The short-term effects of COVID-19 on HIV and AIDS efforts among female sex workers in Indonesia | BMC Women’s Health

By the standards of Southeast Asian countries, Indonesia has been relatively hard hit by COVID-19. The first case was confirmed in early March. By the end of July 2020, the reported number of confirmed coronavirus cases had reached 108,376 with 5,131 deaths [23]. Partly due to testing capacity limitations, the Government of Indonesia (GoI) has been slow to respond to COVID-19. Policy responses included a “Work at Home, Study at Home, Pray at Home” mandate, travel restrictions that limited mobility to/from Jakarta during and after the Muslim month of fasting, the suspension of most domestic airline flights and mobilizing testing capacity to include all labs nationwide that met designated standards. A phased “reopening” was initiated in most provinces in June and July 2020.

Consistent with global experience, the timing of outbreak onset (detected at least) and effectiveness of containment varied geographically. The evolution of COVID-19 in the 23 study districts up to July 2020 is summarized in Fig. 1. The figure shows the distribution of districts by infection rate (number of diagnosed COVID-19 infections per 1,000 population) gleaned from provincial and district websites. and other official communication portals (see Data Links in the “Appendix” section). As can be seen, from a few “hot spot” districts in April (possibly associated with higher levels of testing), COVID-19 infection rates in the study districts increased quite significantly. substantial during the month of July. An AVOVA test for trend was significant at p

Fig. 1

Monthly COVID-19 infection rates per 1000 population in study districts

Figure 2 documents trends in levels of commercial sexual activity and availability of HIV testing services in the 23 study districts from January to July 2020, derived from monthly district analyses. The level of commercial sex ‘hotspots’ is still working and the number of FSWs and clients starts to drop in March when travel restrictions and bans on large gatherings and ‘non-essential’ businesses came into effect and were fell to very low levels in April and May before rebounding in June and July. Declines in sex work in “non-localization” areas were greater and recovery slower than in “localization” areas (the term “localization” refers to areas of cities that are quasi-legal and are managed as “entertainment” areas by local actors) . The availability of HIV testing services in health facilities was slower to be affected, but fell precipitously in April before rebounding in June and July. Mobile clinic HIV testing services ceased in April and had only rebounded to about a fifth of February’s level by July.

Figure 2
Figure 2

Trends in commercial sexual activity and availability of HIV testing services in 23 districts, January-July 2020

The magnitude of reductions in commercial sex and HIV testing services, measured as a percentage drop, from the high point in January to March 2020 to the low point in April to July for the 23 districts overall, is shown in Table 1.

Table 1 District-level changes in commercial sex activity and availability of HIV testing services, January-July 2020

The table also shows the largest and smallest reductions at the district level for the indicators considered. Overall, the three commercial sex activity indicators decreased between 57 and 76% in localization areas and between 86 and 92% in non-localization areas. Some districts were literally shut down in terms of commercial sexual activity, while in others the effects were minimal or greatly attenuated. The larger declines in the number of entertainment areas remaining open and the number of sex workers still working in location areas compared to non-location areas were statistically significant (p

How have these developments impacted the provision and uptake of HIV prevention and testing services by FSWs? Figure 3 presents data on trends in FSW program outcomes across the 23 study districts from January through July 2020. The data displays also include monthly averages from January through June and July through December 2019 to provide a pre-COVID-19 reference for interpretation. 2020 monthly data. Proximity contact levels during January March were roughly comparable to the monthly averages of 2019. These dropped dramatically in the months of april and may, no doubt reflecting at least in part the decline in the number of FSWs who continued to work during those months. However, proximity contracts rebounded strongly in June and July. Similar trends are seen in condom distribution, HIV testing and, as shown in Table 2, the number of HIV cases detected and treatment initiation rates. The March to May declines in all three indicators in the table were statistically significant (p

Figure 3
picture 3

Monthly community outreach and HIV testing results for FSWs in 23 districts, January-July 2020

Table 2 Rates of HIV case detection and treatment initiation among FSWs in 23 districts, by month, January-July 2020

Table 3 quantifies the magnitude of the contraction in program outcome indicators from the peak of the months of January March at the low point of April–July as well as the extremes of district responses. The low point for most indicators occurred in May with high-low spreads ranging from 57% to 94%. The number of FSWs reached through community outreach and the number of condoms distributed were the least affected overall (p

Table 3 District-level changes in FSW HIV program outcomes, January-July 2020

Figure 4 presents trend data on the proportion of FSWs who started ART 2 months before the baseline month and were still on treatment at the end of the baseline month. These data indicate the need to improve treatment retention rates, but show no clear relationship to the onset of COVID-19. The July figure should be viewed with caution as it is based on a very small number of FSW starting treatment 2 months prior.

Figure 4
number 4

Proportion of FSWs who started treatment in the previous 3 months who were still on treatment, by month, January-July 2020

In April 2020, a randomized community trial of community-based HIV testing using an oral fluid-based rapid test was initiated, with 15 out of 23 cities/districts being randomly assigned to receive the intervention and the remaining eight serving as witnesses. The study was planned long before the onset of COVID-19. Although still quite early in the study, results through the end of July 2020 indicate significant demand for community-based HIV testing among FSWs during a time of reduced availability of facility-based HIV testing services. health and via mobile clinics (Table 4). Incidentally, although the numbers are low, the results of community testing are quite promising, with an overall treatment initiation rate of 80% among FSWs with confirmed reactive test results, significantly higher than transition rates observed in Fig. 3. The proportion of reactive community tests that were confirmed at a health facility was lower (60%), which may have been influenced by the reduced availability of HIV testing services at health facilities during the COVID-19 period. ‘observation.

Table 4 Community HIV testing, April-July 2020

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