Sitting in a waiting room at a Bandung health clinic, Ciner patiently prepares herself to undergo a voluntary counseling test.
“It’s been three months since I last took the test,” the 24 year-old transgender said. She tried hard to hide her nervousness, unsure whether this time she will test positive for HIV.
Ciner has taken the test (VCT) at Mawar clinic numerous times where free tests are offered for sex workers, drug users and those who are vulnerable to HIV/AIDS.
Despite her repeated visit, Ciner couldn’t help feeling apprehensive. She is after all a prostitute.
There were five transgenders taking the VCT that day. They were mostly prostitutes like Ciner who roam the Binong area of Bandung.
Ayu, a social worker from Srikandi Pasundan, an organization that advocates for transgender empowerment, said that it is difficult to convince the dozens of transgender prostitutes in Binong to take the voluntary test and practice safe sex.
“Most of them refuse to go to the clinic. Sometimes I feel it is easier to take care of my seven cats than take care of these transgenders,” said Ayu, herself a transgender and a prostitute.
The 31-year-old social worker said that she joined Srikandi two years ago after attending one of the group’s sessions.
“Before [joining Srikandi] I used to take [safe sex] for granted. I wasn’t taking care of my own health let alone helping others. But after joining Srikandi Pasundan and attending their sessions I became more aware of [HIV]. I’ve seen examples, cases. That’s when it hit me. I need to take my friends to these sessions and tests.”
Ayu said that although she still roams the streets of Binong at night, during the day she helps Srikandi by documenting her sex-worker friends, convincing them to attend HIV awareness seminars and sessions as well as taking the VCT.
“I want my friends to be healthy. If I don’t do it, who else?” she said.
Because Ayu can empathize with her friends’ hopes and fears as a transgenders and sex workers, she was able to convince some of them to join Srikandi’s sessions. When three of them tested positive for HIV, the effort snowballed.
“Now they are eager to take the VCT, even though they are busy they always make time for the test,” she said adding that eventually her sex-worker friends began spreading the message to their clients.
“It takes tenacity,” she said. “From constant persuasion to explaining the many diseases that can be transmitted [sexually].”
Okkeu Supriyadi, Srikandi’s coordinator, said that as of June this year, there are 142 transgenders under the group’s watch who have tested positive for HIV, 85 of them are already at the AIDS stage. “There are new cases every month,” he said.
At the moment, Okkeu said, Srikandi has 25 volunteers like Ayu who go to the field to monitor and assist around 400 transgenders in Bandung.
“Actually there is a shift in the transgender community toward a healthier lifestyle. There is now a high demand for condoms. They begin to see the importance of their health. It is pretty rewarding although not yet ideal,” he said.
According to the Ministry of Health as of December last year, the cumulative amount of HIV/AIDS cases in West Java since 1989 has reached 14,596, the fourth-highest in the country after Jakarta, East Java and Papua.
Despite being considered a group that is highly vulnerable to HIV, transgenders only make up 6 percent of those with HIV in the province.
“The HIV trend in West Java is more toward the heterosexual groups,” said Bony Wiem Lestari, a researcher at Bandung Padjadjaran University’s (Unpad) medical school adding that housewives who contracted the disease from their husbands top the list of groups with HIV in the region.
But Arry Lesmana Putra, secretary of the West Java office of the National AIDS Commission said that doesn’t mean the risk is now lower among transgenders.
“However through Srikandi Pasundan’s outreach program, we can control the HIV spread among transgenders easier,” he said.
Srikandi Pasundan was established on Nov. 9, 2004 by five transgenders. Okkeu has been its coordinator ever since.
“The initial goal was to empower transgenders in Bandung. We want to empower them in all fields, health, social and the economy. You see, transgenders are a minority and are often marginalized,” Okkeu explained.
But the group soon realized that there was a more immediate need to prevent the spread of HIV and ensure that those who are already infected have access to professional health care.
The two goals are well aligned, said Pungky Desy, community manager of the Anti-Poverty Confederation (KAP), which works closely with Srikandi.
Pungky said members of the transgender community often find themselves trapped in a cycle of poverty and HIV vulnerability.
Transgenders are stigmatized because they are vulnerable to HIV, which means they are marginalized within society and lack access to formal employment, she said. Eventually, they are forced into the streets to become sex workers, which makes them even more vulnerable to HIV and stigmatization.
“When they have skills, a job that they are interested in, we can take them away from the streets,” she said.
For Ciner however, she chooses to remain in her profession of the last 15 years despite going to Srikandi’s sessions. But she claims that she is now choosier about her clients despite losing some of her regular customers.
“There are so many who refuse to wear condoms. I just keep on persuading them. If they still don’t want to [wear condoms] I turn them down,” she said.
But even then there is no guarantee. “We never know [whether an infection has occurred]. Some don’t use condoms during oral sex and that could lead to infection due to ulcers,” Ciner said of the reason why she regularly takes VCTs at the clinic.
Finally it’s Ciner’s turn to take the test. The doctor took a blood sample and the lab result was ready in just over an hour — Ciner tested negative.