Viral Loads by Lenore Manderson Nancy J. Burke Ayo Wahlberg

Author:Lenore Manderson, Nancy J. Burke, Ayo Wahlberg [Lenore Manderson, Nancy J. Burke, Ayo Wahlberg]
Language: eng
Format: epub
Tags: Nonfiction, Health & Well Being, Medical, Ailments & Diseases, Infectious Diseases, General, Social & Cultural Studies, Social Science, Anthropology, Science & Nature, Science
ISBN: 9781800080263
Publisher: UCL Press
Published: 2021-09-20T04:00:00+00:00

STI and HIV prevention and related services

Routine STI and HIV testing, and mobile testing, stalled in many of the urban neighbourhoods of Jakarta and Yogyakarta. Free mobile clinics and outreach services offering SRH services to hard-to-reach communities are the most accessible services for vulnerable groups, particularly street-dwelling youth, transwomen and sex workers (Hegarty et al. 2020). The cessation of mobile outreach services that offer VCT and free condoms to hard-to-reach groups amplified the vulnerability of those groups to poor SRH outcomes. Many primary healthcare clinics offering SRH services are poorly equipped to offer non-judgemental and non-discriminatory services (Waluyo et al. 2015), as Niko explains: ‘In health facilities [primary healthcare clinics], young people who are vulnerable are often told by a health worker to “stop being sex workers, to stop being gay, and to pray more often”’.

With the suspension of mobile clinics and outreach programmes specialised in the provision of SRH services, highly vulnerable groups lost access to their routine avenues for accessing SRH care. Ari, a peer educator with female sex workers, explains the situation for low-income sex workers unable to access free condoms due to constrained outreach services:

Many people from the [sex worker] community … complain about this. Sex worker friends who only make 50 thousand rupiah or 30 thousand rupiah per customer cannot also provide condoms … So, they [sex workers] really need a free condom, they really need it. I have met a lot of sex worker friends whose fees are cheap, 50 thousand rupiah, yes, some even say that they only get paid 15 thousand rupiah. Well, just imagine if they have to set aside money again for a condom, in one day they will need to increase their customers for example from 10 customers to 15 customers just to cover the condom cost. It should not be like that huh?

Access to free condoms for sex workers also declined as social distancing requirements and funding cuts diminished the capacity of community outreach programmes. Madu, an outreach worker in a HIV prevention and treatment programme, also noted the shortage of condoms among female sex workers: ‘We are still [in June 2020] meeting sex workers who have to buy their condoms themselves, they are not receiving them free, first because the supply [of free condoms] is depleted, and second because peer distribution is interrupted because of COVID’. For most sex workers, purchasing condoms is not an option because they are expensive, especially when people experience a dramatic loss of income.

Reduced outreach services for people living with HIV also occurred, particularly affecting the availability of voluntary testing and counselling. Our participants working to support people living with HIV observed that the number of people seeking routine VTC in Jakarta and Yogyakarta dropped by 75 per cent or more between April and August (when we completed our virtual field work), and there is growing concern within the HIV positive community and frontline workers about rising HIV infections. Utama, a programme coordinator and outreach worker with HIV positive Indonesians and LGBTQI+

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