure orientation programme consists of a fixed format of four sessions with each led by a different instructor. The first session covers employment contracts, while the second outlines the duties and obligations that come with being employed as a foreign worker. The third session covers working conditions in the placement country (including culture); and the last section is devoted to drugs, HIV and sexually transmitted infections (STIs), and human trafficking. Each session is scheduled to last for about two hours, although the actual time devoted to any one topic within the larger topic for that session varies considerably.
Recruitment agents are responsible for ensuring that prospective women migrants attend the programme on the day it is held. The pre-departure programme is supposed to be organised at no cost to migrant workers. However, an NGO staff member I interviewed during fieldwork in Jakarta asserted that the cost is borne by the migrant worker factored into the amount she owes a recruitment agency:
That the cost of the programme is then deducted from her salary on her commencing work in the destination country was a point later found also to be highlighted in the report of another NGO.[21]
On average, a class consists of about sixty to seventy participants. The class that was observed consisted of about seventy married and unmarried women participants in their twenties to late forties, and all were departing for Singapore. The programme is conducted by instructors who undergo intensive training conducted by the Manpower and Transmigration Ministry together with the International Labour Organization.[22]
In the half an hour devoted to HIV in the session I observed, the instructor provided factual information on modes of transmission and protection. For example, prospective women migrants were told that they could not get HIV from kissing unless there was a wound in the mouth of a person with HIV, and that a blood test is necessary to test for HIV. Interestingly, the presentation of HIV facts was punctuated by an example of a woman who suspected her husband of having HIV because of his infidelity. While elaborating on this point, the instructor remarked that if a woman found herself in this situation, she should refrain from getting angry with her husband and instead should use a condom (guna condom) in the event that her husband demands sex.
It was only in this context that the concept of safer sex and condom use was raised. While safer sex is a concept widely used in HIV awareness programmes, this practice was not promoted to prospective women migrants, except for this one instance. In this case, discussion of sexual activity and condom use was confined to women's marital relationships and did not consider sex outside of marriage. Moreover, a migrant woman who might suspect her husband of being unfaithful during their physical separation because of her work abroad was advised by the instructor to be accepting of his HIV status. By doing so, the instructor appeared to be encouraging patriarchal values, in addition to reinforcing passivity among the women he was addressing in matters related to their health outcome. In encouraging an attitude of deference, his advice in this context may have been in accordance with religious as well as social teachings of not breaking up the marriage irrespective of the issue of infidelity. Furthermore, the assumption that the woman is able to negotiate safer sex by requesting that her husband use a condom assumes a level of gender equality and ability to negotiate which may not exist.[23]
Potential women migrants who participated in the programme were also introduced to what a condom looked like through an illustration the instructor drew on the white board. Visually, the participants learned how sperm is trapped in the condom in the event of male ejaculation. At this point, it was observed that many women in the room felt embarrassed since discussing sex openly is taboo in Indonesia.[24] Aside from HIV, the instructor also provided information on STIs, once again using pictures to show symptoms of these infections—illustrations to which most participants reacted with repulsion.
Throughout the session, the term seks bebas (free sex) was used repeatedly in the context of how HIV is sexually transmitted. The term itself refers to having multiple sexual partners and the sexual encounter being 'loose' or 'amoral' and unhampered by marital relations.[25] Participants in the session were constantly reminded not to engage in sex outside marriage or with someone to whom they were not married, or in other words to say no to seks bebas.
Interestingly, the position the instructor took appeared to be in keeping with the teachings of Islamic religious teachers who do not condone condom use because of its association with sex outside marriage and having multiple partners, an issue that was confirmed in the interviews I conducted. The extent to which religious leaders have distorted the facts on HIV and hampered HIV prevention strategies were highlighted by an NGO staff member:
In the same vein, the instructor of the programme I observed had presented HIV as a religious and moral issue rather than a medical problem with social implications. This, however, has become a common method of presenting information on HIV in the country,[27] indicating how powerful the voices of religious leaders had become, a point highlighted by a government official:
That this observation was not unique to the programme I observed may be deduced from a report by Solidaritas Perempuan (2006)[29] that noted instructors at a pre-departure programme in Jakarta emphasised religious involvement and the avoidance of casual sex, alcohol and drugs as strategies for HIV prevention.
In addition, the instructor did not make clear the distinction between HIV and AIDS, and no mention was made of important and vital anti-retroviral treatments available to people living with HIV. The over-simplification of information in this case might be explained by time constraints. On average, most instructors working on this pre-departure programme devote only fifteen minutes to discussing HIV. Although on some occasions, more time may be devoted to the topic because the Manpower and Transmigration Ministry has allocated 30 minutes for this session.[30] In the session I observed, more than thirty minutes was dedicated to HIV and STIs. But that may have been because of my presence on the day and the instructor's knowledge that I was there to observe how information on HIV and STIs was conveyed to the participants.
