Limited Use of Health Facilities among Commercial Sex Workers
after the Closing of Red-areas
Myrtati D. Artaria and Sri Endah Kinasih
Department of Anthropology, FISIP, Universitas Airlangga, Jl. Airlangga 4-6, Surabaya, Indonesia
Keywords: Prostitution, closure of red-areas, HIV/AIDS, negative impact, illegal prostitution.
Abstract: Women's health directly affects the health of children they conceived and they gave birth. Women's health
is often forgotten and women are just objects on behalf of "development" such as family planning programs
and population control. Currently, some red-areas have been closed, and it is feared that if those sex workers
do not have a good understanding of their reproductive organs, they will have a negative impact on the
community after the closure of the red-areas. Therefore this research aimed to know the knowledge of the
sex-workers about the health of their reproductive organs. This research also aimed to know how the sex-
workers utilize the health facilities after the closing of the red-areas. The methods of data collection were
interview and observation. The location of this research was in Dupak Bangunsari, Tambakasri,
Moroseneng, Kalkah Rejo, Jarak and Dolly. The informants of this research were the former sex-workers
located in the study sites and health workers who had duties in the neighborhood. The analysis was done
after all interviews and observations were obtained, and we compiled a report while analyzing the research
data. The results shows that many of the prostitutes have minimum knowledge about HIV / AIDS and
infectious diseases in human reproductive organs. Access to health facilities has been provided, but not well
utilized, especially after the closure of the red-areas in Surabaya, where most prostitution practices take
place illegally. It can be concluded that proactive steps should be taken by health professionals to provide
knowledge on reproductive and infectious diseases, and how to maintain those women’s reproductive
organs’ health; to the active sex-workers after the closure of the red-areas. Given the fact that it is
increasingly difficult to monitor their existence, this is a warning for the government in facing one of the
negative impacts of closing the red-areas in Surabaya.
1 INTRODUCTION
Development in the field of health aims to enhance
public health status (Marmot, 2005). For the sake of
achieving a high degree of health, women as one of
the recipients of health facilities, is a family member
who must play an important role in the family
(World Health Organization, 2003), so that children
grow up well to adulthood. Therefore, women
should be given attention because women are facing
different health problems that men face with regard
to their reproductive function.
Women's health directly affects the health of
children they conceive (Shaw et al., 1995). Women's
health is often forgotten and women are just objects
on behalf of "development" such as family planning
programs and population control. The issue of
women's reproductive health has become an
international agenda in which Indonesia agrees on
the outcomes of the Conference on Reproductive
Health and Population in Beijing and Cairo.
To achieve the international agenda mentioned
above, reproductive health problems in Indonesia
should be resolved. Data from Surabaya City Health
Office show that the number of HIV / AIDS cases in
Surabaya are quite high (Riono, and Jazant, 2004),
especially in some areas such as Sawahan,
Wonokromo, Krembangan, Pabean Cantikan and
Benowo; where the red-areas are located. The
Health Office of Surabaya City found cases of HIV /
AIDS in those areas, as an impact of the existence of
prostitution localization. The HIV/AIDS came from
the red-areas and the area of Kedungdoro, Rungkut,
Gubeng and Sukolilo, which have many
entertainment business. The Surabaya City Health
Office assumes that HIV/ AIDS spread through men
640
Artaria, M. and Kinasih, S.
Limited Use of Health Facilities among Commercial Sex Workers after the Closing of Red-areas.
In Proceedings of the 2nd International Conference on Sociology Education (ICSE 2017) - Volume 1, pages 640-644
ISBN: 978-989-758-316-2
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

who become infected with HIV through sexual
contact with Commercial Sexual Workers (CSWs),
and become a source to the spread of HIV in the
community.
HIV / AIDS case in Surabaya is getting higher.
There are 254 cases of HIV / AIDS sufferers in
Surabaya, and 40% of them are in their productive
age. Among those 254 cases, 30% of them are
housewives, and the remaining 30% are employees.
After the closing of the red-areas, Surabaya City
Health Office (SCHO) checked 486 people of
CSWs. The SCHO found 45 CSWs were HIV
positive, but they were not new patients. Most of the
came from other cities such as Bandung, Indramayu,
Malang and Jember.
