The short-term effects of COVID-19 on HIV and AIDS control efforts among female sex workers in Indonesia.

BACKGROUND: The COVID-19 pandemic has raised concerns as to its impact on other health programs. One program that appears particularly vulnerable is HIV and AIDS. We undertook an assessment of COVID-19 impact on HIV control efforts in Indonesia for a sub-population that has received little attention in the global literature-female sex workers (FSW). METHODS: The study was undertaken in 23 National AIDS program priority districts. Four sources of monthly data during January-July 2020 were considered. COVID-19 infection data were extracted from national and district surveillance systems. Combination prevention program outputs were reported by civil society organizations (CSOs) providing community support services to FSW. These organizations also undertook monthly scans of levels of commercial sex activity and HIV testing availability. We also considered data from an ongoing HIV community screening trial. The primary mode of analysis entailed comparisons of levels and trends of indicators from the four data series. RESULTS: Commercial sex activity was severely curtailed in April-May in many districts. While recovering to pre-COVID-19 levels in "Localization" areas, the number of active FSW in July was one-third below that in February. HIV testing service availability declined by 50% at health facilities before recovering slowly, while mobile clinic services largely ceased during April-June. Numbers of FSW reached, condoms distributed, FSW tested for HIV, HIV cases detected, and FSW starting treatment all declined precipitously in April/May but had largely recovered to pre-COVID-19 levels by July. We found only a temporary dip in treatment initiation rates among HIV positive FSW and no discernible impact on treatment retention. The HIV community screening trial data revealed significant demand for HIV testing among FSW that was not being met even before the onset of COVID-19. CONCLUSIONS: COVID-19 has had at least short-run economic effects on FSW and the national response to HIV and AIDS targeting FSW. However, the effects appear to have been cushioned by community-based services and support in study districts. The findings make a compelling case for the expansion of community-based services irrespective of the future trajectory of COVID-19. As COVID-19 has not yet been contained, the trajectory of economic activity and service delivery is uncertain.

Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen.

This study explored clients' perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.

Evaluation of a training aimed at building capacity for outreaching to men who have sex with men and transgender women in Indonesia.

Implementers of outreach program in Indonesia often provide formal training for their outreach workers (OWs) only at the startup. We believe continuous training can be provided by experienced OWs at any time if an appropriate training package is available. Using a one-group pre-test-post-test study design; we developed, implemented and evaluated an OW-informed training program aimed at increasing OWs' knowledge and skills for outreaching to men who have sex with men and transgender women. We analyzed longitudinal data from 75 OWs from 7 Indonesian cities using one-way within-subjects ANOVA to examine the effects of the training program on participants' knowledge and perceived skills over time Average overall knowledge among participants increased from pre-test to immediate post-test (P < 0.001) and from pre-test to 2-month post-test (P < 0.001), especially in basic human immunodeficiency virus and sexual transmitted infections; condoms and lubricants; sexual and reproductive health and rights; sexual orientation and gender identity and expression; and stages of behavior change. Average overall perceived skills increased significantly from pre-test to 2-month post-test (P = 0.018), especially in creating innovative outreach approaches; building effective teamwork; and coordinating with healthcare providers. This training package increased knowledge and perceived skills among OWs. Thus, if consistently applied, it could help maintaining quality of the outreach program.

Behavioral interventions to reduce HIV risk behavior for MSM and transwomen in Southeast Asia: a systematic review.

This systematic review aims to gain insights from existing literature from Southeast Asian countries to improve future HIV prevention programs for men who have sex with men (MSM) and transgender women (transwomen). We conducted a systematic search in six international databases for literature published prior to 1 January 2015. We included studies describing behavioral interventions targeting MSM and/or transwomen, and conducted in at least one Southeast Asian country. Five out of 575 screened studies met the inclusion criteria and reported a significant intervention effect on at least one outcome measure, that is, condom use (with casual or commercial partner), water-based lubricant use, number of sex partners, HIV prevention knowledge, or willingness to use pre-exposure prophylaxis. Peer education/outreach was the most commonly employed type of intervention in the five included studies and was usually delivered as an element of a larger intervention package, together with condom distribution and the provision of drop-in centers. Motivational interviewing was effective, while internet-based interventions appeared to be a viable platform for intervention delivery. Nevertheless, research on behavioral interventions among MSM and transwomen in Southeast Asia is limited. Future interventions should be culturally appropriate, theoretically grounded, and rigorously evaluated. Only then can we best address the HIV epidemic among MSM and transwomen in this region.

Social-life cycle assessment of oil palm plantation smallholders in Bengkulu province, Indonesia.

