Chasing targets in a pandemic: The impact of COVID-19 on HIV outreach workers for MSM (men who have sex with men) in Jakarta, Indonesia

Abstract

The COVID-19 pandemic has had a significant impact on HIV services globally, including communitybased outreach programmes. This article draws on a qualitative study of HIV outreach workers for men who have sex with men (MSM) in Jakarta, Indonesia undertaken between July and September 2020. The research documented the impact of the COVID-19 pandemic on HIV outreach programmes for MSM based on interviews, focus group discussions and video diaries collected from outreach workers. As a result of the pandemic, and in response to the guidelines issued by international donors and the Indonesian government, outreach workers shifted activities to 'virtual outreach' where possible. However, outreach workers consistently performed in-person work to address what they referred to as 'urgent' cases (e.g. required them to attend the clinic). Regardless of delivery mode, the steps comprising outreach work during the pandemic aligned with the 'cascade of care', which forms the dominant policy narrative for the management of HIV. Outreach work during the pandemic therefore continued to be based primarily on the objective of maintaining testing and treatment rates. Although outreach workers responded innovatively to the pandemic, including to the risk of COVID-19 infection, they were limited by the prevailing emphasis on targets in HIV programmes

Delivering HIV and TB services amidst the COVID-19 pandemic in Indonesia: a qualitative study of challenges and mitigation strategies

“…12 Estimates from UNAIDS in 2023 revealed an alarmingly high HIV prevalence among key population groups at higher risk of HIV infection: 13.7% of people who inject drugs; 17.9% of men who have sex with men; 11.9% of transgender individuals; and 2.1% of sex workers. 11 Our study 6 and several other studies [13][14][15][16] have documented the impact of the COVID-19 pandemic on HIV programs and services in Indonesia. In our study, we noted that compared to the pre-pandemic period, individuals living with HIV who visited hospitals had a lower likelihood of starting anti-retroviral treatment (ART), staying in care, and adhering to ART during the pandemic. 17 These disruptions were due, among other things, to social distancing orders, lockdown, and healthcare workers being redeployed to work on COVID-19 testing, contact tracing, and surveillance activities.…”

HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review

“…Eleven studies in total reported providing HIV treatment and care during COVID-19 remotely through telehealth services such as telephone and videoconferencing. Five of the studies were from the United States of America (USA) [ 50 , 52 , 59 , 60 , 68 ] and one each from Zambia [ 63 ], Myanmar [ 62 ], Philippines [ 65 ], Indonesia [ 56 ], Tanzania [ 51 ], and Kenya [ 54 ]. These studies reported that providers completed the required paperwork, including conducting needs assessments electronically, either through e-mail or over the phone, to minimise in-person contact with their clients.…”

The Biosocial Body: HIV Visibility in an Age of Pharmaceutical Treatment in Indonesia

“…I draw on ethnographic fieldwork conducted since 2017 with Bergembira, primarily focused on the social relationships forged between outreach workers, their clients and healthcare workers in clinics and at hospitals. The research on which this article is based took place over approximately 4 months of participant observation during annual visits made to Indonesia between 2017 and 2019 as part of an ongoing collaborative ethnographic project with epidemiologists and physicians about peer-based outreach work and support groups for MSM (Hegarty, Nanwani, and Praptoraharjo 2020;Hegarty et al 2021). My anthropological engagement is thus oriented toward and takes place in collaboration with Indonesian researchers and activists invested in understanding the impact of health inequities on MSM and waria, an Indonesian transgender population (see Mallay et al 2021).…”