Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE (Open Access)

Understanding the challenges faced in community-based outreach programs aimed at men who have sex with men in urban Indonesia

Benjamin Hegarty https://orcid.org/0000-0002-5240-1143 A D , Sandeep Nanwani B and Ignatius Praptoraharjo C
+ Author Affiliations
- Author Affiliations

A Faculty of Arts, School of Social and Political Sciences, John Medley Building, The University of Melbourne, Parkville, Melbourne, Vic. 3010, Australia.

B Yayasan Kebaya, Daerah Istimewa Yogyakarta, JT III Jl. Gowongan Lor No.148, Gowongan, Kec. Jetis, 55233, Indonesia.

C Atma Jaya University, HIV/AIDS Research Center Jakarta, Jl. Jend. Sudirman No.51, RT.5/RW.4, Karet Semanggi, Kecamatan Setiabudi, 12930, Indonesia.

D Corresponding author. Email: benjamin.hegarty@unimelb.edu.au

Sexual Health 17(4) 352-358 https://doi.org/10.1071/SH20065
Submitted: 20 April 2020  Accepted: 5 June 2020   Published: 5 August 2020

Journal Compilation © CSIRO 2020 Open Access CC BY-NC-ND

Abstract

Background: Community-based outreach programs play an important role in the provision of HIV testing, treatment and health care for men who have sex with men (MSM) in Indonesia. However, qualitative studies of community-based HIV programs have mostly focused on clients rather than on outreach workers (OW). The experiences of MSM peer OW provide insights into how to extend and improve community involvement in HIV programs in Indonesia. Methods: This is a qualitative study based on focus group discussions, which brought together MSM OW (n = 14) and healthcare workers (n = 12). This approach facilitated documentation of the challenges associated with community-based outreach programs in Indonesia through a participatory focus group discussion between OW and healthcare workers. Results: Findings are reported in relation to challenges experienced in the context of community outreach, and solutions to the challenges faced by OW. It was found that awareness of a shared commitment to delivering HIV programs can facilitate good relationships between OW and healthcare workers. Conclusion: Future efforts should consider the role of OW within broader relationships, especially with healthcare workers, when developing community-based responses to HIV testing and treatment. Documenting the role of OW can help contribute to an understanding of ways to adapt HIV programs to reduce barriers to access both for those identified as MSM and others who are ambiguously placed in relation to the programmatic use of such categories.

Additional keywords: discrimination, healthcare workers, online outreach, stigma, transgender.


References

[1]  Kippax S, Crawford J, Connell B, DOWett G, Watson L, Rodden P, et al. The importance of gay community in the prevention of HIV transmission: a study of Australian men who have sex with men. In Aggleton P, Davies P, Hart G, editors. AIDS: rights, risk and reason. London, United Kingdom: Taylor & Francis Group; 1992. pp. 102–18.

[2]  Rodriguez-García R, Wilson D, York N, Low C, N’Jie N, Bonnel R. Evaluation of the community response to HIV and AIDS: learning from a portfolio approach. AIDS Care 2013; 25 S7–19.
Evaluation of the community response to HIV and AIDS: learning from a portfolio approach.Crossref | GoogleScholarGoogle Scholar | 23745633PubMed |

[3]  United Nations General Assembly. Political declaration on HIV and AIDS: on the fast track to accelerating the fight against HIV and to ending the AIDS epidemic by 2030. Geneva: United Nations; 2016. Available online at: https://www.unaids.org/sites/default/files/media_asset/2016-political-declaration-HIV-AIDS_en.pdf [verified 10 March 2020].

[4]  Yang F, Janamnuaysook R, Boyd MA, Phanuphak N, Tucker JD. Key populations and power: people-centred social innovation in Asian HIV services. Lancet HIV 2020; 7 e69–74.
Key populations and power: people-centred social innovation in Asian HIV services.Crossref | GoogleScholarGoogle Scholar | 31818717PubMed |

[5]  UNAIDS Regional Support Team for Asia and the Pacific. HIV AIDS Asia Pacific Research Statistical Data Information Resources AIDS Data Hub. HIV prevalence in men who have sex with men. Bangkok: UNAIDS; 2017. Available online at: https://www.aidsdatahub.org/ [cited 10 March 2020].

