Perspectives on voluntary assisted partner notification among providers, people with HIV and the general population in Indonesia: a formative qualitative study.

BACKGROUND: Voluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Following recommendations by the World Health Organization in 2016, Indonesia evaluated various approaches to aPN. We present the lessons learned from formative operational research undertaken to understand provider and patient perspectives on aPN from three demonstration sites in cities with a high HIV burden. METHODS: We conducted a formative qualitative study in three cities: Jakarta, Semarang, and Denpasar between September and October 2019. We conducted six focus group discussions (FGDs) (n = 44 participants) among health-care providers, people living with HIV and the general population. We explored participant preferences and concerns about how aPN should be delivered, including the methods of and messaging for contacting partners. All FGDs were conducted in the Indonesian language. Qualitative data were analysed using thematic analysis. RESULTS: aPN was acceptable across different participant populations, although with caveats. Some differences were observed between the general population, providers and people living with HIV. People living with HIV were mainly concerned with confidentiality of the procedure and preferred the use of telecommunication and messages that avoid explicit mention of HIV exposure. Providers preferred similar approaches but for different reasons, being concerned mainly with self-efficacy and security. There was consensus regarding dual referral models. The use of phone calls and short messages were preferred as these are perceived to minimize negative reactions and stigma, protect client confidentiality and are suitable in the current legal situation. The general population was mainly concerned with effectiveness and prefer direct provider-led approaches, such as preferring in-person meeting with explicit notification of potential HIV exposure. CONCLUSIONS: We found consensus among stakeholders on acceptance of aPN, especially dual referral methods. Development and implementation of aPN protocols should also consider clients' individual situations and concerns regarding safeguarding of confidentiality, and offer a range of options to accommodate all stakeholders involved.

Conspiracy beliefs and trust as determinants of COVID-19 vaccine acceptance in Bali, Indonesia: Cross-sectional study.

OBJECTIVE: This study aimed to investigate association between conspiracy beliefs, trusts in media and authoritative information sources, with COVID-19 vaccine acceptance. METHODS: We conducted online survey on adult resident of Bali Province, Indonesia in September 14th to October 31st 2020 collecting data on demographics, impacts of the pandemic, conspiracy beliefs, trusts in conventional media and authoritative sources, as well as vaccine acceptance. We conducted bivariate and multivariate analysis for determinants of vaccine acceptance with SPSS 23.0. RESULTS: We recruited 779 respondents with 38.9% male and median age of 24 years old (IQR 20 - 26). The result showed vaccine acceptance of 60.8%. Vaccine acceptance was correlated with conspiracy beliefs, trusts in conventional media and authoritative sources with Spearman's rho of -0.350, 0.269, and 0.287 respectively. Controlling for demographics and impacts of pandemic, showed strong conspiracy beliefs and trust in conventional media as the only independent determinants with OR of 0.33 (CI95% 0.20-0.54) and 1.91 (CI95% 1.37-2.65) respectively. CONCLUSION: The results indicated considerable impacts of infodemic, represented by conspiracy beliefs, trust in media, and in authoritative sources, toward COVID-19 vaccine acceptance. Effective public health messaging should be conducted concurrent with vaccine rollout to improve acceptance and achieve herd immunity.

Open Communication About Reproductive Health Is Associated With Comprehensive HIV Knowledge and a Non-stigmatising Attitude Among Indonesian Youth: A Cross-sectional Study.

OBJECTIVES: Human immunodeficiency virus (HIV) prevention among youth seems under-prioritised compared to other key populations. HIV knowledge and stigma are important parts of HIV prevention. To inform HIV prevention among youths, this study quantitatively analysed the associations between open communication regarding sexuality and sexual health, comprehensive HIV knowledge, and non-stigmatising attitudes in Indonesia. METHODS: This study used data from the Indonesian Demographic and Health Survey (IDHS) 2017. The analysis included unmarried men and women aged 15-25 years old. Comprehensive HIV knowledge and a stigmatising attitude were defined according to the IDHS 2017. Open communication about sexuality and sexual health was defined as the number of people with whom participants could openly discuss these topics in their direct network of friends, family, and service providers, with a scale ranging from 0 to a maximum of 7. Primary analysis used binomial logistic regression with weighting adjustments. RESULTS: The final analysis included 22 864 respondents. Twenty-two percent of youth had no one in their direct network with whom to openly discuss sexual matters, only 14.1% had comprehensive HIV knowledge, and 85.9% showed stigmatising attitudes. Youth mostly discussed sex with their friends (55.2%), and were less likely to discuss it with family members, showing a predominant pattern of peer-to-peer communication. Multivariate analysis showed that having a larger network for communication about sexuality and sexual health was associated with more HIV knowledge and less stigmatising attitudes. CONCLUSIONS: Having more opportunities for open sex communication in one's direct social network is associated with more HIV knowledge and less stigmatising attitudes.

Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study.

