HIV EPIDEMIC PROFILE

IN INDONESIA

Mondastri K Sudaryo,
Dep. Epidemiologi, FKM UI:
Increasing pattern of HIV-AIDS till Dec 2013,
consistent with an estimation and projection of HIV
new infection and numbers of adult PLHIV calculated
2008 to 2014
Predominant distribution of HIV infected
cases: male, aged 25-49 y, heterosexual
10 provinces reported highest AIDS case and AIDS
case rates, 1987-2011: - Papua most advanced, Bali
fastest after Papua, Jawa most burdened
Since 2007-2013, HIV prevalence rates consistently high (> 5%) in
most high risk populations; FSW, MSM, transgender (waria) and
IDU, indicating concentrated epidemic, except in Tanah Papua
which is extended/ generelized (> 2% in general people)

80

60
52.4

42.4
39.5
% 40

27.0
24.3
23.2
20
12.4 12.8
9.89.3 9.17.4
6.57.4 5.3 7.0
4.03.12.6
1.5 0.10.70.40.2 1.2
0
WPSL WPSTL Pria Risti Waria LSL Penasun WBP

2007 2011 2009 2013

HIV prev. rates among 10
9
general population in 8
7
6
5
Tanah Papua according to 4
3
2
type of sexual contacts 1
0

and type of inhabited

lands, indicating
generalized, but not fully
established, mainly
through heterosexual
contacts
100
90 Male (n=2.849)
80 Female (n=3.012)
70
60
50
40
30
20 10.9 13.0
6.6 9.1
10 3.4 5.0
1.2 3.4 0.80.4 3.76.0 2.80.3 0.6
0
 Extended/ generalized epidemic in Tanah Papua:
indigenous Papuan, young adult, equal gender distribution
10 10 10
9 9
8 8 8
7
7 6
6 6 5
4
5 3
4 4 2
3 1
0
2 2
1
0 0

10
10 9
8
9 7
6
8 5
4
7 3
2
6 1
0
5
4
3
2
1
0
Male (n=2.750) Female (n=2.924)
Estimation-projection PLHIV (above) and HIV
new infection (below): special attention to MSM
180000
160000
140000
D-FSW
120000 ID-FSW
100000 CLIENT OF FSW
80000 MSM
IDU
60000
TRANSGENDER
40000
CLIENT OF TRANSG
20000
0
2011 2012 2013 2014 2015 2016

35000

30000

25000 D-FSW
ID-FSW
20000 CLIENT OF FSW
MSM
15000
IDU
10000 TRANSGENDER
CLIENT OF TRANSG
5000

0
2011 2012 2013 2014 2015 2016
Increasing trends of HIV (above) &
Syphillis (below) among MSM and IDU
50.0

40.0

30.0
%
20.0

10.0
2.61.6 1.2
8.0 7.2 0.4 0.2 9.2 7.4 7.012.8 27.0
0.0
WPSL WPSTL Pria Risti Waria LSL 39.5
Penasun WBP

50.0

40.0

30.0

%
20.0
12.0 11.3
9.7
10.0 6.3 8.0
4.0 3.0 1.8 3.6 3.4 2.9 3.5
1.0
0.0
WPSL WPSTL Pria Risti Waria LSL Penasun WBP
 Summary of trends of HIV and Syphilis
Prevalence Rates Among High Risk Populations

High risk HIV prev. rate Syphilis prev. HIV prev rate Syphilis prev.
Pop (2007 vs rate (2009 vs rate
2011) (2007 vs 2013) (2009 vs
2011) 2013)

Direct
FSW

Indirect
FSW

Client of
FSW

Transgend
er

MSM

IDU
Jawa corridor had highest & sharpest increase of HIV cases since
2009 and the largest AIDS burden, followed by Maluku-Papua

Trend of HIV Cases in 6 Economic Corridor Areas

18000
16000 SUMATRA
14000 JAWA
12000 KALIMANTAN
10000 SULAWESI
Number of cases 8000 BALI-NT
6000 MAL-PAPUA
4000
2000
0
2009 2010 2011 2012 2013

Cummulative reported AIDS cases, in 6 corridor economic areas, 1987-2013

30000
25526
25000

20000

15000
10883
10000
4947 4793
5000 2424 2571

0
SUMATRA JAWA KALIMANTAN SULAWESI BALI-NT MAL-PAPUA
Trend of HIV reported cases (2009-2013) in
Sumatra: Sumatra Utara is the highest &
sharpest increase, followed by KEPRI
1800

1600

1400
NAD
1200 Sumatera Utara
Sumatera Barat
1000 Riau
Jambi
800 Sumatera Selat
Bengkulu
600 Lampung
Bangka Belitung
Kep. Riau
400

200

0
2009 2010 2011 2012 2013
 SUMATRA (1)

1. Profile of HIV and AIDS :

The HIV prevalence rates among FSW ranged, from 1.6% (ID-FSW in
Lampung) to 10% (D-FSW in Batam).

