HIV, sexually transmitted infections, and sexual risk behavior among transgenders in Indonesia.

Behavioral surveillance was undertaken among 1,150 male-to-female transgenders (waria) in Java, Indonesia, 2007; samples were collected for HIV and STI testing (n = 748). Almost all waria had ever sold sex (median duration 10 years). Prevalence of HIV was 24.4%, syphilis 26.8% and rectal gonorrhea and/or chlamydia 47.0%. Syphilis and rectal STIs were associated with HIV infection. Consistent condom use during receptive anal sex with clients was reported by 35.9% waria and was higher among those who visited an STI clinic and who knew their HIV status. Efforts should continue to strengthen behavior change and STI care in future HIV prevention programs.

Sexual risk behaviours, HIV and other sexually transmitted infections among female sex workers in Indonesia.

OBJECTIVES: To assess the HIV/AIDS epidemic situation among female sex workers (FSW) in Indonesia using data from the 2007 Integrated Biological-Behavioural Surveillance (IBBS). METHODS: Behavioural data were collected from time-location samples of 5947 FSW in 10 cities in late 2007. HIV, syphilis, gonorrhoea and chlamydia test results were obtained for 4396, 4324, 3291 and 3316 FSW, respectively. Trends in HIV prevalence were assessed via linkage with sentinel surveillance data. Factors associated with HIV, gonorrhoea and chlamydia infection were assessed using multivariable logistic regression. RESULTS: HIV prevalence averaged 10.5% among direct and 4.9% among indirect FSW, and had increased steadily among direct FSW from 2002 to 2007. Prevalence of chlamydia, gonorrhoea and active syphilis averaged 35.6%, 31.8% and 7.3%, respectively, among direct FSW, and 28.7%, 14.3% and 3.5% among indirect FSW. Being a direct FSW, younger age and having current infection with syphilis and gonorrhoea and/or chlamydia were associated with a higher likelihood of HIV infection. Number of clients in the past week and consumption of alcohol before having sex were associated with a higher likelihood of gonorrhoea and/or chlamydia infection, while having received a STI clinic check-up in the previous 3 months and/or periodic presumptive treatment for sexually transmitted infections (STIs) in the past 6 months were associated with reduced likelihood of infection. CONCLUSIONS: The HIV/AIDS epidemic among FSW in Indonesia appears to be expanding, albeit unevenly across provinces and types of FSW. High STI prevalence is conducive to further expansion, but recent efforts to strengthen STI control appear promising.

Syphilis among female sex workers in Indonesia: need and opportunity for intervention.

OBJECTIVE: To study the prevalence and factors associated with syphilis among female sex workers (FSWs) in Indonesia. METHODS: Direct and indirect FSWs were sampled in 10 major cities in Indonesia. A behavioural survey was conducted and samples obtained and tested for HIV (Bioline and Determine) and syphilis (RPR and Determine). Syphilis prevalence and potential factors associated with syphilis were assessed in bivariable and multivariable analysis. Syphilis prevalence among brothel-based sex workers from previous surveillance in 2003 and 2005 was compared to 2007. RESULTS: A total of 2436 direct and 1888 indirect FSWs participated in both the behavioural and biomarker surveys. Prevalence of active syphilis (RPR≥1:8) was high among direct and indirect FSWs (7.5% vs 3.1%) and was not lower among those who had visited an STI clinic in the last 3 months. Prevalence of active syphilis was lower among those who had received at least one dose of a prior periodic presumptive treatment programme (PPT) for chlamydia and gonorrhoea with 1 g azithromycin and 400 mg cefixime compared to those who had not received PPT (3.9% vs 6.0%; p=0.008). Older age (AOR=1.4), longer duration of sex work (AOR=1.7) and PPT (AOR=0.6) were associated with active syphilis in multivariable analysis. Syphilis prevalence among brothel-based FSWs increased from 2005 to 2007 (7.8% vs 14.5%; p<0.001). CONCLUSIONS: Syphilis prevalence among FSWs in Indonesia was high and increased from 2005 to 2007. Receipt of PPT was associated with lower syphilis prevalence. Current syphilis control programmes need to be evaluated and the possibility of alternative syphilis treatment with azithromycin explored.