JMIR Publications

ABSTRACT

Background:

Indonesia's vast archipelago and substantial population present unique challenges in tackling its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. While there is a decline in HIV prevalence among key populations like female sex workers (FSWs) and people who inject drugs (PWID), the prevalence has surged among men having sex with men (MSM) and transgender women (TG).

Objective:

This paper explores Indonesia's key population mapping from 2022.

Methods:

A PLACE strategy-based mapping of key populations (MSM, PWID, TG, FSWs) was conducted across 201 districts/cities in 2022 chosen for their HIV program intensity. This multi-phase process included participatory workshops for hotspot identification, followed by direct hotspot observations. Data from 49,346 informants, primarily from key populations, were collected and analyzed using Microsoft Excel for efficient organization and analysis. Results from individual hotspots were aggregated to district/city levels using a formula to estimate the population size.

Results:

The mapping initiative identified 18,339 hotspots across 201 districts/cities, revealing significant disparities in hotspot distribution among districts/cities. 'Comprehensive' HIV intervention districts had notably more hotspots for key populations than 'Medium' and 'Basic' districts. Of the identified hotspots, 93% (16,964) were observed, with 11% (1,822) undergoing a second review to enhance data accuracy. While these observations largely aligned with local stakeholders' estimates, they showed a slightly lower median. Interviews with informants indicated a shift in key population dynamics, especially a median decrease in hotspot attendance post-pandemic. There was considerable variation in mapping results across different district categories. In 'Comprehensive' areas, the average results for MSM, PWID, TG, and FSW populations were 1,008 (median: 694), 224 (median: 114), 196 (median: 167), and 775 (median: 573), respectively. 'Medium' areas had lower averages for MSM (381, median: 199), PWID (51, median: 54), TG (101, median: 55), and FSW (304, median: 231). 'Basic' areas showed the lowest averages: MSM at 161 (median: 73), PWID at 7 (median: 7), TG at 59 (median: 26), and FSW at 161 (median: 131). Comparisons with ongoing outreach programs revealed significant differences; the mapped MSM population was over 50% lower than program coverage, while PWID estimates were twice as high as the program's reach.

Conclusions:

The mapping results highlight significant variations in hotspots and key populations across different districts/cities and changes observed before and after the pandemic. These findings emphasize the necessity for HIV AIDS prevention strategies that adapt to social and epidemiological dynamics. Developing strategies beyond identified hotspots is crucial, as is integrating mapping data into comprehensive planning for broader coverage and alignment with key populations' dynamics. Furthermore, a longitudinal approach is essential to understand how key population behaviors evolve over time and in response to various factors, providing critical insights for effective HIV AIDS prevention and control.