Sumut &Kepri: highest and sharpest increases of HIV reported

cases until 2013 suggesting fastest transmission n largest
burden

In 2007, Batam (in Kepri): highest prevalence rates in the country

among direct (12%) and indirect (9%) FSW.

IBBS 2011: HIV prevalence rates among IDU was high (39%) in
Medan, but not as high as in Jakarta (56%, the highest in the
country in 2011) and Surabaya (49%).

In addition to Batam and Medan, other epicenters having HIV

prev.rates > 5% in at least 1 key pops. were Deli Serdang,
Lampung, Palembang
 SUMATRA (2)

2. Hotspots and FSW:

Kepri: largest FSW hotspot (350 loc = 22% of total hotspot in
Sumatra) & Riau the second (298 =19%).
Prov. largest FSW pop: Sumsel (3907), Kepri (3621) & Riau
(2923)

3. Batam could be most progressive epicentrum due to:

Having highest HIV rates among FSW in the country (2007)
easy access to FSW hotspots in Kepri and Riau
having open access to international (Singapore & Malaysia) as
one free trade harbours developed for manufacturing and
tourism industries
poor protective factors, such as:
low % of condom use among D & ID-FSW past 1 week (3849%) in
2011
very low % in D & ID-FSW having correct knowledge about HIV
(only 7 8 % in 2011)
 SUMATRA (3)

4. Others (Medan, Deli Serdang & Lampung), in 2011,

showed:
low % of condom use past 1 week (3 - 52%)
very low % of having correct knowledge about HIV (10-25%)
among D & ID-FSW
5. Mobility of direct FSW may accelerate/ intensify HIV
transmission, due to:.
temporary mobility among DFSW (aged 25-35) across cities/
near provinces every 1-3 months to visit family/ relatives,
find new/better location/ payment, new clients or escape
from debt/ conflict. Mostly from Jawa Barat.
quick turnover of FSW, (e.g. in Indragiri every 3-5 days)
increase Northern-Southern mobility, especially in Kepri,
Riau and Sumsel (with large of hotspots and FSW) by
improvement of Trans-Sumatra
Increase Sumatra-Jawa mobility through the development
and improvement transportation through Selat Sunda
(including development of Selat Sunda bridge )
Trend of HIV reported cases (2009-2013) by
econ. Corridor of Jawa; sharp increase in DKI,
Jawa Timur, Jawa Barat n Jawa Tengah

7,000

6,000

5,000

DKI Jakarta
4,000
Jawa Barat
Jawa Tengah
DI Yogyakarta
3,000
Jawa Timur
Banten

2,000

1,000

0
2009 2010 2011 2012 2013
 JAWA (1)

1. Jakarta & Jawa Timur: highest and sharpest increase of

HIV cases highest burden in Jawa
2. Hotspot and FSW pop. in Jawa:
Half of all FSW in the country, stayed in Jawa, mostly in
Jakarta (43%) and Jawa Barat (20%). Highest Clients-FSW
ratio in Jakarta (i.e. 14).
Indramayu: most well known origin of FSW working in
other provinces especially big cities, e.g. Jakarta,
Bandung, Batam and Tanjung Pinang.
Cirebon and Subang the second sources of FSW operating
in Jakarta, Batam, Jambi, Riau and bauksit mining in Pulau
Binton.
 JAWA (2)

3. FSW:
Concentration of FSW in Jawa Tengah: Semarang, Jepara-
Grobogan and Solo.
Surabaya is supplier of FSW for Jawa Timur and eastern
Indonesia, i.e. in Papua and Papua Barat.
Concentration, mobility and quick turn-over (about 1-3
months) of FSW, were important determinants speeding up
the HIV spread
4. Jawa demonstrated highest burden of HIV/AIDS as
indicated by:
Highest IV reported cases, 2009-2013 (54% of the
country cases)
Highest AIDS reported cases,1987-2013 (50% of country)
Highest estimated PLHIV in 2012 (55% of country)
the fastest and sharpest increasing trend during 2009-
2013
 JAWA (3)

