Using surveillance data on men who have sex with men (MSM) from six Indonesian cities, this article reports prevalence of sexual risk taking, HIV and other sexually transmitted infections. Factors associated with HIV, other STIs and consistent condom use were assessed. Behavioral data were collected from 1,450 MSM, among whom 749 were tested for HIV and syphilis and 738 for gonorrhea and Chlamydia. Associations were assessed using multivariate logistic regression. Over 80% of MSM knew HIV transmission routes, 65% of MSM had multiple male sexual partners, 27% unprotected anal sex with multiple male partners, and 27% sex with a female in the prior month. Consistent condom use ranged from 30 to 40% with male partners and 20 to 30% with female partners, depending upon partner type. HIV prevalence averaged 5.2%, but was 8.0% in Jakarta. Prevalence of rectal gonorrhea or Chlamydia was 32%. Multivariate analyses revealed recent methamphetamine use and current rectal gonorrheal or chlamydial infection to be associated with HIV infection. The data confirm diverse sexual networks and substantial sexual risk-taking, despite relatively high levels of education and HIV-related knowledge. In addition to promoting partner reduction and more consistent condom and lubricant use, prevention efforts must also address substance abuse.
First, the high level of therapy refusal in a developing country like Indonesia has an adverse effect on the survival outcome of retinoblastoma patients. Second, the change of the tumor stage from intraocular to extraocular is the most adverse predictive factor for survival. Third, the advanced stage of the tumor is caused by long delay to admission. In a developing country the parents of many young patients refuse to accept the recommended therapy and therefore the tumor may reach a critical stage for the prognosis.
Until 1999 the known prevalence of HIV in Indonesia was low, except for isolated geographic groups exposed to Thai fisherman. Since then, the prevalence among injection drug users in rehabilitation centers in Jakarta has risen rapidly to approximately 45-48%, according to surveys in 2001. By 2002 the prevalence had risen to 8-17% among female sex workers, 22% among transvestite sex workers, and 4% among other male sex workers. Condom use is low in all groups, and there is considerable sexual mixing between risk groups. Surveys suggest that an increasing proportion of adolescents use drugs and have had sexual intercourse. Thus, although the epidemic in Indonesia is currently in the World Health Organization-defined "concentrated stage," all the ingredients for rapid spread are present. Intensive effective intervention strategies--condom use and clean needle use promotions--need to be implemented, especially in the high-risk groups, if a more serious epidemic is to be averted.
The HIV/AIDS epidemic among FSW in Indonesia appears to be expanding, albeit unevenly across provinces and types of FSW. High STI prevalence is conducive to further expansion, but recent efforts to strengthen STI control appear promising.
There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme.
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