UvA-DARE (Digital Academic Repository) Mobilizing motherhood: case study of two women's organizations advocating HIV prevention programs in Indonesia Imelda, J.D. Publication date 2011 Document Version Final published version Link to publication Citation for published version (APA): Imelda, J. D. (2011). Mobilizing motherhood: case study of two women's organizations advocating HIV prevention programs in Indonesia. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. 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UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:25 Sep 2021 Johanna Debora ImeldaJohanna Debora Mobilizing Mobilizing Motherhood: Motherhood: A Case Study of Two Women’s Organizations A Case Study of Two Women’s Organizations Advocating HIV Prevention Programs Advocating HIV Prevention Programs in Indonesia in Indonesia This PhD project examines the strategy of mobilizing motherhood in Indonesia Programs HIV Prevention Advocating Organizations Women’s Study of Two A Case Motherhood: Mobilizing through two Indonesian women’s organizations – the Pembinaan Kesejahteraan Keluarga (Family Welfare Movement, or PKK) and Tim ODHA Perempuan (Seropositive Women’s Team, or TOP Support) – in the attempt to make prevention of mother-to-child transmission of HIV (PMTCT) programs more socially acceptable. Motherhood and HIV/AIDS are in fact seen as contradictory concepts. However, at a time when PMTCT programs are being promoted, the image of HIV is changing from the disease of ‘women without morals’ to a disease of devoted housewives, which has resulted in the better acceptance of HIV prevention programs in society. The PKK is a formal government led community organization which is socially and politically structured from the very lowest level in the community up to the national level. The involvement of the PKK in maternal and child health programs has contributed to their image of being good housewives and responsible mothers, which has enabled the cadres to gain trust, especially from husbands, to allow them to bring pregnant women to participate in the mobile VCT service. Unfortunately, PMTCT project is not considered of prime importance for the PKK cadres. The notion of ‘sacred motherhood’ enables TOP Support members to project an image of being devoted wives and mothers who were infected by their badly behaved husbands, and who therefore unfortunately (and unknowingly) transmitted the disease to their children. They rework their identity from one of sinful and immoral women to innocent and devoted mothers, and thus generate trust between other seropositive mothers and within the community. The general lack of experience of severe symptoms and ease of access to medical care explains why TOP Support members do not actively champion PMTCT as part of the women’s reproductive health movement. In their involvement in the PMTCT pilot project, the PKK cadres and TOP Support members are able to convert the social capital derived from respected motherhood into social benefits and opportunities to access economic capital. These economic benefits lead the PKK cadres and TOP Support members to regard PMTCT more as an income generating activity rather than a part of the women’s reproductive health movement. This study suggests that there are significant challenges to the promotion of programs such as PMTCT for women through motherist organizations. Johanna Debora Imelda cover debby.indd 1 8/5/11 10:24:40 AM Mobilizing Motherhood: A Case Study of Two Women’s Organizations Advocating HIV Prevention Programs in Indonesia Lapdes Isi.indd 1 8/5/2011 10:10:54 PM Lapdes Isi.indd 2 8/5/2011 10:10:54 PM Mobilizing Motherhood: A Case Study of Two Women’s Organizations Advocating HIV Prevention Programs in Indonesia ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. D.C. van den Boom ten overstaan van een door het college voor promoties ingestelde commissie, in het openbaar te verdedigen in de Agnietenkapel op woensdag 14 september 2011, te 14.00 uur door Johanna Debora Imelda geboren te Jakarta, Indonesie Lapdes Isi.indd 3 8/5/2011 10:10:54 PM PROMOTIECOMMISSIE Promotor: Prof. dr. A.P. Hardon Co-promotor: Prof. dr. B.S. Laksmono Overige leden: Prof. dr. J.D.M. van der Geest Prof. dr. F. Gouda Dr. E. Moyer Prof. dr. R. Reis Dr. P. Wright Faculteit der Maatschappij- en Gedragswetenschappen Lapdes Isi.indd 4 8/5/2011 10:10:54 PM List of Contents Acknowledgements ix Chapter 1 Introduction: Mobilizing Motherhood for the Prevention of HIV 1 Chapter 2: Applying the Concepts 15 Chapter 3 The