Asia's fishermen at risk for unwanted catch: HIV

Asia's fishermen at risk for unwanted catch: HIV http://canadianpress.google.com/article/ALeqM5jhV4LiKEuDZPb_IOyuQ-FcoUmo_A

BALI, Indonesia (AP) — In appearance, they couldn't be more different.

Ririn, with her warm brown skin and plump face, simply glows. Young and sweet, just two months after giving birth to a baby girl.

Edi stands out as the roughest in a circle of men on the fishing dock. Streaks of motor oil mix with sweat on his chest and weather-beaten face as he puffs on a cigarette and talks loudly, not caring that his frayed cutoffs are unzipped.

The two are part of an expanding nexus that's spreading HIV and AIDS. He's a deep-sea fishermen who spends his short time ashore prowling for sex; she's a woman in port who gets paid to provide a warm body.

Bali is a famed tourist playground, but there's a side to the island most foreign visitors never see. Indonesian fishermen who often haven't seen land for months put in at Benoa Harbour and make straight for the closest bar with two things in mind: getting drunk and finding women.
These habits have put fishermen at high risk of getting HIV or AIDS - especially in Asia, because it's home to 2.5 million fishermen, or about 85 per cent of the world's total. Yet fishermen have been largely overlooked since the virus began raging 21 years ago, with only a handful of surveys focusing on them.

One report found that out of 10 poor countries, all but one had fishermen with HIV rates four to 14 times higher than the general population.

Two studies of fishermen on big commercial vessels found over 15 per cent were HIV-positive in Thai and Cambodian ports. That's more than five times the rate of other migrants at high risk for infection, such as truck drivers.

A few programs in Papua New Guinea, Thailand and elsewhere in the region are now working to reach fishermen, and the UN Food and Agriculture Organization earlier this year urged that they be recognized as high risk. But fishermen weren't even mentioned in UNAIDS' 630-page 2006 global report.

"I don't think there's been much targeting of treatment and health service availability," says Edward Allison, of The WorldFish Center in Malaysia, who has researched HIV in fishermen.
The bulk of Asia's fishermen are small-scale operators who return to home port frequently or stop at coastal fishing camps where women and booze are readily available. Others work aboard bigger vessels for months at a time.

In Bali, most of the fishermen are bachelors in their 20s and 30s from Indonesia's main island of Java. Many come from conservative Muslim farm families but have traded their traditions for a culture of danger and machismo.

Some return to home port in Bali at voyage's end. Others fish well beyond native waters, docking as far away as South Africa, Sri Lanka, Spain and Panama. Either way, their pockets are filled with money and the only women waiting ashore are those looking to get paid.

Ririn, who like many Indonesians uses only one name, grew up on a rice farm with her parents and seven siblings on the island of Java. She dropped out of school in fifth grade.

At 20, she was offered a chance for a better life, working as a maid on Bali, a neighbouring island she imagined was full of hope and money.

"I wanted to help my family back home," she says. "There's a lot of mouths to feed."
But after three months of cooking, cleaning and caring for someone else's children, she had only US$20.

Like many young women far from home, she was wooed by a man promising $40 to $50 a month for fewer hours. She would only do it for a little while, she thought. Just long enough to save up for a small business of her own.

After six months as a prostitute, she learned about HIV - when she tested positive. She kept working until her sixth month of pregnancy.

There are no condom machines or AIDS outreach workers on the crowded wharf in Bali. Some fishermen say they've had a disease "down there" or know someone who has, but many are convinced that certain women, mostly Indonesians, are free of HIV.

"This area is very safe," fisherman Herman Shokana said above the roar of boat engines. "But when we go abroad, we'll probably get it."

Most sailors infected with STDs treat themselves with cheap antibiotics. They may take the wrong dose or stop treatment when symptoms disappear, allowing STDs to linger, which makes it easier to contract HIV. They also are misled by greedy peddlers.

"When the ships come in, medicine vendors or peddlers are already waiting for them," said Made Setiawan, a doctoral student at the University of Illinois, Chicago, who's researching fishing culture and the risks of HIV in Bali. The peddlers' typical patter runs, "Here, take this medicine and go have sex in the brothels."

In Thailand, most commercial fishermen are Cambodian and Burmese migrants. They change boats regularly and go to different docks, making it difficult to visit clinics or get test results.
At some Thai ports, outreach workers from the nonprofit Raks Thai Foundation distribute condoms and talk to the men about AIDS. Some fishermen also are being trained to provide HIV education and help treat STDs.

But experts say there's a need to establish STD clinics at ports and better educate the fishermen about everything from safe sex to getting infections at tattoo parlors.

"We're making progress," says Brahm Press, a program manager for Raks Thai. "How much of that progress has been able to reduce the spread of HIV, we're not certain."

Edi, 20, is the shortest guy on the dock in Bali, but his muscles are the thickest. He's been on shore nearly two weeks after five straight months at sea fishing between Indonesia and Australia.

He brags he had sex with up to 10 women a night. His monthly pay of about $70 wouldn't have lasted long at the going rate of about $6 for 15 minutes.

He usually doesn't use condoms, complaining it's not satisfying. He's never been sick or tested for STDs, but points to a friend who's had syphilis.

"There's a medicine for HIV. There is a cure," he says. "Maybe it will take longer to cure, but you will get better."

While at sea, the men get little sleep and regularly risk injury or even death. They could be swept overboard in storms, get fouled in lines or cut off fingers while cleaning fish. They live in cramped boats smelling of diesel and gutted fish. Some question why they should lessen the little pleasure they get by wearing a condom.

Some fishermen also insert BB-sized, glass or plastic pellets into cuts in their penises for enhancement. The wound is sometimes still fresh when they make shore, but it doesn't stop them from hitting the bars lined with women in miniskirts.

"They don't have any self-esteem. They are ordered around by the company and the captain to do this and that," said Setiawan, who's researching the fishermen. "Sex workers can give them their self-esteem back."

Ririn, 22, may sleep with up to 10 men a night. Many are fishermen. Worried she may infect a man who could then give HIV to his wife, she sometimes begs customers to wear condoms - which is more than anyone did for her.

Most refuse.

"I tell them, 'I'm a working girl. There's a chance you might catch something from me,"' she says.

"The man says, 'That's tomorrow's problem.' "

She fears, too, that her daughter Meisa may be infected, but it will take 18 months for the test results.

Now, Ririn's back on the street, still trying to earn enough to open a small shop. She hopes she can quit within a year, but realizes it won't be easy. Especially with a hungry little one at home and a steady stream of fishermen like Edi, all in search of love for sale.