During the session, the instructor did not discuss how women migrants could protect themselves if they found themselves in a situation where their sexual rights may be violated. In fact, this point was not raised in any of the sessions I observed. For example, there was no mention of the courses of action available to a migrant woman if she found herself subject to unwanted sexual advances from her male employer or members of his extended family. This issue is important because the training programme is aimed at ensuring protection for women migrants in relation to HIV transmission, and research has shown that migrant domestic workers are particularly vulnerable to such abuses.[31] Instead, the instructor emphasised the point that migrant women be 'serviceable' to employers, indeed, even if this was at the expense of her rights and dignity as a worker and a human being.
In sum, the programme assumes that the prospective woman migrant is solely responsible for her own health outcomes in relation to the decisions she may make regarding sex. The undue emphasis placed on abstinence from seks bebas and the underlying assumption that women are able to protect themselves shows the highly individualistic health promotion strategy informing the pre-departure programme. However, there is a need to provide migrant women with information on safer sex, for migrant women do engage in sex with local and foreign men while on placement abroad, which suggests the need to rethink the current approach of just saying no to seks bebas.
The assumption that a prospective woman migrant is solely responsible for her own health outcomes has the effect of blaming the victim because migrant women are considered solely responsible for the circumstances in which they may find themselves (for example, contracting HIV while working overseas or from her unfaithful husband), without recognising the existing social, structural and institutional factors in sending and receiving countries which also contribute to a woman's vulnerability to HIV.[32] Notably, there is a relative absence of targeted HIV prevention initiatives in Singapore, which is a labour-receiving country.[33] Singapore's labour laws stipulate that only migrant women in their reproductive years be recruited to work in the country,[34] and, as a temporary low-skilled labourer, women are not permitted to bring their husbands and families with them. In such situations, it is not uncommon for women to seek friendships and relationships with men as a way of coping with loneliness felt during their long absences from loved ones.[35] In this case, their behaviour should also be understood within a specific social context as these women move from a country marked by strict codes of sexual conduct, that is, their home country to another which is more liberal or at least different such as Singapore or Hong Kong where there is an absence of social pressure to maintain their religious norms and identity.[36] As a result, 'all kinds of sexual behaviour seem to be possible abroad, as long as other people do not find out';[37] for this reason, they may act differently than usually expected of them if they were back in their home countries. Katie Walsh argues that performances of couple intimacy are closely associated with the 'broader processes of the re-constitution of identities through travel'.[38] In the context of Indonesian migrant women, 'the imagined distance between home and away provides…the confidence to feel able to take risks'.[39]
The questions around the adequacy of the information covered in the pre-departure orientation programme protecting migrant women are complicated by other factors. In Singapore, for example, the labour laws do not grant low-skilled female migrants access to reproductive and sexual health services through the national healthcare system and private clinics are generally inaccessible because these clinics are expensive. The only exception to this is found in the labour laws which stipulate that migrant women must undergo bi-annual medical check-ups during their period of contracted employment. This check-up includes testing for pregnancy and HIV. If a woman's results come back as positive for either, she is immediately deported from the country, regardless of the circumstances surrounding her case.[40] Because of this policy of deporting HIV-positive migrant women, Singapore has little incentive to actively drive home the message about HIV prevention.
However, migrants may receive reproductive and sexual health information from non-governmental organisations that focus on migrant worker issues. But outreach efforts tend to be piecemeal. Brochures on HIV printed by the government are also available at government hospitals and clinics as well as private clinics; however, these materials are not aggressively promoted. If migrant women come from countries where HIV awareness levels are low in the general population, these women may place their health at risk if they engage in unprotected sex with local men, fellow-country men in the destination country, or other foreigners. Furthermore, prospective women migrants are also vulnerable to HIV in Indonesia before departing for work abroad because there are no legal or policy mechanisms to ensure their sexual safety in the dormitories where they are housed.[41]
Clearly, a migrant woman's vulnerability to HIV does not rest solely on her own actions and, as such, the programme tends to 'blame' these women rather than raise the levels of protection. It must be noted here that the idea that 'individual decision-making is the key site for risk minimization'[42] is simplistic for two other reasons. First, it presupposes the absence of power differentials in the relationship between the migrant worker and the other stakeholders in the migration process, namely, the state (both sending and receiving countries), recruitment agents and brokers, and the employer, and the employer's family and friends. Second, the highly-gendered social order in sending and receiving countries means that practising safer sex is a complex terrain in which women are often less able to negotiate for condom use with men.[43]
Furthermore, while the home may be regarded as a safe haven for families, for migrant domestic workers who work behind closed doors, their vulnerability to sexual abuse by their employer and members of their extended family may be heightened, especially in light of the power differentials between employer and employee.[44] Poverty, low levels of education and language and cultural barriers further marginalise domestic workers, making it more difficult for them to protect themselves from such harms.