[6]  Boellstorff T. But do not identify as gay: a proleptic genealogy of the MSM category. Cult Anthropol 2011; 26 287–312.
But do not identify as gay: a proleptic genealogy of the MSM category.Crossref | GoogleScholarGoogle Scholar |

[7]  Pisani E, Girault P, Gultom M, Sukartini N, Kumalawati J, Jazan S, et al HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sex Transm Infect 2004; 80 536–40.
HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia.Crossref | GoogleScholarGoogle Scholar | 15572631PubMed |

[8]  Simoni JM, Nelson KM, Franks JC, Yard SS, Lehavot K. Are peer interventions for HIV efficacious? A systematic review. AIDS Behav 2011; 15 1589–95.
Are peer interventions for HIV efficacious? A systematic review.Crossref | GoogleScholarGoogle Scholar | 21598034PubMed |

[9]  Higa DH, Crepaz N, Marshall KJ, Kay L, Vosburgh HW, Spikes P, et al A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM). AIDS Behav 2013; 17 1231–44.
A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM).Crossref | GoogleScholarGoogle Scholar | 23397183PubMed |

[10]  Nugroho A, Erasmus V, Krier SE, Reviagana KP, Laksmono PA, Widihastuti A, et al Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen. Health Promot Int 2019; 1–9.
Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen.Crossref | GoogleScholarGoogle Scholar |

[11]  UNAIDS. HIV in Asia and the Pacific. Geneva: United Nations; 2013. Available online at: http://www. unaids.org/sites/default/files/media_asset/2013_HIV-AsiaPacific_en_0.pdf [verified 3 June 2020].

[12]  Ministry of Health Republic of Indonesia. National Action Plan of HIV Response 2015–2019. Jakarta: Publisher; 2015. Available online at: http://www.aidsdatahub.org/dmdocuments/IBBS_2011_Report_Indonesia.pdf [verified 3 June 2020].

[13]  Fact Sheet Integrated Biological and Behavioural Survey (IBBS). High Risk Group in Indonesia. Jakarta: Directorate General of Disease Control and Environmental Health Ministry of Health Republic Indonesia; 2013. Available online at: http://www.slideshare.net/ ditkeswa/finalstbp-totaldraft13-januari1 [verified 3 June 2020].

[14]  Januraga PP, Reekie J, Mulyani T, Lestari BW, Iskandar S, Wisaksana R, et al The cascade of HIV care among key populations in Indonesia: a prospective cohort study. Lancet HIV 2018; 5 e560–8.
The cascade of HIV care among key populations in Indonesia: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 30143455PubMed |

[15]  Lazuardi E, Newman CE, Anintya I, Rowe E, Wirawan DN, Wisaksana R, et al Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities. Health Policy Plan 2020; 35 16–25.
Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities.Crossref | GoogleScholarGoogle Scholar | 31625559PubMed |

[16]  Lazuardi E, Bell S, Newman CEA. ‘Scoping review’ of qualitative literature about engagement with HIV care in Indonesia. Sex Health 2018; 15 283–91.
‘Scoping review’ of qualitative literature about engagement with HIV care in Indonesia.Crossref | GoogleScholarGoogle Scholar | 30021685PubMed |

[17]  Harsono A, Knight K. ‘Scared in public and now no privacy’: human rights and public health impacts of Indonesia’s anti-LGBT moral panic. New York: Human Rights Watch; 2018. Available online at: https://www.hrw.org/report/2018/07/01/scared-public-and-now-no-privacy/human-rights-and-public-health-impacts-indonesias [verified 20 July 2018].

[18]  Katjasungkana N, Wieringa SE, Poore EG. Creeping criminalisation. New York: Outright Action International; 2016.

[19]  Young RM, Meyer IH. The trouble with “MSM” and “WSW”: erasure of the sexual-minority person in public health discourse. Am J Public Health 2005; 95 1144–9.
The trouble with “MSM” and “WSW”: erasure of the sexual-minority person in public health discourse.Crossref | GoogleScholarGoogle Scholar | 15961753PubMed |

[20]  Wulandari LPL, Ruddick A, Guy R, Kaldor J. “Self-testing sounds more private, rather than going to the clinic and everybody will find out”: facilitators and barriers regarding HIV testing among men who purchase sex in Bali, Indonesia. PLoS One 2019; 14 e0214987
“Self-testing sounds more private, rather than going to the clinic and everybody will find out”: facilitators and barriers regarding HIV testing among men who purchase sex in Bali, Indonesia.Crossref | GoogleScholarGoogle Scholar | 30958845PubMed |

[21]  Tromp N, Prawiranegara R, Subhan Riparev H, Siregar A, Sunjaya D, Baltussen R. Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for reasonableness framework. Health Policy Plan 2015; 30 345–55.
Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for reasonableness framework.Crossref | GoogleScholarGoogle Scholar | 24740708PubMed |

[22]  Boellstorff T. Nuri’s testimony: HIV/AIDS in Indonesia and bare knowledge. Am Ethnol 2009; 36 351–63.
Nuri’s testimony: HIV/AIDS in Indonesia and bare knowledge.Crossref | GoogleScholarGoogle Scholar |

[23]  Hardon AP, Oosterhoff P, Imelda JD, Anh NT, Hidayana I. Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: diverging care dynamics. Soc Sci Med 2009; 69 838–45.
Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: diverging care dynamics.Crossref | GoogleScholarGoogle Scholar | 19576671PubMed |

