Indonesia’s HIV epidemic is concentrated among key populations. While prevalence among men who have sex with men (MSM) is high, transmission among young MSM (15–24-years-old) remains poorly understood. We conducted a respondent driven sampling survey of 211 young MSM in urban Bandung, Indonesia in 2018–2019 to estimate HIV prevalence and associated risk factors. Thirty percent of young MSM were HIV antibody positive. This is nearly 100-fold greater than Indonesia’s population prevalence and sevenfold higher than average estimates for young MSM across Asia and the Pacific Region. Individual risk factors associated with HIV infection were being 20–24 years old, having a steady partner and preferring the receptive position during sex. Issues of stigma, discrimination and social exclusion were common. Few young MSM who were open with friends and family members about their sexual identity. Among those that were, close to half reported experiencing feelings of aversion from these groups. Wider structural factors that reduce social tolerance, restrict the rights of young MSM and compel concealment of sexual identity are likely to fuel high-risk behaviors and limit access to essential testing care and support services including pre-exposure prophylaxis which is not yet widely available. Urgent health, social, legal and political actions are required to respond to these factors and reduce the disproportionate contribution of young MSM to Indonesia’s HIV epidemic.

Background The COVID-19 pandemic has raised concerns as to its impact on other health programs. One program that appears particularly vulnerable is HIV and AIDS. We undertook an assessment of COVID-19 impact on HIV control efforts in Indonesia for a sub-population that has received little attention in the global literature—female sex workers (FSW). Methods The study was undertaken in 23 National AIDS program priority districts. Four sources of monthly data during January–July 2020 were considered. COVID-19 infection data were extracted from national and district surveillance systems. Combination prevention program outputs were reported by civil society organizations (CSOs) providing community support services to FSW. These organizations also undertook monthly scans of levels of commercial sex activity and HIV testing availability. We also considered data from an ongoing HIV community screening trial. The primary mode of analysis entailed comparisons of levels and trends of indicators from the four data series. Results Commercial sex activity was severely curtailed in April–May in many districts. While recovering to pre-COVID-19 levels in “Localization” areas, the number of active FSW in July was one-third below that in February. HIV testing service availability declined by 50% at health facilities before recovering slowly, while mobile clinic services largely ceased during April–June. Numbers of FSW reached, condoms distributed, FSW tested for HIV, HIV cases detected, and FSW starting treatment all declined precipitously in April/May but had largely recovered to pre-COVID-19 levels by July. We found only a temporary dip in treatment initiation rates among HIV positive FSW and no discernible impact on treatment retention. The HIV community screening trial data revealed significant demand for HIV testing among FSW that was not being met even before the onset of COVID-19. Conclusions COVID-19 has had at least short-run economic effects on FSW and the national response to HIV and AIDS targeting FSW. However, the effects appear to have been cushioned by community-based services and support in study districts. The findings make a compelling case for the expansion of community-based services irrespective of the future trajectory of COVID-19. As COVID-19 has not yet been contained, the trajectory of economic activity and service delivery is uncertain.

This study explored clients’ perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.

This is the first report of M. genitalium infection in Indonesia. The high prevalence of STIs and low condom use among these FSWs suggest their vulnerability to the HIV epidemic in Indonesia. They need enhanced interventions, including outreach screening, and periodic presumptive treatment.

Background: HIV-AIDS and sexually transmitted infections are still a public health burden in Indonesia. Women living with HIV have a higher risk of transmitting HIV, Syphilis, and Hepatitis B to their babies. While the effort to increase the services coverage for the prevention of mother-to-child transmission (PMTCT) was detained due to the COVID-19 pandemic and the lack of published studies that explore this, this study aimed to assess the determinant of service utilization for triple elimination of mother-to-child transmission of HIV, Syphilis, and Hepatitis B among women living with HIV during COVID-19 pandemic in Indonesia. Methods: This cross-sectional study targeted women living with HIV in Indonesia who are planning to get pregnant. A simplified-snowball sampling technique was used in this study. A dependent variable in this study was the service utilization of PMTCT for HIV, Syphilis, and Hepatitis B. In contrast, the independent variables in this study consisted of demographic characteristics, perception according to Health Belief Model constructs, and stigma and discrimination experiences. Multiple logistic regression was used to find the determinants of service utilization. Results: Among 336 women living with HIV that were interviewed, only 28.27% (95% CI = 23.69 – 33.34) accessed the PMTCT services during the COVID-19 pandemic. Moreover, the likelihood of PMTCT service utilization was decreased among the women living with HIV who perceived higher barriers (aOR = 0.56; 95% CI = 0.31 – 0.99) and experienced stigma and discrimination from partner (aOR = 0.50; 95% CI = 0.25 – 0.99). On the other hand, the PMTCT service utilization was increased among those who perceived less severity (aOR = 2.07; 95% CI = 1.21 – 3.54). No other factors were associated with the PMTCT service utilization among women living with HIV during the COVID-19 pandemic. Conclusion: The PMTCT service utilization was relatively low, increased by the higher perceived severity, and reduced among those who perceived higher barriers and experienced stigma and discrimination from the partner. Therefore, improving the knowledge about HIV, Syphilis, and Hepatitis B related to PMTCT services is essential, as well as providing social support to reduce the stigmas and discrimination among women living with HIV.