“The biggest barriers to ending HIV are stigma, discrimination and internalized stigma,” says Wawan from Organisasi Perubahan Sosial Indonesia
In Indonesia, community organizations and the Government are focusing on HIV prevention in their strategy to reach the goals of reducing new HIV infections. In 2023, with numbers of new infections hovering around 28 000 and 49% of these among young people aged 15–24 years, the Government initiated PrEP in six locations, using a broad approach to access.
Following UNAIDS and World Health Organization HIV prevention guidelines, women, transgender people, men, sex workers, people who use drugs, men who have sex with men and others are benefiting from the ongoing expansion of the PrEP programme. The programme grew to 21 sites in 2023 and is aiming for 95 sites by the end of 2024. PrEP is provided by primary health-care centres, hospitals and community organizations.
“In Indonesia’s decentralized system, the national government provides guidelines, but each district implements on their own authority,” says Adi Mantara of Bali Health Foundation, an organization working with people at high risk for HIV. Adi, who formerly used drugs and is now a lawyer, also works with the Indonesia Network of People Living with HIV on policy analysis and community-led monitoring. “We must see the big picture of the whole HIV response. We are changing the perspective towards community health services,” says Adi, highlighting that when programmes focus on selected criteria, other criteria get left behind.
Dr Putu Ariastuti of Yayasan Kerti Praja is a public health expert working in eastern Indonesia. Her organization and local partners collaborate with the Government to introduce sex workers to the PrEP programme via existing outreach. “The challenge is that it is a new programme and there can be misinformation among the community. Therefore, we train peer leaders to provide correct information and connect community members with the district health office for services.” HIV testing and PrEP initiation are also offered via mobile clinics.
Access to PrEP provides sex workers with a self-determined strategy to prevent HIV, not limited by their situational power to negotiate condom use. Wawan from Organisasi Perubahan Sosial Indonesia explains: “PrEP is important for us to prevent HIV. But we also must educate that you still need to use a condom and check regularly for sexually transmitted infections. We want to integrate sexual and reproductive health into HIV prevention.”
Indonesia’s turn towards PrEP for reducing new infections may reduce stigma and discrimination by shifting blame away from specific people. “The biggest barriers to ending HIV are stigma, discrimination and internalized stigma,” says Wawan.
Adi and others involved in the 2023 Indonesia stigma index assessment agree that continuing to increase intersectional approaches and incorporating the 10–10–10 targets (targets on laws, discrimination and violence) will proliferate progress for all.
Education by communities for communities is a driving factor behind the increase in HIV testing and access to PrEP in Indonesia. Dr Ari points out that more people seek follow-up services when they have a personal connection to peer leaders, thereby increasing the number of people who know their status and who access antiretroviral therapy. In some places, Government facilities allow community organizations to transport medicines to individuals in their communities who are not able to regularly pick up PrEP themselves, which helps with adherence.
In the first quarter of 2024, over 6000 people used PrEP, three times more than in the same period in 2023. Young people are also benefiting from PrEP. The introduction of new technologies, such as long-acting PrEP and antiretroviral medicines, holds promise for reducing HIV transmission further. Continued public and community partnerships are crucial for maintaining these advancements.