Emergence of a PMTCT Program in Indonesia: From the Disease of Women without Morals to the Disease of Mothers 24 Chapter 4 The Role of PKK Cadres in PMTCT: Different Job, Same Role 38 Chapter 5 Empowerment of the Domestic Identity 65 Chapter 6 TOP Support Group Members: HIV Trajectories and Interpretations 89 Chapter 7 The Reworking of HIV Positive Identities 132 Chapter 8 Conclusion and Challenges 154 References 168 Summary 182 Samenvatting 187 Lapdes Isi.indd 5 8/5/2011 10:10:54 PM List of Figures, Graphics, and Tables Chapter 1 Figure 1 : PMTCT Pilot Project 5 Figure 2 : Cumulative AIDS cases in Jakarta, March 2009 12 Chapter 2 Figure 1 : Mobilizing Motherhood to Prevent HIV 20 Table 1 : Social Capital Mobilized by the PKK 3 and TOP Support to Promote PMTCT 23 Chapter 3 Graphic 1 : Number of AIDS Cases Reported by Year up to December 2010 25 Graphic 2 : Number of Male and Female PLWHA 26 Graphic 3 : Cumulative AIDS Cases among Positive Children in Indonesia up to December 2010 27 Figure 1 : HIV/AIDS Transmission to Low Risk Population 28 Figure 2 : UNICEF PMTCT Public Service Advertisement 34 Chapter 4 Figure 1 : The Formal Structure of the Safe Motherhood Movement (GSI) 43 Figure 2 : Mobile VCT in Jakarta 50 Table 1 : Pre-Test and Post-Test Counselling at the Mobile VCT in Jakarta 51 Figure 3 : Mobile VCT Expansion in Six Provinces 52 Figure 4 : PMTCT Training for PKK Cadres 59 Figure 5 : PMTCT Campaign by PKK Cadres 60 Chapter 5 Figure 1 : The Number of PKK Cadres Engaged in PMTCT in Jakarta 70 Table 1 : The Profile of PKK Cadres 71 Chapter 6 Figure 1 : Support Groups for PLWHA in Indonesia, June 2007 102 Table 1 : TOP SUPPORT MEMBER LIST 124 Chapter 7 Figure 1 : Vina on a Talk Show, 2006 134 Figure 2 : Winta’s Family Tree 141 Figure 3 : Sinta’s Family Tree 143 Lapdes Isi.indd 6 8/5/2011 10:10:54 PM List of Abbreviations AIDS Acquired Immuno Deficiency Syndrome ART Antiretroviral Theraphy ARV Antiretroviral CDC-EH Centre for Disease Control and Environmental Health DFID Department for International Development DKT/KFW Dharmendra Kumar Tyagi/Kreditstanstalt für Wiederaufbau FHI Family Health International GFATM The Global Fund to Fight AIDS, Tuberculosis, and Malaria HIV Human Immunodeficiency Virus IDR Indonesian Rupiah IDU Injecting Drug User IEC Information, Education, and Communication IHPCP Indonesia HIV AIDS Prevention and Care Project ILO International Labour Organization IPPA Indonesian Planned Parenthood Association IPPF International Planned Parenthood Federation MDGs Millennium Development Goals MOH Ministry of Health NAC National AIDS Commission NGO Non Governmental Organization PCR Polymerasi Chain Reaction PLWHA People Living With HIV/AIDS PMTCT Prevention Mother-To-Child Transmission POSYANDU Pos Pelayanan Terpadu (Integrated Health Station) PUSKESMAS Pusat Kesehatan Masyarakat (Community Health Centre) UNDP United Nations Development Program UNESCO United Nations Educational, Scientific, and Cultural Organization UNFPA United Nations Population Fund Lapdes Isi.indd 7 8/5/2011 10:10:54 PM UNGASS United Nations General Assembly Special Session UNHCR United Nations Human Rights Council UNICEF United Nations Children’s Fund UNV United Nations Volunteers VCT Voluntary Counselling and Testing VOC Vereenigde Oost-Indische Compagnie (Dutch East India Company) WHO World Health Organization YPI Yayasan Pelita Ilmu Lapdes Isi.indd 8 8/5/2011 10:10:54 PM Acknowledgements I would like to express my sincere thanks to all of those who supported me in any respect during the completion of my PhD project. I am thankful to my promoter, Professor Anita Hardon, whose encouragement, supervision, and support from the preliminary to the concluding level enabled me to develop an understanding of the subject. She was always there to listen and to give advice. She showed me different ways to approach a research problem and the need to be persistent to accomplish my goal. A special thank you also goes to my co-promoter, Professor Bambang Shergi Laksmono, for his continuous support. He helped me complete the writing of this dissertation as well as the challenging research that lies behind it. He had confidence in me when I doubted myself, and brought out the good ideas in me. To all my informants, especially the mothers involved in the PKK and TOP Support, I am sincerely and heartily grateful. Without your cooperation I could not have gotten such relevant data. I have to give a special mention to the support given by the former and current staff of Yayasan Pelita Ilmu (YPI), especially to Dr.