INTRODUCTION: The threat of new SARS-CoV-2 variants indicates the need to implement COVID-19 vaccine booster programs. The aim of this study was to identify the level of booster acceptance and its determinants. METHODS: A cross-sectional online survey was conducted in Jakarta and Bali, Indonesia. Booster acceptance was divided into three categories: non-acceptor, planned acceptor, and actual acceptor. The primary independent variables were health beliefs, media influence, and trust in authoritative sources. Other covariates included demographics, socioeconomic status, and COVID-19 history. A primary analysis was conducted through multinomial logistic regression. The effects of the hypothetical situations on booster acceptance were tested using the Wilcoxon signed-rank test. RESULTS: The final analysis included 2674 respondents with a booster acceptance rate of 56.3% (41.2% planned acceptors, 15.1% actual acceptors). Health beliefs, social media influence, and trust in authoritative information sources were identified as determinants for planned and actual booster acceptance. Socioeconomic status indicators were also identified as determinants for actual booster acceptance. Booster acceptance was increased in hypothetical scenarios involving booster requirements for work, travel, and accessing public places. CONCLUSIONS: Booster acceptance was found to be lower than the predicted primary vaccine acceptance prior to its launch. The acceleration of booster coverage requires strategies that leverage health beliefs and focus on people with a lower socioeconomic status.

Anxiety and prior victimization predict online gender-based violence perpetration among Indonesian young adults during COVID-19 pandemic: cross-sectional study.

Background: Most of human interactions moved to the cyberspace for much of the pandemic. It was no surprise that online violence was also on the rise. One of the objectives of this study was to describe the prevalence and risk factors of online gender-based violence (OGBV) perpetration during the COVID-19 pandemic. Results: The final analysis included 1006 respondents, 84.2% of whom were women and 94.5% were heterosexual. Over 60% of respondents admitted having perpetrated at least one type of OGBV once. It included 58.6% of women who admitted having perpetrated OGBV. Logistic regression analysis identified anxiety, online disinhibition, and history of victimization as independent risk factors of perpetration with an adjusted odds ratio (aOR) of 1.82 (95% CI 1.30-2.56), 1.38 (95% CI 1.03-1.85), and 9.72 (95% CI 5.11-18.51), respectively. Sub-group analysis that identified these factors also facilitated increased frequency and severity of OGBV perpetration. Conclusions: We found a high proportion of OGBV perpetration among young adults during the pandemic among all genders although women were grossly overrepresented among the respondents. Risk factors of perpetration included anxiety, online disinhibition, and prior victimization. The pandemic situation which heightened general anxiety and increased dependency on online communication may facilitate the perpetration of OGBV. The generalization of this result should pay attention to the caveat that the demographic of respondents is heavily skewed toward women.

Women's Empowerment Facilitates Complete Immunization in Indonesian Children: A Cross-sectional Study.

OBJECTIVES: The primary objective of this study was to examine the effect of women's empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association. METHODS: We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women's empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women's empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group. RESULTS: The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women's empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles. CONCLUSIONS: To our knowledge, this study is the first to explore women's empowerment as a determinant of child immunization in Indonesia. The results indicate that women's empowerment must be considered in Indonesia's child immunization program. Women's empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women's empowerment on health outcomes.

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic.

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Correlation of Demographics, Healthcare Availability, and COVID-19 Outcome: Indonesian Ecological Study.

Objective: To analyze the correlation between demographic and healthcare availability indicators with COVID-19 outcome among Indonesian provinces. Methods: We employed an ecological study design to study the correlation between demographics, healthcare availability, and COVID-19 indicators. Demographic and healthcare indicators were obtained from the Indonesian Health Profile of 2019 by the Ministry of Health while COVID-19 indicators were obtained from the Indonesian COVID-19 website in August 31st 2020. Non-parametric correlation and multivariate regression analyses were conducted with IBM SPSS 23.0. Results: We found the number of confirmed cases and case growth to be significantly correlated with demographic indicators, especially with distribution of age groups. Confirmed cases and case growth was significantly correlated (p < 0.05) with population density (correlation coefficient of 0.461 and 0.491) and proportion of young people (-0.377; -0.394). Incidence and incidence growth were correlated with ratios of GPs (0.426; 0.534), hospitals (0.376; 0.431), primary care clinics (0.423; 0.424), and hospital beds (0.472; 0.599) per capita. For mortality, case fatality rate (CFR) was correlated with population density (0.390) whereas mortality rate was correlated with ratio of hospital beds (0.387). Multivariate analyses found confirmed case independently associated with population density (ß of 0.638) and demographic structure (-0.289). Case growth was independently associated with density (0.763). Incidence growth was independently associated with hospital bed ratio (0.486). Conclusion: Pre-existing inequality of healthcare availability correlates with current reported incidence and mortality rate of COVID-19. Lack of healthcare availability in some provinces may have resulted in artificially low numbers of cases being diagnosed, lower demands for COVID-19 tests, and eventually lower case-findings.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study.

PURPOSE: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. METHODS: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. RESULTS: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. CONCLUSION: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.