Conclusion

The plea for government intervention in protecting the rights of migrant women is reflected in the words of Normawati, an HIV activist who heads the non-governmental organisation, Migrant Workers' Advocacy and Development (PPTKI), based in Indonesia:
In its current form, the HIV prevention programme for Indonesian migrants focuses on raising awareness as a means to preventing HIV transmission. But, focussing entirely and exclusively on the individual with scant attention paid to the social, structural and institutional determinants increases the vulnerabilities women face to HIV and other forms of sexual abuse and exploitation in the migration process. Overall, the programme places pressure on women to protect themselves, and when they find themselves in situations where they are unable to do so, the system tends to blame them for the outcome. While the pre-departure orientation programme does provide relevant information to the participants aimed at protecting women migrants, this research reveals that the inherent flaws in the programme give rise to questions about the validity and extent of its helpfulness to migrant women.
The fundamental problem in the programme is that it fails to acknowledge the distinction between 'knowing' and 'doing.' This is to say that while women may know how to protect themselves having gained some knowledge on HIV during the programme or for that matter in other circumstances prior to attending the programme, this does not automatically translate into specific actions that would ensure their protection in the migration process. To put it differently, the programme assumes that women migrants have 'some choice and some power in [their lives. While this may be true for the middle class,]…this vastly exaggerates the options for the poor and economically vulnerable',[46] a group to which female migrants belong since they face different forms of marginalisation at the various stages of the migration process.[47]
Given the complex interplay of factors related to migrant worker health outcomes, holding the individual accountable for his/her health outcome may be said to be 'infinitely easier–than to write policy that addresses structural change.'[48] On the part of the Indonesian government, it is much easier to have prospective migrant women attend an orientation programme rather than address the social, structural and institutional factors shaping migrant women's vulnerability to HIV. Moreover, the programme continues to rely on the rhetoric of public health promotion and its focus on individuals and behavioural change as a way to prevent HIV, and in a way this provides the Indonesian and Singaporean governments with an escape clause for their failure to address the inequities and power differentials embedded in the migration process and the social determinants of health among their migrant worker communities.[49]

Endnotes

[*] The author wishes to acknowledge the Institute of Southeast Asian Studies in its generous financial support towards this research project. She also wishes to thank the anonymous reviewers and editor of this Special Issue for their comments as well as the individuals whom she had interviewed in Indonesia and Singapore for their patience and kind assistance.

