Age Disaggregation Analysis of BSS Survey Data Among Most at Risk Population For HIV Infection

REPORT
Age Group Disaggregation of Survey and Reseach Data
This report was prepared by Aang Sutrisna with valuable inputs from Severine Leonardi, Kemal Siregar, Fonny Silvanus and Irawati A. Inputs were also received from the National AIDS Commission (Suriadi Gunawan), and the UNICEF team in Indonesia. 10th Floor, Wisma Metropolitan 2, Jl. Jenderal Sudirman, Jakarta 12920 Tel: +62 (0)21 2996 8000 Email: jakarta@unicef.org
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EXECUTIVE SUMMARY
Introduction
Millions of young people throughout the world face a high risk of HIV infection and other negative consequences of sexual health as a result of behavior that they adopt, or are forced to do. Three groups of young people considered most at risk of contracting HIV in Indonesia is young men who have sex with other men and young people who sell sex or injecting drugs. In addition to these three groups, other young people also have a high risk of HIV infection, especially in areas where the HIV epidemic enters such an advanced level as in Tanah Papua and Prisons.
Therefore, the National AIDS Commission (NAC) with the help of UNICEF Indonesia, perform advanced analysis of survey data and existing research to determine the distribution of young people in most at risk group, as well as differences in the level of knowledge, attitudes and behavior as well as program coverage and prevalence of HIV and STIs among most at risk group of HIV transmission by age group This advanced analysis using secondary data from several cross sectional survey data in the period of 2007 to 2009.
Result
Youth
Analysis of the group of adolescents in general was use the Indonesia Adolescent Reproductive Health Surveys in Indonesia (IYARS) data conducted in 2007 across 33 provinces with number of 8.481 female respondents and 10.830 male respondents aged 15-24 years, as well as the Behavioral Surveillance Survey (BSS) among second grade high school students as population of 15-19 years age group conducted in 2007 in Jakarta and Surabaya, and in 2009 in Yogyakarta, Tangerang, Pontianak and Samarinda, with total number of 3.043 female and 3.113 male respondents.
One out of five Indonesia's populations are young people aged 15-24 years, of which more than half is high school graduate or have higher education. Percentage of female who graduated from high school or college (69%) is higher than males (51%). One out of four of high school students BSS respondents who have comprehensive knowledge of HIV transmission and prevention is 11 times higher than IYARS respondents age group 15-19 years (2.2%). While the source of information about HIV and AIDS mostly mention by youth is TV (75% of IYARS respondents and 94% of High School Students BSS
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respondents), while education session about drug abuse is the most widely accessed by high school students in the past 1 year.
Percentage of female aged 15-19 years who had ever been married (9%) is 6 times higher than male in the same age group (1.5%). In addition, 9% of male and 4% of female respondents of high school students BSS claimed to have had sex, higher than IYARS respondent of 15-19 years age group (4% male and 1.3% female). The mean number of sexual partners in past one year among high school students BSS respondents ranged between 1.6 - 2.7 people, and the level of condom use at last sexual intercourse among high school students BSS respondents ranged between 41% - 73%. 2% - 13% of high school students also have used drugs where half were already using it since junior high, meanwhile those who ever injecting drug is still below 1%.
Youth in Tanah Papua

Analysis of youth in Tanah Papua using Tanah Papua IBBS data conducted in 2006 across 10 district / city in the province of Papua and West Papua with number of 3.176 male and 3.129 female respondents aged 15-49 years. 36% of female and 32% of male respondents aged 15-24 years, where levels education among female respondents is generally lower than male. Percentage of female aged 15-19 years who had ever been married (21%) is 2 times higher than male in the same age group (11%). IBBS respondents in Tanah Papua who have comprehensive knowledge on HIV transmission and prevention are relatively similar in all three age groups ranging from 7% -9%. Sources of information about HIV and AIDS most frequently mentioned by respondents 15-19 years age group was Teacher (51% male and 45% female) while among the age group 20-24 and 25 years and older is the TV (54% and 52% ). Percentage of respondents who ever attend the HIV education session in a sequence from the youngest age group was 21%, 19% and 15%, while those who had received IEC materials is 19%, 20% and 15%. The Odds Ratio of respondents who had received IEC materials shows that they are 2.1 times more likely to have a comprehensive knowledge compare to those who did not receive IEC materials.
