A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia
Kate Whitford
A K , Elke Mitchell A , Elan Lazuardi A B , Emily Rowe C , Irma Tasya Anintya D , Dewa N. Wirawan C E , Rudi Wisaksana D F , Yanri W. Subronto B G , Hellen D. Prameswari H , John M. Kaldor A and Stephen Bell A I J
+ Author Affiliations
- Author Affiliations
A Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
B Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
C Kerti Praja Foundation, Denpasar, Indonesia.
D Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia.
E Department of Public Health and Preventive Medicine, Faculty of Medicine, Universities Udayana, Denpasar, Indonesia.
F Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.
G Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
H HIV AIDS and STI Sub-directorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia.
I Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
J Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW, Australia.
K Corresponding author. Email: kwhitford@kirby.unsw.edu.au
Sexual Health 18(1) 77-83 https://doi.org/10.1071/SH20085
Submitted: 11 May 2020 Accepted: 7 October 2020 Published: 16 February 2021
Journal Compilation © CSIRO 2021 Open Access CC BY-NC-ND
Abstract
Background: HIV prevalence among female sex workers in Indonesia remains high and large proportions of female sex workers have never been tested for HIV. International research highlights the importance of community-led strategies to increase HIV testing in this population. Little qualitative research has been conducted to address these issues in Indonesia or other Asia-Pacific countries. This paper documents social influences that enhance HIV testing among female sex workers in urban Indonesia. Methods: This was an interpretive qualitative study in Yogyakarta, Denpasar and Bandung. In total, 57 female sex workers participated in 11 focus group discussions, and four participated in individual semi-structured interviews. Deductive and inductive thematic analysis techniques were used to identify narratives of strengths pertaining to uptake of HIV testing. Results: Participants described supportive relationships with peers, community-based organisations and ‘bosses’. Participants reported trusted networks with peers within which to share information about HIV testing and receive emotional support. Relationships with community outreach workers facilitated HIV testing through reminders, accompanied visits, and emotional/informational support. Community-based organisations worked with health services to facilitate mobile, community-based testing to overcome employment- and family-related constraints that inhibited women’s clinic attendance. ‘Bosses’ employed a variety of practices to encourage HIV testing among their workers. Conclusions: Relationships, practices and action in community- and workplace-based settings outside formal health service spaces enhanced HIV testing among female sex workers. Community- or workplace-based HIV testing with outreach support from health services, peer-led HIV testing within existing social and work-based networks, and working with bosses to implement HIV prevention strategies can address low HIV testing rates in this key population.
Keywords: HIV, HIV care, HIV testing, Indonesia, qualitative research, sex workers, HIV care cascade, community, key populations, strengths-based research.
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