[1] Pandu Riono and Saiful Jazant, 'The current situation of the HIV/AIDS epidemic in Indonesia,' in AIDS Education and Prevention, vol. 16, Supplement A (2004): 78–90.

[2] Rokiah Ismail, 'Sexually transmitted disease (STD) and acquired immunodeficiency syndrome (AIDS) in South East Asia,' in Clinics in Dermatology, vol. 17(1999): 127–35.

[3] National AIDS Commission, National AIDS Commission 2007–2010 HIV and AIDS Response Strategies, 2007, URL: http://www.undp.or.id/programme/propoor/The%20National%20HIV%20&%20AIDS%20Strategy%202007-2010%20%28English%29.pdf, accessed 5 June 2010.

[4] National AIDS Commission, National AIDS Commission 2007–2010 HIV and AIDS Response Strategies; see also Hasil Sensus Penduduk 2010: Data Aregat per Provinsi. Jakarta, Indonesia: Badan Pusat Statistik, 2010, p. 7, online: http://dds.bps.go.id/eng/download_file/SP2010_agregat_data_perProvinsi.pdf, site accessed 5 January 2011.

[5] National AIDS Commission, National AIDS Commission 2007–2010 HIV and AIDS Response Strategies.

[6] Riono and Jazant, 'The current situation of the HIV/AIDS epidemic in Indonesia', p. 78.

[7] National AIDS Commission, National AIDS Commission 2007–2010 HIV and AIDS Response Strategies.

[8] The term 'documented migration' refers to human flows taking place through official and legal recruitment channels which are often heavily bureaucratic and mostly governed by the state. In contrast, human flows also occur through unofficial, illegal channels dominated by informal networks of brokers and agents. There is a fine line, however, between being documented versus undocumented. For example, a woman may leave her country on a tourist visa and end up in Singapore, for example, with a work permit issued by the Singapore government. While she is a documented migrant worker in Singapore, her movements have not been recorded in her own country. While a substantial proportion of migrants leave the country through official channels, Graeme Hugo (2007) maintains that there is 'an even larger number leav[ing] the nation legally but do not register as overseas contract workers (OCWs) with the Ministry of Labor, or depart from Indonesia without going through any official process,' (see 'Indonesia's Labor Looks Abroad,' Migration Information Source, URL: http://www.migrationinformation.org/feature/display.cfm?ID=594, accessed 5 January 2011, paragraph 22). Elsewhere, Graeme Hugo mentions that women dominate legal channels of migration compared with men. See Internal and International Population Mobility: Implications for the Spread of HIV/AIDS, Indonesia: UNDP South-East Asia HIV and Development Office, UNAIDS and International Labour Organization, 2001, online: http://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo-jakarta/documents/publication/wcms_141794.pdf, accessed 5 January 2011.

[9] Since the pre-departure programme only captures the participation of documented workers, it may be deduced that those who leave through undocumented processes fall through the cracks because they would not have attended the pre-departure programme. According to the Indonesian Director-General of Labor Placement Overseas, there were more than a million Indonesians working abroad illegally in 2005. Of this figure, he estimated there were 400,000 undocumented Indonesians working in Malaysia; 400,000 in Saudi Arabia; 20,000 in South Korea; and 8,000 in Japan. See 'Indonesia's Labor Looks Abroad,' paragraph 31.

[10] Aris Ananta, 'Estimating the value of the business of sending low-skilled workers abroad: an Indonesian case,' Paper presented at XXVI IUSSP International Population Conference, Marrakech, Morocco, 27 September – 2 October 2009.

