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

Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia

The WHO's Asia-Pacific framework for triple elimination recommends that countries evaluate their programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B (EMTCT), including identifying gaps to improve program planning and the implementation of elimination strategies in antenatal care (ANC) services. In 2022, the Indonesian Ministry of Health reported that only 39% of pregnant women were tested for HIV, 14% for syphilis, and 28% for hepatitis B, respectively. We conducted a qualitative study involving a focus group discussion (FGD) and in-depth interviews with 25 key stakeholders in Bali and West Nusa Tenggara Provinces to identify specific challenges to testing for HIV, syphilis, and hepatitis B in ANC settings. Thematic analysis was used to identify the themes generated from the data. Health system bottlenecks experienced by stakeholders included supply chain management issues involving stock forecasting and stock monitoring, stock-outs of rapid test reagents which were particularly most frequent and for longer durations for syphilis and hepatitis B, high staff turnover, lack of staff training on how to perform the test, the complexity and time needed to record the data on women's characteristics, risk behaviours, and testing in both paper format and into the computer-based surveillance systems, discrepancies in program coverage data from different divisions of the district health office involved in the reporting system, high levels of stigma that prevented women from being followed up, challenges in notifying partners, and inadequate reporting and referral of women from private providers to public ones for testing. Interventions addressing the above challenges are worthy of consideration to improve the health system function and integrate EMTCT into the ANC settings.

Does the perception of HIV risk among Female sex workers affect HIV prevention behavior? application of the Health Belief Model (HBM)

BACKGROUND

High prevalence of Human Immune virus/Acquired immunodeficiency syndrome (HIV/AIDS) in Female Sex Workers (FSWs) is identified as a bottleneck in fighting against HIV/AIDS. To this end, the international community planned a strategy of 'Ending inequality' and 'Ending the AIDS epidemic' by 2030. This could not be achieved without due attention to FSWs. Thus, this study attempted to assess HIV prevention behavior and associated factors among FSWs in Dima district of Gambella region, Ethiopia by using the Health Belief Model.

METHODS

A community-based cross-sectional study was conducted from March to May 2019 among 449 FSWs selected using the snowball sampling technique. Socio-demographic features, knowledge about HIV, attitude toward HIV prevention methods, and Health Belief Model (HBM) constructs (perceived susceptibility to and severity of HIV, perceived barriers, and benefits of performing the recommended HIV prevention methods, self-efficacy, and cues to practice HIV prevention methods) were collected using face to face interview. Data were entered into Epi-data 3.1 and analyzed using SPSS version 23. Bivariable and multivariable binary logistic regression analysis was done to identify the association between dependent and independent variables. P-value < 5% with 95 CI was used as a cutoff point to decide statistical significance of independent variables.

RESULTS

In this study, 449 FSWs participated making a response rate of 98.90%. Of these, 64.8% had high HIV prevention behavior. Age (AOR = 1.911, 95% CI: 1.100, 3.320), knowledge of HIV (AOR = 1.632, 95% CI: 1.083, 2.458), attitude towards HIV prevention methods (AOR = 2.335, 95% CI: 1.547, 3.523), perceived barriers (AOR = .627, 95% CI: .423, .930), and self-efficacy (AOR = 1.667, 95% CI: 1.107, 2.511) were significantly associated with high HIV prevention behavior.

CONCLUSION

The study identified that about two third of FSWs practiced the recommended HIV prevention methods. Age of respondents, knowledge of HIV, favorable attitude towards the recommended HIV prevention methods, high self-efficacy, and low perceived barrier were associated with high HIV prevention behavior. Therefore, focusing on these factors would be instrumental for improving effectiveness of the ongoing HIV prevention efforts and attaining the 'Sustainable Development Goals of 'Ending inequality' and 'Ending the AIDS epidemic' by 2030.

Ending AIDS in the Asia-Pacific region by 2030: are we on track? Policy, epidemiological and intervention insights

The Asia-Pacific region is home to nearly 6 million people living with HIV. Across the region, key populations - men who have sex with men, transgender women, people who inject drugs, sex workers, prisoners - and their sexual partners make up the majority of those living with HIV. While significant progress has been made in the past 5 years towards UNAIDS's 90-90-90 goals (90% of people with HIV diagnosed, 90% on antiretroviral therapy, 90% virologically suppressed), significant gaps remain. The papers in this Special Issue address important questions: are we on track to end the AIDS epidemic in the Asia-Pacific region? And can countries in this region reach the new UNAIDS targets for 2030?