Author: Nelsensius Fauk
Fauk, Nelsensius, 2022 Risk factors and the impact of HIV among women living with HIV and their families in Yogyakarta and Belu district, Indonesia, Flinders University, College of Medicine and Public Health
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Introduction: Women living with HIV (WLHIV) account for more than half of all people living with HIV (PLHIV) globally (53%). In Indonesia, women aged 15 years and older represent 38% of the total number of PLHIV. HIV infection adds a significant burden on women, often leading to severe detrimental impact, not only on themselves, but also on their families. Despite the manifold increase of HIV infections in Indonesia in general, and among women in particular, little evidence exists about HIV-risk factors among WLHIV and impact on themselves and their families. The aims of this study were four-fold, to: (i) understand and compare HIV-risk factors among WLHIV and the impact of HIV on themselves and their families in Yogyakarta and Belu, Indonesia, (ii) understand and compare HIV-risk factors and the impact of HIV on WLHIV and MLHIV in Yogyakarta and Belu, (iii) understand and compare the perspectives and experiences of women/men living with HIV and healthcare providers about the determinants of access to HIV care services in Yogyakarta and Belu, and (iv) explore and compare the current and future perspectives of policy makers in Yogyakarta and Belu about policies and programs to address HIV and its impact on WLHIV and their families.
Methods: This thesis employed a qualitative design and one-on-one in-depth interviews with four groups of participants: (i) WLHIV (n=52), (ii) men living with HIV (n=40), (iii) healthcare providers (n=20), and (iv) policy makers (n=9) in both study settings. Participants were recruited using a combination of purposive and snowball sampling techniques. Data were analysed using a framework approach with five steps of qualitative data analysis. This analysis was guided by the logical model for behavioural and environmental determinants diagnosis, the conceptual framework for socio-economic impact of HIV on households and HIV stigma framework, and the access to healthcare framework. The consolidated criteria for reporting qualitative research (COREQ) with a 32-item checklist was also employed to represent best-practice in qualitative research as well as to support a transparent and comprehensive reporting of this qualitative study. Ethics approvals were obtained from Flinders University, South Australia (No. 8286) and Duta Wacana Christian University, Indonesia (No. 1005/C.16/FK/2019).
Results: The identified risk factors which facilitated HIV transmission among women and men living with HIV included: (i) poor knowledge of HIV and condoms, (ii) behavioural factors, (iii) socio-environmental factors, (iv) financial factors, (v) intimate partner violence, and (vi) religious and cultural factors. The study also identified several impacts of HIV on women and men living with HIV and their families: (i) stigma and discrimination, (ii) the psychological impact, (iii) family disputes and separation, and (iv) the physical impact. It also identified determinants of access to HIV care services among women and men living with HIV, including availability, approachability, affordability, appropriateness, acceptability of the services, and the ability of women and men living with HIV to reach the services, perceive need for the services, pay, engage in and seek the services. The study also reported HIV policies and programs that were in place in Yogyakarta and Belu, based on the perspectives of policy makers.
Conclusions: This thesis reports several risk factors for HIV transmission among women and men living with HIV and outlines a range of factors, including cultural norms, values, practices and religious beliefs that influenced sexual relations, practices and behaviours of women and men living with HIV as novel findings or the independent contributions of this study to knowledge of risk factors for HIV transmission. It also reports on several negative impacts HIV has on women and men living with HIV and their families, and outlines social perceptions, norms, values, cultural practices, religious beliefs and moral judgements about HIV, PLHIV, illicit drugs, sex, and spousal relationships that drive stigma and discrimination as novel findings of this study, which contribute to the understanding of HIV impact on PLHIV and their families. It also reports determinants of HIV care access among PLHIV, and presents traditional treatments of HIV using traditional medicines through traditional healers, and the social influence of families, friends and neighbours in supporting traditional treatments as novel findings which are also key contributions of this study to the knowledge about barriers to HIV care access among PLHIV. The thesis suggests the need for HIV policies in Yogyakarta and Belu, which continue to address both HIV-risk factors and impacts on PLHIV and their families, support and expand the provision and coverage of antiretroviral therapy and HIV interventions or programs and activities. Future large-scale studies to explore socio-cultural and religious aspects that contribute to HIV transmission, HIV impact on women in Indonesia, and hinder their access to HIV care services are recommended.
Keywords: HIV-risk factors, HIV impact, facilitators and barriers to access to HIV care services, women living with HIV, men living with HIV, healthcare providers, policy makers, qualitative study, Yogyakarta, Belu, Indonesia
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Medicine and Public Health
Supervisor: Amy Reynolds