[11] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin, Jakarta: International Labour Organization, 2007, online: http://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo-jakarta/documents/publication/wcms_125696.pdf, accessed 25 May 2011.

[12] Alan Beattie, 'Knowledge and control in health promotion: a test case for social policy and social theory,' in The Sociology of the Health Service, ed. Jonathan Gabe, Michael Calnan and Michael Bury, London: Routledge, 1991, pp. 162– 202; David Mechanic, 'Promoting health: implications for modern and developing nations,' in Health and Social Change in International Perspective, ed. Lincoln C. Chen, Arthur Kleinman and Norma C. Ware, Boston, Massachusetts: Harvard University Press, 1994, pp. 471–89.

[13] Paul Bennett and Ray Hodgson, 'Psychology and health promotion,' in Health Promotion: Disciplines and Diversity, ed. Robin Bunton and Gordon Macdonald, London: Routledge, 1992, pp. 22–38.

[14] Elisabeth Kals and Leo Montada, 'Health behavior: an interlocking personal and social task,' in Journal of Health Psychology, vol. 6, no. 2 (2001): 131–48.

[15] Carunia M. Firdausy, 'Trends, issues and policies towards international labour migration: an Indonesian case study,' UN Expert Group Meeting on International Migration and Development, New York, 6–8 July, 2005, as cited in Md Mizanur Rahman, Gender Dimensions of Remittances: A Study of Indonesian Domestic Workers in East and Southeast Asia, Bangkok: UNIFEM, n.d., online: http://unifem-eseasia.org/docs/2008_Gender_dimension_of_Remittances.pdf, accessed 15 January 2011.

[16] Asian Migration Centre, 2005, as cited in Rahman, Gender Dimensions of Remittances.

[17] Solidaritas Perempuan, Migrant Workers & HIV/AIDS, Special Publication on XVI International AIDS Conference, Toronto, Canada, 13–18 August 2006.

[18] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[19] Solidaritas Perempuan, Migrant Workers & HIV/AIDS.

[20] Telephone interview with Agung, Researcher, 19 July 2011.

[21] See also Thaufiek Zulbahary and Tabah Elanvito, State of Health of Indonesian Migrant Workers: Access to Health of Indonesian Migrant Workers, 2005 Report, Jakarta: Solidaritas Perempuan, 2006. In Singapore, for example, new foreign domestic workers have their salaries deducted from a few months up to more than a year. It was found that maid agencies declare that the deducted amount goes into covering the costs she had incurred in securing employment: her airfare, the training she had received to prepare her for the job (including her accommodation, food, and so forth when she lived at the dormitories), the medical check-up, insurance, and the processing of her passport and other documents. On average, a Filipina domestic worker in Singapore had her salary deducted over a period of five to eight months to repay these costs, whereas an Indonesian domestic worker could take up to a year. See Chi Ying Sim, '$10 a month for 11 months,' The New Paper, 10 August, 2005.

[22] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[23] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[24] Gary Smith, Susan Kippax, Peter Aggleton and Paul Tyrer, 'HIV/AIDS school-based education in selected Asia-Pacific countries,' in Sex Education, vol. 3, no. 1 (2003): 3–21.

[25] Simon Simon and Susan J. Paxton, 'Sexual risk attitudes and behaviours among young adult Indonesians,' in Culture, Health & Sexuality, vol. 6, no. 5 (2004): 393–409.

[26] Interview with Aris, Director for Healthcare Programme, 18 July 2008, Jakarta.

[27] Note also that condom use linked to high risk sex is thought of in Indonesia to be a moral and not a public health issue. See Kai Spratt, 'Implementing 100% condom use policies in Indonesia: a case study of two districts in Jakarta,' USAID Health Policy Initiative, 2007, online: http://www.healthpolicyinitiative.com/Publications/Documents/398_1_Indonesia_Cup_Case_Study_FINAL_2_28_08.pdf, accessed 12 January 2011; see also Simon and Paxton, 'Sexual risk attitudes and behaviours among young adult Indonesians.'

