Facilitators to Accessibility of HIV/AIDS-Related Health Services among Transgender Women Living with HIV in Yogyakarta, Indonesia

Abstract

The study aimed to explore facilitators or enabling factors that enhance accessibility (defined as the opportunity to be able to use) to HIV/AIDS-related health services among HIV positive transgender women, also known as Waria in Yogyakarta, Indonesia. A qualitative study employing one-on-one in-depth interviews was conducted from December 2017 to February 2018. Participants were HIV positive Waria recruited using purposive and snowball sampling techniques. Data were analysed using the framework analysis for qualitative research. The findings showed that participants’ knowledge of HIV/AIDS and the availability of HIV/AIDS-related health services were enablers to the services accessibility. Emotional support from fellow Waria displayed in various ways, such as kind and caring attention, attentive listening, and encouraging words, was an important social support that played a role in supporting Waria’s accessibility to the services. HIV/AIDS-related health service information shared personally or jointly by fellow Waria and instrumental support including helping each other to collect antiretroviral (ARV) from hospitals or community health centres, contacting ambulance in emergency situations, accompanying each other to health service facilities, and helping those without the health insurance to receive free health services were also the social support enabling accessibility to the services among the study participants. Appraisal support such as providing constructive feedback and affirmation was another enabling factor to Waria’s accessibility to the services. The findings indicate the needs to broadly disseminate information and educate Waria populations and their significant others about HIV/AIDS and related health services to raise their awareness of HIV/AIDS and acceptance of HIV/AIDS positive individuals. Educating and broadly disseminating this information in other settings in the country will also increase accessibility to the HIV/AIDS services among Waria, their families, and communities addressing the currently existing inequities in health. The findings also reinforce the importance of the establishment of Waria peer-support groups within Waria communities and the involvement of Waria in HIV/AIDS activities and programs, which may increase their awareness of HIV/AIDS, and accessibility to HIV/AIDS-related health services.

HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta

“…Consistent with previous studies [59][60][61][62], the participants in this study were reluctant to access healthcare services in healthcare facilities where they had previously experienced discriminatory attitudes or treatment, which is indicative of the need for training programs among health care professionals across facilities. Training of health professional has been identified as effective in addressing HIV stigma, as indicated previously in a study with transgender women in the same study setting, where the availability of positive support by healthcare professionals led to effective access to HIV services by transgender participants [35].…”

“…The participants' moral judgement also led them to endorse negative stereotypes regarding themselves or self-stigma. The current findings indicate the need for HIV stigma-related training for healthcare professionals, which has been reported to be effective for stigma reduction [35,83,84], and broader coverage of HIV information dissemination for people within families and communities to improve their knowledge on HIV, and mitigate stigmatising and discriminatory attitudes, behaviours or treatments and services for PLHIV within families, communities and healthcare facilities.…”

“…The municipality of Yogyakarta, where the current study was conducted, provides HIV-related health services in four hospitals and 10 community health centres. The services provided include dissemination of health information on HIV/AIDS and the related services, HIV counselling and testing, CD4 tests, viral load tests, and ART provision [34][35][36]. In addition, several non-governmental organisations in collaboration with the health sector in the study setting provide HIV-related support, such as regular HIV information sessions and mobile voluntary counselling and testing for target groups and general communities, peer support groups for PLHIV, monthly meetings with PLHIV and sustained support to ensure access and adherence to treatment among PLHIV [35].…”

“…The services provided include dissemination of health information on HIV/AIDS and the related services, HIV counselling and testing, CD4 tests, viral load tests, and ART provision [34][35][36]. In addition, several non-governmental organisations in collaboration with the health sector in the study setting provide HIV-related support, such as regular HIV information sessions and mobile voluntary counselling and testing for target groups and general communities, peer support groups for PLHIV, monthly meetings with PLHIV and sustained support to ensure access and adherence to treatment among PLHIV [35]. Yogyakarta is one of the few cities in Indonesia where HIV-related information and health services have been reported to be relatively well disseminated and provided [37,38].…”

HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia

“…Sociocultural values and norms that do not accept sex with same sex partners and consider it as a deviant and contaminated behaviour also influenced the participants' acceptance toward HIV positive patients, treatment and perceptions about PLWHA or facilitated HIV stigma and discrimination toward PLWHA by the participants. The findings of previous studies in Indonesia have reported that general perceptions about sex with same sex partner as deviant and contaminated behaviours prevented men who have sex with men and transgender people to openly talk about their health status and to seek healthcare services (49)(50)(51)(52).…”