IBBS respondents in Tanah Papua who have had HIV test is relatively similar across all three age groups which ranged between 2% -3%, same thing also for those who had received HIV test results, ranged between 0.3% - 1.6%. Thirty nine (39%) male and 37% female 15-19 years age group ever had sex or 10-28 times higher than IYARS respondents in the same age group. Percentage of male who have more than one sex partner in the past 1 year, in a sequence, starting from the age group 1519 years, 20-24 years and 25 years and older was 31%, 27% and 20%, while among female respondents is 14% , 11% and 7% or higher in the younger age groups. Levels of condom
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use at last sex with steady sex partners relatively similar among all three age groups, all of which are still below 10%. While condom use with casual and non-commercial sex partners is highest among respondents of 20-24 years age group (20% male and 11% of female), followed by 15-19 years age group (11% of male and female ), and the lowest in the age group 25 years and older (10% of male and 2% of female). The condom use among male respondents at last sex with sex worker, in sequence, from the youngest age group is 0%, 17% and 15%. HIV prevalence among male 15-19 years age group (3.2%) is higher than 20-24 years age group (2.5%) and 25 years and older (2.9%). HIV prevalence among female age group 1519 years and 20-24 years is similar, which is 2%, and among 25 years age group was 1.8%.
Young Sex Worker

The survey data used in advanced analysis on Sex Workers are IBBS among Female Sex Worker (FSW) in 2007 across 17 District / City and 2009 in 9 district / city as well as BSS in 4 City in 2008 with a total of 9.999 FSW respondents. In addition, data of 2007 IBBS/BSS among transgender (Waria) in 5 cities and 2009 in 3 cities with total number of 1.655 Waria respondents also being used. Percentage of FSW aged 15-19 years ranged between 2% (Malang) - 15% (Bitung) with a mean of 8%, and aged 20-24 years between 13% (Malang) to 41% (Deli Serdang) with a mean of 26%. While Waria respondents aged 15-19 years ranged from 5% (Semarang) to 21% (Makassar) with a mean of 10%, and aged 20-24 years is 13% (Malang) to 27% (Makassar) with a mean of 19%.
Percentage of FSW who started to become sex worker before age 20 years ranged between 10% (Mimika) to 38% (Tangerang) with a mean of 22%, and among Waria between 46% (Pontianak) up to 61% (Semarang) with a mean of 55%. While FSW who started the commercial sex debut age 20-24 years ranged from 21% (Malang) to 39% (Batam & NAD) with a mean 31% and among Waria between 21% (Semarang) up to 35% (Bandung) with a mean 29%. Therefore in general 1 of 3 FSW and 1 of 4 Waria currently under the age of 25 years, and 1 of 2 FSW and 2 of 3 Waria started to become sex workers before the age of 25 years. The mean length of time of becoming Sex Workers among FSW age group 15-19 years is 1.2 years, rising to 1.6 years in age group 20-24 years and 3 years in the age group 25 years and older. While among Waria, the mean length of time of becoming Sex Workers in a sequence from the youngest age group is 2, 4 and 12 years. Percentage of FSW who graduated from junior high or higher sequentially from the youngest age group was 76%, 74% and 54%, while among Waria was 81%, 86% and 75%. Therefore it can be concluded that sex worker from the younger age groups have better educational levels.
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Percentage of FSW who ever reached by field workers in the last 3 months in a sequence from the youngest age group is 40%, 46% and 55%, while among Waria is 50%, 53% and 61%. Odds Ratio of FSW age group 20-24 years and 25 years and older who had been reached by the field workers in the last 3 months were 1.3 and 1.7, while among Waria is 1.3 and 2.5 times more likely to be reach by field worker rather than the age group 15-19 years.
Percentage of FSW who have comprehensive knowledge about HIV transmission and prevention in sequence from the youngest age group is 16%, 20% and 20%, while among Waria is 20%, 26% and 27%. This indicates that the older Sex Worker has a slightly better comprehensive knowledge than the younger ones.
Percentage of FSW ever been tested for HIV in a sequence from the youngest age group was 28%, 40% and 48%, while among the Waria is 41%, 51% and 59%. Odds Ratio of FSW age group 20-24 years and 25 years and older who ever been tested for HIV was 2.1 and 3.0, while among Waria was 2.8 and 4.4 times more likely to have HIV test than age group 1519 years.
