Indonesia’s growing HIV epidemic among young MSM
Integrated biological-behavioral surveillance survey among adolescent and young people who inject drugs, female sex workers, males who have sex with males, and male to female transgender persons
Indonesia’s HIV epidemic is concentrated among key populations. Apart from two provinces in eastern Indonesia with a low-prevalence generalized epidemic (2.4%), adult HIV prevalence has stabilized at around 0.4%, and new infections decreased by one-third over the past decade. Among key populations, while transmission among female sex workers and people who inject drugs has been stable or declining, HIV prevalence among MSM increased at least three-fold in the past decade – from 5.3% in 2007 to 17.9% in 2019.
While countries in Asia and the Pacific have witnessed declining HIV infections over the past decade. Men who have sex with men (MSM) account for nearly one-third of new infections in the region, with several countries confronting high prevalence and increasing trends.
In Indonesia, while prior national surveys have suggested increasing prevalence among MSM between 2011 and 2019 - these assessments employed convenience sampling and recent assessments do not disaggregate younger vs older groups.
To address this gap in knowledge, UNICEF with the support of UNPAD and the Ministry of Health, recently conducted the first Respondent Driven Sampling assessment of AY-MSM in an urban center in Indonesia. HIV prevalence was of 30% among which is 6-fold higher than regional estimates and among the highest reported globally. Importantly, background adult HIV prevalence is just 0.4%.
With few individual risk factors were identified, aspects of the structural environment including stigma, discrimination and exclusion are likely driving risk behaviour further underground and making it more difficult for service providers and NGOs to engage this hard-to-reach population. In Indonesia today, levels of tolerance and public discussion of LGBT issues are low; police crackdowns on gay men are common; laws are being tabled to outlaw gay sex; and few gay men have disclosed their sexual identity to their families.
With declining HIV prevalence among other key population groups, AY-MSM are driving Indonesia’s HIV epidemic. We profile a range of priority health, social and legal interventions that require immediate action.