One of the targets of Millennium Development
Goals (MDGs) is reducing the number of HIV/
AIDS (Haines, and Cassels, 2004). Indonesia is
committed to reduce HIV/ AIDS sufferers to at least
under 0.5 percent (Kompas, Saturday, 26 November
2011). HIV/AIDS is closely related to the health of
the reproductive organs of women. The health of the
reproductive organs is closely related to the quality
of life of women.
Meanwhile, poverty is very influential to the
health of women's reproductive organs, and the
quality of their life. The inability to access
information related to reproductive healthcare,
buying a quality contraceptive device, and paying
for an ultrasound service; and ignorance of
information related to reproductive healthcare, result
in the neglect of women's reproductive organs,
including suffering from HIV/AIDS that causes
very high mortality (Guadamuz et al., 2015). The
mortality is among the highest in ASEAN
(307:100,000). Reproductive organ health is one of
the cornerstone programs in every country. This is
very much in line with the millennium development
goals that Indonesia must achieve.
CSWs’ access to health facilities is closely
linked to the decreased transmission of certain
diseases in the community, such as HIV/AIDS, and
transmittable reproductive organ diseases. Therefore
it is interesting to know, how is the CSWs’, and
former CSWs’ access to health facilities?
2 METHODS
This study employs a descriptive approach to
analyze the data. Actions and behavior are observed,
and to be analyzed qualitatively.
The research sites of this study were in Dupak
Bangunsari, Tambakasri, Moroseneng, Klakah Rejo,
Jarak, and Dolly. The researchers chose those areas
under the consideration that the six areas of
localization were: 1. It is the “hotspots”, as it had
operated as red-areas for a long time; 2. The six red-
areas were the target of East Java Governor
Soekarwo through the Decree number
260/15612/031/2011, dated December 20, 2011 and
East Java Governor's Decree Number 460 /
15612/031/2011 for immediate closure of
localization designed until 2014; 3. The six
localization is suspected by the Governor of East
Java as the center of the increasing HIV/AIDS in
Surabaya.
Some data were from the observations made
through social interaction, to find out how the access
of CSWs in reproductive organs health services.
Thus the researcher can study it, and interpret it.
The data were also obtained from in-depth
interviews. The researcher composed some basic
questions as a guide to start the conversation. The
next question is based on the answer to the main
question. To support an in-depth interview, the
researcher uses another tool, the diary, which is
divided into two: 1) a diary on research activities
and 2) a diary on interview results. The interview
was recorded and some notes were made to help
highlighting the important informations.
In addition to in-depth interview and
observations, we gathered data available in the
districts, sub-districts, Posyandu—Integrated Health
Service Unit, Statistical Center, Health Centers,
Education Center, and NGOs in the research
locations.
The informants of this study were 23 (twenty
three) informants consisting of six CSWs and former
CSWs, and two pimps who own karaoke houses and
are still operationalizing their CSWs after the
closing of the red-areas. Other than those, we
interviewed two heads of Dupak and Moroseneng
Health Centers, three staff employees who examines
the health of reproductive organs among sex workers
and former CSWs. We also interviewed the Head of
Kampongs (RW) in those areas. We interviewed
staff members from Embun Foundation that is
concentrating on the development of communicable
diseases and HIV/AIDS among CSWs in six red-
areas in Surabaya. We also interviewed one member
of FPL--Front of Localization Defenders, who
refused the closing of the red-areas.
The analysis was performed on data derived
from the observations, in-depth interviews, and
documentation. The collected data is then classified.
Furthermore, after classification, the researcher
makes the interpretation by giving meaning to the
Limited Use of Health Facilities among Commercial Sex Workers after the Closing of Red-areas
641

theme and sub theme, and searching the correlation
between data.
3 RESULTS AND DISCUSSION
3.1 The Read Areas in Surabaya
The largest red-area is located on Jl. Jalan Kupang
Gunung Timur V Raya and Putat Jaya Sawahan
subdistrict. It is well-known as “Gang Dolly”—
Dolly alley—since the 1960s.
Dolly area is not far from the transportation hub
and the inter-city and inter-provincial
transportations, making it easier for people to come
and go. Of the six red-areas in Surabaya, Dolly is the
largest. In fact, it is the largest in Southeast Asia.
