Objectives: This article reports new surveillance data on the prevalence of sexual risk taking, HIV and other sexually transmitted infections (STI) among four occupational groups of Indonesian men thought to be at elevated risk of infection.
Methods: Behavioural survey data were collected from 3008 men in 11 cities, among whom 2158 men were tested for HIV and syphilis and 1950 for gonorrhoea and chlamydia. Risk factors for STI were assessed using multivariable logistic regression.
Results: Thirty-six per cent of men had sex with a female sex worker (FSW) in the previous year and 20% with non-marital female partners. Consistent condom use was low with both sex workers (17%) and other non-marital partners (13%). HIV prevalence was 2% in Papua and less than 1% elsewhere, but was for the first time detectable in a non-core transmitter male population outside of Papua. STI rates were high for a non-core transmitter group, especially syphilis. Truck drivers were the most at risk. Multivariable analyses revealed exposure to FSW and inconsistent condom use, along with geographical location (Papua vs non-Papua) and unobserved factors associated with certain occupational groups, to be key risk factors for STI infection.
Conclusions: The results confirm that men in the four occupational groups are reasonable proxies for “high-risk men” for surveillance purposes in Indonesia. Although HIV prevalence was low, the extent of sexual risk taking and the moderately high levels of STI among these men, along with rising HIV rates among FSW, indicate the potential for HIV/AIDS transmission in Indonesia to accelerate.
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Funding: Primary financial support for this research was provided by the US Agency for International Development (USAID) and the Indonesian Partnership Fund. Additional financial support was provided by the World Health Organization and the Australian Agency for International Development (AusAID) through the Indonesian HIV/AIDS Prevention and Care Project (IHPCP).
Competing interests: None.
Ethics approval: The study protocol was approved by the Ethics Committee of the Indonesian Center for Biomedical and Pharmaceutical Research as well as the Protection of Human Subject Committee of Family Health International.
Patient consent: Obtained.
Contributors: DEM was responsible for surveillance operations at the Ministry of Health, participated in technical design and operational oversight and contributed to the writing of and reviewed the manuscript. GM participated in technical design and operational oversight, led the data analysis, prepared the tables and contributed to the writing of the manuscript. N coordinated and provided operational oversight for all biological sample acquisition and laboratory testing activities. YI was responsible for surveillance operations at Central Statistics Bureau, participated in technical design and operational oversight and reviewed the manuscript. PR participated in technical design, operational oversight and data analysis and reviewed the manuscript. SP facilitated government clearances for the surveillance effort, participated in technical design and reviewed the manuscript. RM participated in technical design and data analysis and was the primary author of the manuscript.