Smallholders are often seen as a weak point in the development of oil palm plantation production. The quality and yield of their production are considered low according to world market standards; the continuity of their production is irregular; and finally, improving the welfare of farmers is difficult to achieve. However, smallholder plantations have an important and strategic role in achieving sustainable development. This study aims to assess the social life cycle assessment of smallholder oil palm plantations in Bengkulu Province by involving stakeholders consisting of workers, local communities, farm owners, and value chain actors. A total of 600 respondents were selected using quota sampling and interviewed using a structured questionnaire. Data analysis was conducted using social-life cycle assessment, involving various social issues and relevant social indicators for each stakeholder. The findings in our research show that smallholder oil palm plantations still do not meet the minimum wage for workers, and the equipment used by workers is still very minimal in terms of security and safety guarantees. The price of palm oil continues to fluctuate, and plantation policies are constantly changing, making it difficult for oil palm owners to meet the standards and various rules that are set for managing oil palm plantations. In addition, oil palm plantations are no longer a guarantee for the fulfillment of food security conditions for household owners, workers, communities, and actors involved in the oil palm institutional chain. Our finding is that, surprisingly, there is a low level of commitment by smallholders and the government to sustainability in oil palm plantations. The Indonesian Sustainable Palm Oil and Roundtable on Sustainable Palm Oil as standards for sustainable oil palm plantations, as well as global standards for oil palm plantations to demonstrate environmentally friendly production processes, have not been able to compel smallholders to implement sustainable development in oil palm. Various policies formulated by the Indonesian government are perceived to have not addressed the core issues faced by small-scale farmers. Policies supporting small-scale farmers, particularly those related to increasing productivity, fostering and monitoring the environmental management of palm oil plantation activities, and ensuring ownership of plantation, are necessary for the achievement of sustainable smallholder palm oil plantation development.

Retrofitting of concrete for rigid pavement using bacterial: A meta-analysis.

Cracking in tension causes damage to regular concrete. When the surface of the concrete cracks, liquids can enter and damage the structure. Remediating concrete in rigid pavements is time-consuming, costly, and challenging. Concrete cracking can be reduced using sustainable solutions, such as concrete bacteria. Using concrete bacteria is an innovative method for continuously retrofitting concrete, improving its durability, and reducing maintenance costs. Several studies have explored the possibilities of a wide range of bacteria and demonstrated concrete retrofitting. However, in these extensive studies of sustainable solutions, the role of concrete bacteria in retrofitting concrete for rigid pavement has not been clarified. This meta-analysis aims to compare and contrast the performance of various microorganisms in concrete restoration, considering the bacteria concentration, total concrete components, and water/cement ratio. Data from 371 articles were entered into the initial database and 37 articles into the final database for meta-analysis. Low concentrations (10 CFU/mL) of Bacillus subtilis increased the compressive strength after 28 days at 46.8 MPa, and the optimum concentration of Bacillus subtilis was 105 CFU/mL, resulting in an optimum compressive strength of 58.2 MPa after 28 days, an optimum water/cement ratio of 0.3, and the optimum total ingredients (cement, fine and coarse aggregates) ranging from 2000 to 2400 kg/m3. This meta-analysis study supports a new approach to selecting concrete bacteria and developing sustainable advances in concrete technology.

An integrated biorefinery strategy for the utilization of palm-oil wastes.

Each year, the palm oil industry generates a significant amount of biomass residue and effluent waste; both have been identified as significant sources of greenhouse gas (GHG) emissions. This issue poses a severe environmental challenge for the industry due to the possibility of long-term negative effects on human well-being. The palm-oil industry must invest significantly in the technology that is required to resolve these issues and to increase the industry's sustainability. However, current technologies for converting wastes such as lignocellulosic components and effluents into biochemical products are insufficient for optimal utilization. This review discusses the geographical availability of palm-oil biomass, its current utilization routes, and then recommends the development of technology for converting palm-oil biomass into value-added products through an integrated biorefinery strategy. Additionally, this review summarizes the palm oil industry's contribution to achieving sustainable development goals (SDGs) through a circular bioeconomy concept.

Driving factors of retention in care among HIV-positive MSM and transwomen in Indonesia: A cross-sectional study.

Little is known about the prevalence of and factors that influence retention in HIV-related care among Indonesian men who have sex with men (MSM) and transgender women (transwomen, or waria in Indonesian term). Therefore, we explored the driving factors of retention in care among HIV-positive MSM and waria in Indonesia. This cross-sectional study involved 298 self-reported HIV-positive MSM (n = 165) and waria (n = 133). Participants were recruited using targeted sampling and interviewed using a structured questionnaire. We applied a four-step model building process using multivariable logistic regression to examine how sociodemographic, predisposing, enabling, and reinforcing factors were associated with retention in care. Overall, 78.5% of participants were linked to HIV care within 3 months after diagnosis or earlier, and 66.4% were adequately retained in care (at least one health care visit every three months once a person is diagnosed with HIV). Being on antiretroviral therapy (adjusted odds ratio [AOR] = 6.00; 95% confidence interval [CI]: 2.93-12.3), using the Internet to find HIV-related information (AOR = 2.15; 95% CI: 1.00-4.59), and having medical insurance (AOR = 2.84; 95% CI: 1.27-6.34) were associated with adequate retention in care. Involvement with an HIV-related organization was associated negatively with retention in care (AOR = 0.47; 95% CI: 0.24-0.95). Future interventions should increase health insurance coverage and utilize the Internet to help MSM and waria to remain in HIV-related care, thereby assisting them in achieving viral suppression.