Dolly's wisma—brothels—have a dramatic way
to show off sex workers by putting them in large
display areas, just like merchandized goods.
Other large prostitution areas in Surabaya are
Jarak and Putat. Each region has wismas. Every
wisma operates under the supervision of a
mucikari—a pimp.
Usually villagers who live in the same area do
not want to get too close to the sex workers. When
the sex workers have problems, the villagers do not
want to be involved. This may be because the sex
workers also tend to distance themselves to the
villagers. However, the local community often
initiated religious activities, asking the sex workers
to attend them. They think that they are helping the
sex workers to stop being sinners.
Tambakasri area is known as Kremil. The
customers in Kremil usually are lower classes,
especially crew members in Tanjung Perak. The
wismas in Tambakasri tend to blend in with the
residential houses.
In West Surabaya, 15 km from the city center
there is Moroseneng Complex. Adjacent to this is
another prostitution complex, in Klakah Rejo
Village. Both localizations are usually for the middle
class.
After the closure of these red-areas, the situation
has changed greatly. Now the activities of sexual
transactions are not done blatantly in those areas.
The activities tend to be concealed, and are assisted
by modern gadgets and social medias.
3.2 The Knowledge of CSWs:
Contagious Diseases and HIV/AIDS
Based on interviews we find that in general CSWs
do not have accurate knowledge of reproductive
organ’s health, and sexuality. In addition they also
do not access to reproductive organ health services,
and information. Information is usually only
obtained from friends or media, which often is
inaccurate. This is why the CSWs are vulnerable to
reproductive organ health problems such as STDs,
HIV/AIDS, unsafe abortions, and others that may
result in death. Furthermore, this brings risks to
other women who get the diseases from the
husbands.
According to UNICEF in 2000, if all CSWs have
access to effective reproductive organ health
information, it is estimated that the disease will
decrease by 50%. CSWs often do not protect
themselves from reproductive organ health problems
due to lack of information and autonomy to decide
or negotiate before intercourse. For example, CSWs
are unable to persuade their sexual partners to use
condoms.
According to UNAIDS (Shane and Ellsberg,
2002), risky behaviors such as having more than one
sexual intercourse partners, causes STDs to be
spread to others. Integrated Health Services for
HIV/AIDS preventions can reduce STDs through
counseling, to enable them to discuss their problems
with health personnels.
Sexually transmitted diseases, or STDs, are
infectious diseases that can be transmitted from one
person to another through sexual activities (
Bull, and
McFarlane, 2000). According to the Centers for
Disease Control (CDC) there are more than 15
million cases of STDs reported per year. Women
and young adults--15-24 years-- are the age group
with the highest risk of becoming infected with
STDs, 3 million new cases each year are from this
group.
Nearly all STDs can be treated. However, even
though treatable, STDs such as gonorrhoea have
become resistant to many older versions of
antibiotics (Ventola, 2015). Other STDs, such as
herpes, AIDS, and genital warts, all of which are
STDs caused by viruses, can not be cured. Syphilis,
AIDS, genital warts, herpes, hepatitis, and even
gonorrhoea have all been known that they can cause
death. Some STDs may persist such as Pelvic
Inflammatory (PID), cervical cancer, and pregnancy
complications.
It is important to note that sexual activities are
not only sexual intercourse through the genitals.
Sexual activities also include kissing, oral-genital
contact, and the use of "sexual toys", such as
vibrators. In fact, there is no sexual activity that is
"safe sex". The only true "safe sex" is sex in the
context of a monogamous relationship in which both
ICSE 2017 - 2nd International Conference on Sociology Education
642

individuals are free of the STD. Most people
consider kissing as a safe sexual activity.
Unfortunately, syphilis, herpes and other diseases
can be transmitted through kissing. Condom is
considered to be a good protection against STDs.
Condom is very useful in preventing the
contamination of some diseases such as HIV and
gonorrhoea.
All CSWs are vulnerable to health problems,
especially infectious diseases and HIV/AIDS.
