Im/moral healthcare: HIV and universal health coverage in Indonesia

Abstract

In 2014, Indonesia reinvigorated its commitment to the provision of a universal health care system by introducing the National Health Insurance Program ( Jaminan Kesehatan Nasional , JKN), with the aim of increasing access to health care for all sectors of society. A key question that emerges in the current climate is: how can Indonesia ensure people can access HIV health care? This question is critically important given Indonesia is on the verge of passing a law criminalising all sex outside of marriage. If passed, anyone presenting with HIV will be suspected ipso facto of involvement in criminal activity (e.g. them or their partner having sex outside of marriage and/or using intravenous drugs). In this environment, preventing transmission of HIV from mother to child becomes more difficult. In exploring these issues, we argue that, in a time of populist morality, Indonesia must give significant attention to how universal health coverage can prevent HIV transmission, particularly from mother to child. We offer three key strategies for Indonesia to implement in this regard: removing health care provision from a moral framework; de-idealising the category of woman; and repositioning shame and stigma around HIV.

‘It’s better to treat a COVID patient than a HIV patient’: using feminist participatory research to assess women’s challenges to access HIV care in Indonesia during the COVID-19 pandemic

“…Research on the experiences of women living with HIV during the COVID-19 pandemic is still limited, particularly in relation to Indonesia. 1 – 3 This article will explore two main themes that arose through our research. Theme one explores the perception of stigma experienced by women living with HIV and mothers without HIV.…”

“…Indonesia has provided opportunities for women living with HIV to access health services under the National Health Insurance Programme. 2 However, while Prevention of Mother to Child Transmission (PMTCT) of HIV services and other services might be available, the stigma associated with accessing such services prevents many women from accessing help. 2 , 6…”

“… 2 However, while Prevention of Mother to Child Transmission (PMTCT) of HIV services and other services might be available, the stigma associated with accessing such services prevents many women from accessing help. 2 , 6…”

“…Despite this, women who disclose their HIV status face discrimination in health services, including denial of confidentiality or privacy. 2 , 4 , 5 This is compounded by a fear of HIV held by many healthcare workers who experience difficulty in discussing HIV in antenatal services, or treating women living with HIV. 6…”

Perceptions of and barriers to HIV testing of women in Indonesia

“…The promotion and protection of women’s rights to health care, including early HIV screening and timely and relevant HIV treatment, is central to the UHC goal. 15 , 16 At the global level, women’s right to health care is well recorded in a number of international conventions including the 1985 International Convention on the Elimination of All Forms of Discrimination Against Women, and the Cairo International Conference on Population and Development Programme of Action ICPD (PoA) in 1994. 17 At the national level, the Indonesian government passed a number of regulations between 2013 and 2017, including the 2014 Universal Health Care Policy to include integrated HIV testing in antenatal clinics and ARV treatment for women and children in PMTCT programmes.…”