Understanding the Social Influences on Engaging Key Populations With HIV Prevention: A Qualitative Study With Men Who Have Sex With Men in Three Indonesian Cities

Abstract

The globally recognized test and treat approach underpins Indonesian national strategies to reduce and prevent HIV among key populations, including men who have sex with men. More comprehensive understanding of how engagement with HIV prevention is shaped by social and community practices will support these efforts. Between 2015 and 2016, focus groups and semi-structured interviews were conducted with 54 men who have sex with men in three urban settings in Indonesia to elicit their views on, and experiences of, HIV prevention and care. Focused on data relating to testing, findings documented the important influence of informal peer networks, community-based organizations and outreach workers. Some social dimensions of service access complicated this, particularly fear of stigma or lack of confidentiality in large service settings. The many differences between men challenges assumptions that a single set of HIV prevention strategies will work to engage all men who have sex with men living in Indonesia.

Corrigendum to: A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia

“…CBOs worked closely with health services to deliver mobile testing in work and community locations convenient for sex workers, as well as in puskesmas. Our findings complement those from studies in other key populations in Indonesia, 35,36 which took place in parallel to this study, and are consistent with research involving female sex workers in south India. 24 Our findings also highlight the importance of implementing innovative testing services outside clinicsin work places, using social network-based approaches 9 at times and locations that fit with women's work and family commitments.…”

“…Consistent with global HIV guidelines that emphasise community involvement in national HIV responses, 42,43 our findings show that relations and practices involving female sex workers, community outreach workers, health workers and bosses enabled HIV testing among female sex workers in three urban settings in Indonesia. Our findings complement recent qualitative research around engagement with HIV care for testing and/or treatment among other key populations in Indonesia [35][36][37][38] which also illustrate how community mechanisms enhance engagement in HIV care. As such, our findings provide insight into the improvement of, and community participation and leadership in, HIV responses in Indonesia and other LMICs in the region.…”

“…This qualitative study was part of a larger implementation research project designed to evaluate strategies to improve the HIV care cascade among female sex workers, people who inject drugs, transgender women and men who have sex with men in Indonesia. [35][36][37][38][39] Women were eligible to participate in the study if they were currently engaged in sex work, aged 16 years and able to provide informed consent. Participants were sampled purposively 40 to ensure diverse experiences with engagement in HIV testing, treatment and care services along the HIV care cascade.…”

Stigma and discrimination: Barrier for ending AIDS by 2030 and achieving the 90-90-90 targets by 2020

“…Some studies showed that the high prevalence of HIV among sex workers and men who have sex with men is compounded by stigma, discrimination and criminalization, which hampers their access to HIV testing services and ART services. [13][14][15] Analysis conducted by a team of health experts showed that the decriminalization of sex work would reduce new HIV infections by 33-46% over the coming decade. 13 Public campaigning for the ongoing discrimination and criminalization of sex workers and MSM remains high in Indonesia both at the local and national level.…”

HIV and stigma in the healthcare setting

“…More than 70 countries are using the stigma index across the globe, and more than 70,000 PLHIV have been interviewed; findings from this study suggest that one in eight people living with HIV is being denied health services as a result of HIV‐related stigma (UNAIDS, 2017). Healthcare providers can show various expressions of HIV stigma: neglect of patients, differential treatment than non‐HIV patients, denial of care, testing and disclosing HIV status without consent, unwarranted use of precautions to prevent transmission, labelling of belongings or files, and verbal abuse/gossip (Lazuardi et al., 2019; Mahendra et al., 2006). Experience and fear of these expressions can hamper PLHIV to disclose their HIV status to healthcare providers and distrust of healthcare providers.…”