Getting Indonesia’s HIV epidemic to zero? One size does not fit all

Gedela, Keerti; Wirawan, Dewa Nyoman; Wignall, F S; Luis, Hendry; Merati, Tuti Parwati; Sukmaningrum, Evi; Irwanto, Irwanto

doi:10.1177/0956462420966838

Cited by 19 publications

(19 citation statements)

References 48 publications

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“…Many people from all over Indonesia migrate to Bali to work in the tourist industry, meaning that they are away from family and the friends they grew up with. For many MSM and waria, this may be motivated in part by the desire to establish a new, somewhat more open life in Bali [17]. For Bali-born respondents, this freedom may be more difficult to access, due to close proximity to family and childhood friends, community responsibilities, and pressures to marry.…”

Section: Discussionmentioning

confidence: 99%

Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia

et al. 2021

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In recent years, prevalence of Human Immunodeficiency Virus (HIV) has increased substantially in Bali, Indonesia, in men who have sex with men (MSM) and transgender women, known locally as ‘waria’. There are limited behavioural data in this population. We conducted a behavioural survey of MSM/waria in Bali in March–April 2018. Respondents were primarily recruited by HIV outreach workers. Respondents reported details about anal intercourse events with their last male/waria romantic partner and/or last male/waria casual partner (respondents could report on both if relevant). Statistical significance was tested with generalised estimating equations. Among 709 participants, median age was 27 (interquartile range = 24–31), and 92.1% were male and 7.9% were waria. One-third were born in Bali. Overall, 85.9% had ever had an HIV test; 55.1% reported being HIV-negative, 15.0% HIV-positive, and 30.0% had unknown serostatus. Most (86.5%) reported sex with men, 9.5% with waria, and 20.0% with women in the previous 6 months. Respondents described 703 anal intercourse events (397/306 with romantic/casual partners, respectively; 191 reported on both). Over half (56.5%) of the events were protected by condoms and 7.3% by biomedical prevention (2.6% by PrEP in either partner, 4.7% by HIV treatments in either partner). Thus, 36.3% of events involved unprotected condomless anal intercourse (40.8%/30.4% in romantic/casual partners, respectively). In multivariate analysis, unprotected condomless anal intercourse events were associated with romantic partners (p < 0.001), being born in Bali (p = 0.002), lower education (p = 0.013), believing that withdrawal before ejaculation is effective (p < 0.001), liking to use withdrawal (p = 0.021), and not liking condoms (p < 0.001). One-quarter of events had potentially reduced HIV transmission risk through non-condom-based risk reduction strategies, while 11.1% had no potential risk reduction. Events presenting the highest potential risk of HIV transmission were more commonly reported by respondents born in Bali.

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Section: Discussionmentioning

confidence: 99%

Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia

et al. 2021

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“…Most exist in major cities and provinces like Jakarta, Surabaya, Medan and Bali. However, in Indonesia, the provision of HIV care depends on state healthcare institutions, which has been associated with the marginalization of key populations given high rates of institutional and healthcare‐related stigma [ 2 , 7 , 8 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Bali Peduli opened in January 2015 and has two sites in Bali, one in Denpasar and the other in Ubud, integrated within a government community service. It aims to provide a friendly, stigma‐free, accessible service and makes significant efforts to streamline HIV care despite constraints [ 2 , 7 , 12 ]. HIV testing, assessment for and provision of ART, and clinical care are provided free of charge.…”

Section: Methodsmentioning

confidence: 99%

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Antiretroviral drug switches to zidovudine‐based regimens and loss to follow‐up during the first COVID‐19 lockdown in Bali, Indonesia

Gedela

Rajus²,

Luis³

et al. 2022

HIV Medicine

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Objectives International lockdowns during the COVID‐19 pandemic impacted antiretroviral drug supplies in Indonesia. We assessed the impact of antiretroviral treatment (ART) provision and being lost to follow‐up (LTFU) on people living with HIV, attending a key population‐focused HIV clinic in Denpasar, Bali. Methods This was a retrospective note review of anonymized data from adult Indonesian patients living with HIV. We collected demographic data and information on being LTFU, and assessed the numbers of patients impacted by ART switches from fixed‐dose combination (FDC) tenofovir/lamivudine/efavirenz to multi‐pill zidovudine‐based regimens, during the first international lockdown from March 2020. Results Records of 260 Indonesian adult patients registered for HIV care and prescribed ART were reviewed; 240 (92.3%) were men, and 90% were men who have sex with men. Between 13 March and 28 May 2020, 214 (87%) out of 247 patients (previously diagnosed with HIV) had to switch to individual, multi‐pill zidovudine‐based regimens from their FDC. The switch lasted a mean of 35 days (range 10–85). Twenty‐five patients (10%) were LTFU; patients who switched were more likely to remain in care. Data on viral load status and toxicity are lacking as laboratory testing requires self‐payment. Conclusions The majority of patients living with HIV had no choice but to switch to multi‐pill, zidovudine‐based regimens. Despite significant efforts to minimize the impact of lockdown on care, 10% of patients were LTFU. Patients switching ART required greater clinic attention and support, improving retention. Complete national data are needed to understand the impact of ART stockouts on virological suppression and drug resistance throughout Indonesia.

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“…Its capital, Jakarta, is home to an estimated 110,000 people with HIV [16]. HIV prevalence is highest in key populations, including an estimated one quarter of MSM [17]. In 2019, two-thirds of new cases in Jakarta occurred outside of key populations among people considered low risk for HIV infection [16].…”

Section: The Current Study: Apn Opportunities In Indonesiamentioning

confidence: 99%

“You can’t do that; they’ll throw the cooking pot at you!” A qualitative study of healthcare providers’ attitudes toward assisted partner notification for people with HIV in Indonesia

Levy

Earnshaw

Milanti

et al. 2022

Preprint

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Assisted partner notification (APN) is recommended as a public health strategy to increase HIV testing in people exposed to HIV. Yet its adoption globally remains at an early stage. This qualitative study sought the opinions of HIV health service providers regarding the appropriateness and feasibility of implementing APN in Indonesia where such services are on the cusp of adoption. Focus group discussions were held with 40 health service providers to consider APN as an innovative concept and to share their reactions regarding its potential implementation in Indonesia. Voice-recorded discussions were conducted in Bahasa, transcribed verbatim, and analyzed. Participants recognized APN’s potential in contacting and informing the partners of HIV-positive clients of possible viral exposure. They also perceived APN’s value as a client-driven service permitting clients to select which of three partner notification methods would work best for them across differing partner relationships and settings. Nonetheless, participants also identified personal and health system challenges that could impede successful APN adoption including medical and human resource limitations, the need for specialized APN training, ethical and equity considerations, and lack of sufficient clarity concerning laws and government policies regulating 3rd party disclosures. They also pointed to the job-overload, stress, personal discomfort, and the ethical uncertainty that providers might experience in delivering APN. Overall, providers of HIV services embraced the concept of APN but forecast practical difficulties in key service areas where investments in resources and system change appeared necessary to ensure effective and equitable implementation.

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Getting Indonesia’s HIV epidemic to zero? One size does not fit all

Cited by 19 publications

References 48 publications

Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia

Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia

Antiretroviral drug switches to zidovudine‐based regimens and loss to follow‐up during the first COVID‐19 lockdown in Bali, Indonesia

“You can’t do that; they’ll throw the cooking pot at you!” A qualitative study of healthcare providers’ attitudes toward assisted partner notification for people with HIV in Indonesia

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