Venereal diseases are sexually transmitted diseases
(STDs). Some of the type’s diseases are syphilis,
gonorrhoea, bubo, fungus, herpes, hepatitis B, and
HIV/AIDS (Malla, and Goyal, 2012). Almost all
informants mentioned that they had experienced
itching on their genitals. Data obtained from several
Health Centers around the red-areas mentioned that
many sex workers came to get treatment for sexually
transmitted diseases, including gonorrhoea and
syphilis.
One of the informants (Wwk, 38 years old) said:
“When I give service to my customer, it is
up to him whether he wants to use condom
or not. But mostly they don’t want to use
it”.
The informant said that she never examined her
reproductive organs because she thought she did not
have to do it. Now she is one of the sex-workers
who is having HIV/AIDS.
3.3 Health Facilities in the Red-areas
Surabaya City Health Office through Health Centers
in the former red-areas are still open for visits from
CSWs who are still living in the region or who have
been repatriated to the area of origin.
In their home regions, they are reluctant to
conduct health check-ups because many of them did
not tell their families regarding their actual
profession, so they are afraid that their profession
will be known by the community or their families if
they do a health check up in a Health Center in their
home area of origin.
Despite a decrease in the number of visits to
Health Center in the former red-areas, there was an
additional Voluntary Counseling Test (VCT)
service. Before the closure of the localization, there
were only 4 Health Center that had VCT service
program. Now after the closing of red-areas, VCT
service was developed to 62 Health Center in
Surabaya. The policy of the Surabaya city
government in the context of HIV/AIDS prevention
post-closing the red-areas is the development of
VCT services to 62 Health Center in Surabaya. The
presence of Health Centers in Surabaya equipped
with Voluntary Counseling Test (VCT) makes the
existence of HIV/AIDS patients to be quickly
detected. This VCT test is voluntary. However, the
CSWs are not easy to find, let alone coming
voluntary.
The decrease in the number of visits to Health
Center, especially for reproduction organs health
examination, is recognized by the Head of Surabaya
City Health Office. In order to avoid the spread of
HIV/AIDS, there is a new facility in the Health
Center--the clinic car. This clinic car will monitor a
number of areas that are suspected to be CSWs
community areas. This Clinic car conducts
reproduction organ health check up in the morning,
after coordinating with karaoke owner, café, or
discotheque. Surabaya City Health Office informs
the arrival schedule of clinic car to karaoke, cafe or
discotheque owners; so that the information is
forwarded to the CSWs; so that they do not go home
right away in the morning, and will do a health
check-up. However, this policy does not work well.
The clinic car according to the Director of “Yayasan
Embun” Surabaya is unable to perform well.
Surabaya City Health Office, NGO and Surabaya
Tourism Office have conducted MoU on
reproductive organ health examination in order to
prevent the spread of HIV/AIDS in Surabaya. For
the implementation of the MoU, the government
invited 82 owners of entertainment venues and
massage parlors, but only 29 came. Of the 29 owners
of entertainment venues and massage parlors, only
23 who approved and were willing to sign the MoU.
The karaoke owners resist to the car clinic
because: 1) they said the have their own doctor, 2)
the CSWs are restless and worried when the car
clinic is there, and 3) the car clinic intrude the
regular activities. Therefore the car clinic can not be
implemented as expected in the MoU.
It seems that the Provincial Health Office as a
leading sector is not optimal in monitoring,
coordinating and supporting each other with the
local District Health Office at the origin of CSWs.
Lack of monitoring has caused data surveillance to
be inaccurate. They have difficulties to intervene, so
that the target is not achieved. Data Surveillance is
intended as a strict monitoring attempt to HIV/AIDS
sufferers. When they found someone as an
HIV/AIDS sufferer, a prompt action can
immediately be carried out to isolate, or control the
spread of the disease.
After the closing of the red-areas, cafes and
karaoke popping up at the former locations,
Limited Use of Health Facilities among Commercial Sex Workers after the Closing of Red-areas
643

including in Sememi (Moroseneng), Klakah Rejo,
Tambakasri (Kremil), and Dupak Bangunsari.
Surabaya Tourism Department should also be
involved in preventing the new form of CSWs. Call
girls make their sexual transactions in hotels, cafes
and karaoke, because they already have networks
with customers. However, they are not detected by
the health authorities, and they do not have their
health checked. This causes the susceptibility of
transmission of STDs and HIV/AIDS to increase.