The mean number of clients in the past 1 week among FSW age group 15-19 years and 2024 years are relatively similar (7.5 and 7.6 people / week) and more than FSW 25 years and older age group (6.1 people / week). While among Waria it is relatively similar across all age groups i.e. 3.5, 3.8 and 3.6 persons / week.
Percentage of FSW who used condoms during the last commercial sex in a sequence from the youngest age group is 52%, 63% and 68%, while among Waria was 61%, 65% and 58%. HIV prevalence among FSW in sequence from the youngest age group is 5%, 8% and 7%, while the Syphilis prevalence is 6%, 6% and 9%. Meanwhile among Waria, HIV prevalence (5%, 14% and 19%) and Syphilis (10%, 11% and 24%) increased along with the older age group. In contrast occurs with the gonorrhea prevalence and Chlamydia infection, where the younger is the age group of FSW, the higher is the prevalence. Gonorrhea prevalence among FSW in sequence from the youngest age group is 40%, 32% and 24%, while among Waria was 39%, 34% and 24%. While the prevalence of Chlamydia infection among FSW in sequence from the youngest age group is 52%, 43% and 32%, while among Waria was 34%, 35% and 30%.
Young Injecting Drug Users (IDUs)

The survey data used in the advanced analysis for young IDUs is the 2007 IBBS and BSS in six cities and the 2009 IBBS/BSS in 4 cities with the total number of 2,085 IDU respondents. Percentage of IDU aged 15-19 who become respondents ranged between 2%
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(Surabaya, Malang, Semarang, Bandung and Medan) to 25% (Pontianak) with a mean of 9%, while the percentage of IDUs aged 20-24 years ranged from 23% (Malang and Surabaya) to 37% (Jogjakarta) with a mean of 29%. This indicates that 1 out of 3 IDUs is a young people.
Eight out of 10 IDUs started to injecting drugs before age of 25 years. The percentage of IDUs who first injected drugs before age 15 years ranged between 0% (Semarang) - 15% (Makassar) with a mean 6%, at the age of 15-19 years between 18% (Semarang) - 58% (Banten) with a mean 42 %, and at age 20-24 years was 25% (Makassar and Banten) to 49% (Semarang) with a mean of 35%. Duration of being injecting drug users has a strong relationship with HIV infection, where 1-5 years duration of being IDU is 3.5 times more likely and more than 5 years duration is 9 - 47 times more likely to be infected with HIV compared to those who is being IDU for less than 1 year. The mean duration of being IDU among respondents in sequence from the youngest age group was 1.6, 3.7 and 6.8 years. There is no respondent from the 20-24 years and 25 years and older age groups and only 2% of the age group 15-19 years who did not complete elementary school. While of those only graduated from elementary school are relatively similar across all three age groups and ranged between 4% - 6%.
The older the respondent age group, the higher the percentage who have comprehensive knowledge about HIV transmission and prevention as well as knowing the site of Methadone Maintenance Treatment (MMT) and HIV testing. Percentage who have comprehensive knowledge in a sequence from the youngest age group is 25%, 43% and 49%, while who knows where MMT site is 49%, 60% and 72%, meanwhile who knows where HIV testing is 60%, 66% and 76 %.
Similar with the level of knowledge, percentage who ever been reached by field workers in the last 3 months increased along with the older age group, where the percentage in sequence from the youngest age group is 30%, 53% and 61%, meanwhile those who had received Needle-Syringe Program (NSP) services within the past 1 year was 32%, 43% and 49%, while those who had received MMT service is 17%, 28% and 32%. Same thing for those who ever been tested for HIV, where the percentage in a sequence from the youngest age group is 20%, 36% and 52%, while those receiving the last HIV test results was 16%, 32% and 47%. Almost all IDUs in the age group 15-19 years were not married and the percentage of respondent age group 20-24 years and 25 years and older who were married were 12% and 35%. Although almost all IDUs age group 15-19 years were not married, but more than half have had sex, same thing with the 5 out of 6 IDUs from the older age groups. The mean number of sexual partners in the past 1 year in a sequence from the youngest age group was 3.1, 3.4 and 2.7 people.
