HIV-related knowledge and attitudes among Indonesian prison officers

Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety

With adequate support, people with HIV (PWH) may achieve high levels of adherence to antiretroviral therapy (ART) during incarceration. We examined factors associated with ART utilization and adherence among incarcerated PWH (N = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2-24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2-12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7-6.2, p < 0.001), and perceived need for medical treatment (aOR = 1.6, 95% CI 1.1-2.5, p = 0.011), and negatively associated with chance locus of control (aOR = 0.3, 95% CI 0.1-0.7, p = 0.013). Most participants utilizing ART (74.5%) reported less than "perfect" ART adherence. ART adherence was independently associated with perceived personal safety (β = 0.21, 95% CI 0.01-0.40, p = 0.032) and methadone utilization (β = 0.84, 95% CI 0.10-1.67, p = 0.047). PWH receiving methadone had a sixfold higher adjusted odds of being highly-adherent to ART (aOR = 6.3, 95% CI 1.1-35.7, p = 0.036). Interventions that increase methadone utilization and personal safety may improve ART adherence among incarcerated PWH.

Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia

PURPOSE

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix.

FINDINGS

Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV.

RESEARCH LIMITATIONS/IMPLICATIONS

The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics.

PRACTICAL IMPLICATIONS

The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting.

ORIGINALITY/VALUE

This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

The health of female prisoners in Indonesia

Purpose

– Indonesian law provides prisoners with basic rights, including access to education, health care and nutrition. Yet, structural and institutional limitations, notably overcrowding and under-resourcing, prohibits penal institutions from fulfilling these commitments for female prisoners. The purpose of this paper is to explore their health concerns.

Design/methodology/approach

– Six prisons and one detention centre were researched, comprising: female prisoners (n=69); clinical officers (six); clinic heads (seven); wardens (seven); heads of prisons (seven); and a Directorate representative. Data were collected through observation, focus group discussions, in-depth interviews and a semi-structured questionnaire. Raw data were transcribed and analysed thematically, adopting the General Principles of Grounded Theory.

Findings

– Both “formal” and “informal” health-coping strategies were dependent upon a range of factors which determined access to treatment, medicines and other items procured both inside and outside of the prison, as well as referral services. Informal systems of support existed for women, especially in regard to pregnancy and raising of babies born in detention. Systems that maintain harmony within cell blocks were identified as an important informal coping strategy.

Originality/value

– This research is important in informing policy and practice. There is a clear need for gender-sensitive legislative frameworks, penal policies and prison rules to ensure women's needs are addressed. The identified coping strategies were considered viable, but do not replace the need for a health system providing women prisoners with levels of care as available in the community, including commensurate budgeting, personnel, access and referral to more specialised external health services.