[28] Interview with Eko, Senior Advisor, 27 June 2008, Jakarta.

[29] Solidaritas Perempuan, Migrant Workers & HIV/AIDS.

[30] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[31] Brenda Yeoh, Shirlena Huang and Theresa Devasahayam, 'Diasporic subjects in the nation: foreign domestic workers, the reach of the law and civil society in Singapore,' in Asian Studies Review, vol. 28, no.1 (2004): 7–23.

[32] See Howard Waitzkin, The Second Sickness: Contradictions of Capitalist Health Care, New York: Free Press, 1983.

[33] Although there are no targeted HIV prevention interventions for women migrant workers in Singapore, there have been efforts directed at male migrant workers by non-governmental organisations focused on migrant worker health concerns. At the Karunya Community Clinic located in Little India, brochures on HIV prevention are distributed without cost to patients comprising mostly male foreign workers.

[34] Theresa W. Devasahayam, 'Placement and/or protection?: Singapore's labour policies and practices for temporary women migrant workers,' in Journal of the Asia Pacific Economy, vol. 15, no. 1 (2010): 45–58.

[35] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[36] Ivan Wolffers, Irene Fernandez, Sharuna Verghis and Martijn Vink, 'Sexual behaviour and vulnerability of migrant workers for HIV infection,' in Culture, Health & Sexuality, vol. 4, no. 4 (2002): 459–73.

[37] Wolffers, Fernandez, Verghis and Vink, 'Sexual behaviour and vulnerability of migrant workers for HIV infection,' p. 470.

[38] Katie Walsh, 'It got very debauched, very Dubai! Heterosexual intimacy amongst single British expatriates,' in Social & Cultural Geography, vol. 8, no. 4 (2007): 507–33, p. 508.

[39] Martin Cox, 'Gay holidaymaking: a study of tourism and sexual culture,' PhD thesis, University of London, 2001, p. 103, as cited in Walsh, 'It got very debauched, very Dubai!, p. 510.

[40] Avanti Aiyer, Theresa W. Devasahayam and Brenda S.A Yeoh, 'A clean bill of health?: Filipinas as domestic workers in Singapore,' in Asian and Pacific Migration Journal, vol. 13, no. 1 (2004): 11–38.

[41] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[42] Shari L. Dworkin and Anke A. Ehrhardt, 'Going beyond "ABC" to include "GEM": critical reflections on progress in the HIV/AIDS epidemic,' in American Journal of Public Health, vol. 97, no. 1 (2007): 13–8; p. 13.

[43] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[44] Yeoh, Huang and Devasahayam, 'Diasporic subjects in the nation: foreign domestic workers, the reach of the law and civil society in Singapore.'

[45] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin, p. 18.

[46] Katy Richmond and John Germov, 'Health promotion dilemmas,' in Second Opinion: An Introduction to Health Sociology, ed. John Germov, Melbourne, Victoria: Oxford University Press, pp. 208–28, p. 218.

[47] International Labour Organization, HIV/AIDS and Migrant Workers Bulletin.

[48] Low, Jacqueline and Luc Thériault, 'Health promotion policy in Canada: lessons forgotten, lessons still to learn,' in Health Promotion International, vol. 23, no. 2 (2008): 200–6, p. 205.

[49] Kim L. Bercovitz, 'Canada's active living policy: a critical analysis,' in Health Promotion International, vol. 13, no. 4 (1998): 319–28, as cited in Low and Thériault, 'Health promotion policy in Canada.'

Published with the support of Gender and Cultural Studies, School of Culture, History and Language, College of Asia and the Pacific, The Australian National University.
URL: http://intersections.anu.edu.au/issue26/devasahayam.htm
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