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Indonesia recorded their first positive case of severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) on the March 2, 2020. All 34 provinces have recorded cases, but currently the highly densely populated areas of Jakarta and East and West Java appear to have suffered the greatest. 1 Although coronavirus disease-2019 (COVID-19) is not as established in Indonesia compared with major economy European countries and the United States, it is observing increasing numbers of cases as testing improves. The dynamics of spread among populations and its potential impact remains unclear. There is speculation that the impact of COVID-19 in Indonesia may differ related to diverse social mixing patterns and population health/age dynamics; climate and virus survival; poorer testing and case finding strategies comparatively and less transparency on disease burden and death. 2,3 There remains uncertainties and concern as to the future trajectory. If COVID-19 continues on the trajectory as has been observed in other settings, the impact on Indonesia's fragile health systems will be devastating. Indonesia is the world's largest island nation and world's fourth most populated with more than 260 million people; its size, geographical diversity, and remoteness puts it in a position that very few other nations face. Equity and resource within health care systems is highly varied between districts, but in general is poor, particularly in remote areas. 4 While trying to protect their health systems and in coping with the global lock down, the economic, social, and non-COVID-19-related health system impact has already taken a great toll on Indonesia. This is observed most acutely for populations living with and at risk of HIV. Indonesia has an existing fast-growing HIV epidemic that is on course to dramatically worsen amid COVID-19 lockdowns. AIDS-related deaths have never fallen in Indonesia and alarmingly have increased by 60% since 2010; in addition, children being born with HIV continue to rise amid poor rates of antiretroviral treatment (ART) coverage to pregnant women for prevention of mother to child transmission of

Indonesia has one of the fastest growing HIV epidemics in the world. AIDS related deaths in Indonesia have not fallen and have increased significantly since 2010. HIV infection rates remain high and rising in key affected populations. We provide an on the ground, evidence-based perspective of the challenges Indonesia faces. We discuss what is required to adopt tailored public health approaches that address context specific challenges, confront structural barriers and the heterogeneity of the current evolving HIV epidemic.

To evaluate the respective part of HIV-1, HIV-2, and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-1 varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.

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