5. HIV prevalence rates in key pops, 2007 to 2011,

were:
Jakarta: high prevalence rates among all key pops.
highest prevalence rates:
among D & ID-FSW: Batang (20.7%), Bandung (12%),
Jakarta (10.5%) & Surabaya (10.4%).
among TG: Jakarta (34%), Surabaya (25% ), &
Semarang (24.7%)
among MSM: Yogyakarta (20.3%), Tangerang (18.8%) &
Jakarta (17.2%).
among IDU: Jakarta (56.2%), Surabaya (56%) &
Tangerang (53.5%). Bandung (43%) and Malang
(36.4%) also showed high rates
Although not too high, HIV rates in Bekasi (6.8%) &
Banyuwangi (7,2%) also showed concentrated
transmission among D-FSW
 JAWA (4)

7. KAP & HIV care profile:

In 2011, low condom use % past 1 week among D&ID-
FSW in 8 cities, i.e. 15-52%, except in Surabaya (76%)
In 2011, low % of condom use among clients when
having recent sex (7 - 27 %) in Jakarta Utara, Batang,
Semarang, Surabaya
In 2011, low % D&ID-FSW in 8 cities having correct
understanding about (3-34%)
In 2011, very low % of clients of FSW in Jakarta Utara,
Batang, Semarang, Surabaya having correct
understanding about HIV (3% - 22%)
In 2012, only 335 sites for counseling and testing (CT)
available to give service for estimated 286,738 PLHIV,
giving a ratio PLWH: CT=856. second largest ratios,
after Maluku - Papua, indicating CT service burden is
heavy.
Trend of HIV reported cases (2009-2013) by econ.
Corridor of Kalimantan; sharp increase in KalTim
and KalBar

700

600

500

400 Kalimantan Barat

Kalimantan Tengah

300 Kalimantan Selatan

Kalimantan Timur

200

100

0
2009 2010 2011 2012 2013
 KALIMANTAN (1)
1. Kalbar & Kaltim: highest and sharpest increase of HIV cases
highest burden in Kalimantan, with Pontianak n Samarinda as the
epicenters
2. Kalbar: largest hotspot of FSW (274 location = 60% of
Kalimantan) with 1,857 FSW (= 27% of FSW in Kalimantan).
However, Kaltim: has highest FSW (2,566)
3. In 2009, Pontianak high HIV prevalence rates among IDU (32%)
and in 2013 the rates in this city doubling (61%). However, the
rates in 2009 among FSW and TG in Pontianak were not high (4%
&7% respectively), similarly among D-FSW in Samarinda (5%).
This underlining more significant role of IDU transmission in
Pontianak
4. In 2009, KAP among FSW:
in Pontianak: low % condom use past 1 week among D&ID-FSW
(54-61%)
in Pontianak: very high % misconception among D&ID-FSW
about HIV transmission & prevention (93-96%).
increase of proportion of risky behavior of sharing needles past
1 week (from 23% in 2009 to be 45% in 2013).
Trend of HIV reported cases (2009-2013) by econ.
Corridor of Sulawesi; sharp increase in SulSel and
SulUt, with Attention to SulTeng

900

800

700

600
Sulawesi Utara
500 Sulawesi Tengah
Sulawesi Selatan
400 Sulawesi Tenggara
Gorontalo
300 Sulawesi Barat

200

100

0
2009 2010 2011 2012 2013
 SULAWESI (1)

1. Sulsel the largest hotspot of FSW (236 hotspots=51%

of hotspot in Sulawesi) with 4,049 FSW (=55% of all
FSW). Sulut the second largest FSW (1174) and
Sulteng (928).
2. In 2009, Makasar: highest HIV prev. rate in Eastern
Indonesia among ID-FSW (5%) and second highest
rate among D-FSW (9%).
3. In 2009-2013, HIV prev. rates in Makasar among TG
(13%) and IDU (37%) were high
4. KAP among FSW in Makasar:
lowest % consistent condom use when having sex among
FSW (15%)
low % condom use past 1 week among D&ID-FSW (24-
29%)
very high % misconception among D&ID-FSW about HIV
Trend of HIV reported cases (2009-2013) by
econ. Corridor of Bali-NT; sharp increase in
Bali

