Abstract
Background
Over the past 10 years or so, the organization of commercial sex in Indonesia has undergone profound changes via the closures of red light areas (hereafter referred to as “localizations”). Such closures, pressured particularly by conservative religious groups on the grounds of morality, have created debates on increasing difficulties for controlling the ongoing heterosexual HIV epidemic. Using data from the Integrated Behavioural-Biological Surveys (IBBS) conducted during such closures, this study examines how changes in the organization of commercial sex have influenced levels of risk of HIV transmission among female sex workers in Indonesia.
Methods
Closures of localizations during years 2013-2018 reflect changes in the organization of commercial sex in Indonesia. Changing levels of risk of HIV transmission per a sexual contact episode was measured through changing access to health care and use of condom at sexual encounters. Changing volumes of sexual contacts in the commercial sex network was measured through changing numbers of male sex clients per week. Prevalence of HIV or Syphilis, diagnosed through antibody serological test, and Gonorrhoea, diagnosed through vaginal swab test, used as a proxy of HIV or STI new infections. Statistical tests of different between two or more proportions by controlling for socio-demographic factors, were employed to assess whether changes in the organization of commercial sex have influenced levels of risks of HIV transmission among female commercial sex workers.
Findings
Closures of localizations had distanced female sex workers from HIV control efforts and critical commodities, caused reduced use of condom and lacked STI screening and testing. The reduced use of condom during sexual encounters and the lacked STI screening and testing meant increased levels of risk of HIV transmission per sexual contact episode. The closure of localizations on the other hand had immediately reduced the numbers of male sex clients, led to reduced volumes of sexual encounters at commercial sex networks. The declining numbers of male sex clients caused the declining of HIV and STI new infections.
Interpretation
The effect of closing localizations on increasing the risk of HIV transmission per episode of sexual contact is likely to be long-lasting due to health system limitations in providing HIV outreach services. On the other hand, the effect of localization closures on decreasing the number of male sex clients tends to be temporary due to the culture of buying sex from some of the male mobile population. Future evaluations need to be carried out to assess whether the trend in the number of male sex clients among FSW and HIV trends is increasing again. The results of this study imply the need for the government to find appropriate and adequate strategies to control and monitor the heterosexual HIV epidemic.
Funding
UNAIDS funded for data processing, analysis and writing of a policy brief: “Closures of Indonesia commercial sex localizations invites changing approach of con trolling the heterosexual HIV epidemic” uploaded in the website. Universitas Indonesia Directorate of Research and Community
Over the past 10 years or so, the organization of commercial sex in Indonesia has undergone profound changes via the closures of red light areas (hereafter referred to as “localizations”). Such closures, pressured particularly by conservative religious groups on the grounds of morality, have created debates on increasing difficulties for controlling the ongoing heterosexual HIV epidemic. Using data from the Integrated Behavioural-Biological Surveys (IBBS) conducted during such closures, this study examines how changes in the organization of commercial sex have influenced levels of risk of HIV transmission among female sex workers in Indonesia.
Methods
Closures of localizations during years 2013-2018 reflect changes in the organization of commercial sex in Indonesia. Changing levels of risk of HIV transmission per a sexual contact episode was measured through changing access to health care and use of condom at sexual encounters. Changing volumes of sexual contacts in the commercial sex network was measured through changing numbers of male sex clients per week. Prevalence of HIV or Syphilis, diagnosed through antibody serological test, and Gonorrhoea, diagnosed through vaginal swab test, used as a proxy of HIV or STI new infections. Statistical tests of different between two or more proportions by controlling for socio-demographic factors, were employed to assess whether changes in the organization of commercial sex have influenced levels of risks of HIV transmission among female commercial sex workers.
Findings
Closures of localizations had distanced female sex workers from HIV control efforts and critical commodities, caused reduced use of condom and lacked STI screening and testing. The reduced use of condom during sexual encounters and the lacked STI screening and testing meant increased levels of risk of HIV transmission per sexual contact episode. The closure of localizations on the other hand had immediately reduced the numbers of male sex clients, led to reduced volumes of sexual encounters at commercial sex networks. The declining numbers of male sex clients caused the declining of HIV and STI new infections.
Interpretation
The effect of closing localizations on increasing the risk of HIV transmission per episode of sexual contact is likely to be long-lasting due to health system limitations in providing HIV outreach services. On the other hand, the effect of localization closures on decreasing the number of male sex clients tends to be temporary due to the culture of buying sex from some of the male mobile population. Future evaluations need to be carried out to assess whether the trend in the number of male sex clients among FSW and HIV trends is increasing again. The results of this study imply the need for the government to find appropriate and adequate strategies to control and monitor the heterosexual HIV epidemic.
Funding
UNAIDS funded for data processing, analysis and writing of a policy brief: “Closures of Indonesia commercial sex localizations invites changing approach of con trolling the heterosexual HIV epidemic” uploaded in the website. Universitas Indonesia Directorate of Research and Community
Original language | English |
---|---|
Publisher | The Lancet Publishing Group |
DOIs | |
Publication status | Published - 28 Aug 2024 |
Publication series
Name | Preprints with the Lancet |
---|---|
Publisher | The Lancet |