Relocalization makes many prostitutes to be
repatriated to their hometown, or have to work as
prostitutes elsewhere. This has caused the area has
become more vacant, including the Health Center.
According to Ty (30 years old):
“The difference is just.., in the past, when we
came here, there was a long line. We could meet our
friends who were doing the same. Now, we can’t do
that….”
The knowledge of CSWs about HIV / AIDS is
only 21.25%, out of 85% target. The use of condom
is as low as 35.65%.
The awareness of some informants in using
condom is very high. However, they can not force
their customers to use condoms. Their weak position
makes them unable to insist that customers who
refuse to use condoms. In the meantime they do not
conduct check-ups at the health facilities, for various
reasons. This is also happening in Nepal (Ghimire,
and Van Teijlingen, 2009). Overcoming the problem
of sexually transmitted diseases, among others, is to
conduct regular health check-ups at the nearest
health center. The CSWs who are now doing the
practice illegally are reluctant to do the health
check-up for fear that they are discovered practicing
it illegally.
Guidebooks for the health of women's
reproductive organs need to be distributed as
modules and pocket books. This handbook should
focus more on improving women's knowledge on
reproductive organs health; including materials such
as causes and consequences of certain sexual
behavior. Information on service facilities should be
written at the booklets.
An Integrated Health Clinic should be
established to open access and information on
reproduction organs health. Services for people
especially marginalized women are needed, to give
them the right on maintaining reproductive organs
health, and to gain knowledge to maintain them. The
target of this clinic is marginalized poor women--
including former CSWs, who have low income
levels.
4 CONCLUSIONS
It can be concluded that the knowledge of CSWs is
very minimum, about the health of women's
reproductive organs, because of reluctance to find
them out from health offices. Therefore, it is
necessary for the health services providers to be
more proactive in providing knowledge for them.
Otherwise it will have a negative impact on the
community. This impact is due to the occurrence of
disease transmission, indirectly to partners, and
possibly to the child conceived.
The effort to be more proactive is now more
difficult, because the closing of the red-areas has
caused the difficulties to find the illegally practising
CSWs. The government needs to be ready for the
impact in the coming years.
REFERENCES
Bull, S.S., McFarlane, M., 2000. Soliciting sex on the
Internet: what are the risks for sexually transmitted
diseases and HIV? Sexually transmitted
diseases, 27(9), pp.545-550.
Ghimire, L., Van Teijlingen, E., 2009. Barriers to
utilisation of sexual health services by female sex
workers in Nepal. Global Journal of Health
Science, 1(1), p.12.
Guadamuz, T.E., Cheung, D.H., Wei, C., Koe, S., Lim,
S.H., 2015. Young, online and in the dark: scaling up
HIV testing among MSM in ASEAN. PloS one, 10(5),
p.e012665
Haines, A., Cassels, A., 2004. Can the millennium
development goals be attained? BMJ: British medical
journal, 329(7462), p.394.
Malla, N., Goyal, K., 2012. Sexually Transmitted
Infections: An Overview. In Sexually Transmitted
Infections. InTech.
Marmot, M., 2005. Social determinants of health
inequalities. The Lancet, 365(9464), pp.1099-1104.
Riono, P., Jazant, S., 2004. The current situation of the
HIV/AIDS epidemic in Indonesia. AIDS education
and prevention, 16(Supplement A), pp.78-90.
Shane, B., Ellsberg, M. (2002). Violence against women:
effects on reproductive health. Outlook, 20(1), 1–8.
Shaw, G.M., Wasserman, C.R., O'Malley, C.D., Tolarova,
M.M., Lammer, E.J., 1995. Risks of or facial clefts in
children born to women using multivitamins
containing folic acid periconceptionally. The
Lancet, 346(8972), pp.393-396.
Ventola, C.L., 2015. The antibiotic resistance crisis: part
1: causes and threats. Pharmacy and
Therapeutics, 40(4), p.277.
World Health Organization, 2003. Primary health care: 25
years after ALMA-ATA.
ICSE 2017 - 2nd International Conference on Sociology Education
644