2000

1800

1600

1400

1200
Bali
1000
NTB
800 NTT

600

400

200

0
2009 2010 2011 2012 2013
 BALI-NT (1)

1. Bali: highest the sharpest increase of HIV cases from

2009 2013
2. In 2011, Bali has 236 hotspots with 4402 FSWs, which
vast majority (90%) was hotspot for ID-FSW
commercial sex transactions in Bali mostly provided in
masking manner by ID-FSW
3. Bali: first AIDS case reported and having second
highest AIDS case rate (after Papua) rapid &
advanced HIV spread within concentrated phase of
epidemic
4. HIV prevalence rate among direct FSW in Denpasar in
2011 (16%) was the second highest after Jayawijaya
(25% in 2011) and just the same with Sorong (16% in
2011). HIV prevalence rates among indirect FSW (8.8%
in 2011) in Denpasar, was the highest, while among
 BALI-NT (2)

5. KAP among FSW in Denpasar, 2011:

Low (26-50%) condom use past 1 week among D &
ID-FSW.
very low (15-16%) of correct understanding about HIV
among D & ID-FSW.
highest proportion of teenagers reporting having ever
had sexual intercourse (14%), as compared to other 6
big cities (Medan, Batam, Jakarta, Semarang,
Surabaya, Jayapura).
According literature , permissive and liberal way of
life, especially from foreign people may penetrate to
local custom and culture bringing acculturation and
openness and tendency for the local Baliness people
to engage with permissive high risk behaviors.
Trend of HIV reported cases (2009-2013) by econ.
Corridor of Papua-Maluku ; sharp increase in
Papua

4500

4000

3500

3000

2500 Maluku
Maluku Utara
2000 Papua Barat
Papua
1500

1000

500

0
2009 2010 2011 2012 2013
 PAPUA-MALUKU (1)

1. HIV prevalence rates among populations were :

2009 -2011, HIV prevalence rates among D & ID-FSW in Jayawijaya
(25%), Sorong (21%), Jayapura (16%) and Timika (14%). The rate in
Jayawijaya (25%) the highest in the country.
HIV prev. rate among D-FSW in Ambon (12.3%) - higher than most of
the rates in other corridors cities.
HIV prev. rates among ID-FSW in 2007 and 2011 all rather low, except
in Sorong (8%).
HIV prevalence rate among clients of FSW in Sorong (4.4% in 2007)
the highest in the country, while the rate among clients in Jayapura
(2% in 2011) also quite high.
HIV prevalence rates among general population has exceeded 1% (i.e.
2,4% in 2006 and 2.3% in 2013), indicating that the epidemic has
extended to general population.
IBBS 2013: main behavior risk factor: variety of heterosexual contacts,
either commercial or casual.
HIV prevalence rates in general population through MSM contact and
through IDU were assumed very low, since only 0.6% (in 2013) had
sexual contact with MSM and only 0.8% (in 2006) used drug.
 PAPUA-MALUKU (2)

2. In 2011-2012, not many hotspots in Tanah Papua

and Maluku. No hotspots of high risk population
could be identified in 3 less accessible lowland
areas like districts of South Sorong, Bintuni Bay and
Mappi. Among all FSW in the country, there were
only 4% staying in Papua Barat and 2% staying in
Papua. D-FSW working in Tanah Papua mostly came
from Sulut.
3. Certain social conditions in females. e.g. having
lower educational status & lower family income
(IBBS 2006) than the males, being a wife among
several wives in polygamy and paternalistic family,
put female general population in more problematic
situation related to HIV promotion and prevention
programs
4. KAP in key and general population in Tanah Papua
 PAPUA-MALUKU (3)

In 2013 only 6% among male general pop. and 1%

among female gen. population consistently using
condoms within the last 1 year
In 2011 the % condom use past 1 week among FSW
were 26-66%
In 2013, 80% of male Papuan people were not
circumcised
5. HIV care profile:
only 45% of those HIV cases, eligible for treatment in
Tanah Papua received ARV the lowest, compared to
proportions in other 6 corridors. Among those treated,
24% were loss to follow-up ( the biggest lost to
follow-up % compared to other corridors)
Estimate in 2012: 106,827 PLHIV in this corridor, only
86 sites available for counseling and testing (CT)
TERIMA KASIH

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