[24]  Sagung Sawitri AA, Sumantera GM, Wirawan DN, Ford K, Lehman E. HIV testing experience of drug users in Bali, Indonesia. AIDS Care 2006; 18 577–88.
HIV testing experience of drug users in Bali, Indonesia.Crossref | GoogleScholarGoogle Scholar | 16831786PubMed |

[25]  Parker R, Ehrhardt AA. Through an ethnographic lens: ethnographic methods, comparative analysis, and HIV/AIDS research. AIDS Behav 2001; 5 105–14.
Through an ethnographic lens: ethnographic methods, comparative analysis, and HIV/AIDS research.Crossref | GoogleScholarGoogle Scholar |

[26]  Pigg SL. On sitting and doing: ethnography as action in global health. Soc Sci Med 2013; 99 127–34.
On sitting and doing: ethnography as action in global health.Crossref | GoogleScholarGoogle Scholar | 23953135PubMed |

[27]  Redman-MacLaren M, Mills J, Tommbe R. Interpretive focus groups: a participatory method for interpreting and extending secondary analysis of qualitative data. Glob Health Action 2014; 7 25214
Interpretive focus groups: a participatory method for interpreting and extending secondary analysis of qualitative data.Crossref | GoogleScholarGoogle Scholar | 25138532PubMed |

[28]  Palys T. Purposive sampling. In Given L, editor. The SAGE encyclopedia of qualitative research methods. Thousand Oaks, California: SAGE; 2008. pp. 697–8.

[29]  Bryman A. Social research methods - 5th edn. Oxford: Oxford University Press; 2015.

[30]  Liamputtong P. Focus group methodology: principles and practice. London: SAGE; 2016.

[31]  Madriz E. Chapter 32: focus groups in feminist research. In Denzin NK, Lincoln YS, editors. Handbook of qualitative research. 2nd edn. London: Sage; 2000. pp. 835–50.

[32]  Mosavel M, Simon C, van Stade D, Buchbinder M. Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question. Soc Sci Med 2005; 61 2577–87.
Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question.Crossref | GoogleScholarGoogle Scholar | 15955605PubMed |

[33]  Beres LK, Simbeza S, Holmes CB, Mwamba C, Mukamba N, Sharma A, et al Human-centered design lessons for implementation science: improving the implementation of a patient-centered care intervention. J Acquir Immune Defic Syndr 2019; 82 S230–43.
Human-centered design lessons for implementation science: improving the implementation of a patient-centered care intervention.Crossref | GoogleScholarGoogle Scholar | 31764259PubMed |

[34]  Green J, Thorogood N. Qualitative methods for health research. London: SAGE; 2009.

[35]  Ryan GW, Bernard HR. Techniques to identify themes. Field Methods 2003; 15 85–109.
Techniques to identify themes.Crossref | GoogleScholarGoogle Scholar |

[36]  Padgett D. Qualitative and mixed methods in public health. London: SAGE; 2012.

[37]  Hegarty B. ‘When I was transgender’: visibility, subjectivity, and queer aging in Indonesia. Med Anthropol Theory 2017; 4 70–80.
‘When I was transgender’: visibility, subjectivity, and queer aging in Indonesia.Crossref | GoogleScholarGoogle Scholar |

[38]  Editorial People have the power. Lancet HIV 2020; 7 e1
People have the power.Crossref | GoogleScholarGoogle Scholar | 32621876PubMed |

[39]  Bekker L-G, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, et al Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission. Lancet 2018; 392 312–58.
Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission.Crossref | GoogleScholarGoogle Scholar | 30032975PubMed |

[40]  Sabin LL, Semrau K, DeSilva M, Le LTT, Beard JJ, Hamer DH, et al Effectiveness of community outreach HIV prevention programs in Vietnam: a mixed methods evaluation. BMC Public Health 2019; 19 1130
Effectiveness of community outreach HIV prevention programs in Vietnam: a mixed methods evaluation.Crossref | GoogleScholarGoogle Scholar | 31420034PubMed |

[41]  van der Elst EM, Gichuru E, Muraguri N, Musyoki H, Micheni M, Kombo B, et al Strengthening healthcare providers’ skills to improve HIV services for MSM in Kenya. AIDS 2015; 29 S237–40.
Strengthening healthcare providers’ skills to improve HIV services for MSM in Kenya.Crossref | GoogleScholarGoogle Scholar | 26372492PubMed |

[42]  Kapanda L, Jumbe V, Izugbara C, Muula AS. Healthcare providers’ attitudes towards care for men who have sex with men (MSM) in Malawi. BMC Health Serv Res 2019; 19 316
Healthcare providers’ attitudes towards care for men who have sex with men (MSM) in Malawi.Crossref | GoogleScholarGoogle Scholar | 31101107PubMed |

[43]  World Health Organization. Consolidated guidelines on HIV testing services for a changing epidemic. Geneva: WHO; 2019. Available online at: https://www.who.int/publications-detail/consolidated-guidelines-on-hiv-testing-services-for-a-changing-epidemic [verified 3 June 2020].