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Percentage of respondents who had sex with casual and non-commercial partners in the past 1 year is increasing along with the more younger age groups, from 38% in the age group 25 years and older to 48% and 56% in the age group 20-24 years and 15 - 19 years. Meanwhile, the percentage of respondent who had commercial sex in the past 1 year was relatively similar across all three age groups which ranged between 39% - 43%. In general, levels of condom use among IDUs in the last commercial sex are relatively similar across three age groups; in sequence from the youngest age group was 55%, 55% and 48%. Likewise with the percentage of condom use during last sex with casual and noncommercial partners, in sequence was 39%, 47% and 43%. While the percentage of condom use at last sex with steady partners of respondents 15-19 years age group (42%), almost two-fold higher than the 20-24 years age group (23%) and 25 years and older (22%).
The mean frequency of injecting in the past 1 week increased along with the older age group of respondents, ranged from 3.2 times / week in the 15-19 years age group increased to 6.1 and 6.6 times / week in the age group 20-24 years and 25 years and older. However, levels of needle-sharing behavior among IDUs in the age group 15-19 years (52%) were significantly higher than IDUs in the age group 20-24 years (33%) and 25 years and older (30%).
HIV prevalence increased along with the older age group, where in a sequence from the youngest age group is 6%, 30% and 50%, same thing happened with syphilis prevalence which increased from 0% in the age group 15-19 years to 0.8% and 1.3% in age group 2024 years and 25 years and older. The largest Odds Ratio among several factors considered to have relation with HIV infection are 3.7 which generated by duration of drug injecting of more than 2 years.
Young MSM
The survey data used in the advanced analysis for MSM group is 2007 IBBS and BSS in six cities and 2009 IBBS and BSS in 3 cities with total number of 2,050 MSM respondents. Percentage of MSM aged 15-19 years who become respondents in the survey ranged from 4% (Medan) to 41% (Makassar) with a mean of 13%, while the percentage of MSM aged 20-24 years ranged from 18% (Medan) to 40% (Yogyakarta) with a mean of 29%.
There is no respondent age group 20-24 years and 25 years and older and only 1% of the age group 15-19 years who did not complete elementary school. While the percentage of those who only complete elementary school do not differ significantly among the three age groups and ranged between 4% - 8%. Percentage of MSM who have first time sex before age 15 ranges from 5% (Bandung) to 25% (Makassar) with a mean 14%, and in general 2 out of 3 MSM have had sex before age
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20. Fifty nine percent (59%) MSM from 15-19 years age group admitted to have regular sex partners, slightly higher than the MSM from 20-24 years age group (55%) and 25 years and older (57%).
Five out of 6 MSM from all age groups had sex with casual and non-commercial partners in the past 1 year. While the percentage who had commercial sex in the past 1 year in a sequence from the youngest age group was 58%, 70% and 60%. Therefore the percentage of MSM who had sex with more than one partner in the past 1 year in a sequence from the youngest age group was 43%, 55% and 52% with a mean number of sex partners 2.5, 4 and 3.5 people. Levels of condom use at last sex with casual and non-commercial partners relatively similar across age groups ranging from 43% - 45%, likewise to condom use with commercial partners that ranged between 55% - 59%.
In general, MSM who have ever injecting drug use is higher than other at-risk population except IDUs and there is no significant difference between age groups. Percentages of MSM who have ever injecting drugs, in a sequence from the youngest age group are 2%, 5% and 3%. Just like any other risk groups, the percentage of MSM 15-19 years age group (23%) who have comprehensive knowledge about HIV transmission and prevention is the smallest compared to the age group 20-24 years (38%) and 25 years and older (37%).
HIV prevalence among MSM respondents is higher along with the older age group, where in a sequence from the youngest age group is 2%, 5% and 7%. So also with the prevalence of syphilis which increased from 2.4% in the 15-19 age group to 5.7% and 7.3% in the age group 20-24 years and 25 years and older. While the prevalence of Gonorrhea among MSM in sequence from the youngest age group is 16%, 22% and 18%, while the prevalence of Chlamydia infection is 17%, 22% and 21%.
Percentage of MSM who had been reached by the field workers in the past 3 months increased along with the older age group, where in a sequence from the youngest age group was 24%, 35% and 38%. Likewise with who had accessed STI service which is 20%, 27% and 27%. Percentage of MSM from 15-19 years age group (21%) who have had HIV test is also the lowest compared to age group 20-24 years (35%) and 25 years and older (33%). While the percentage who received the last HIV test results in a sequence of the youngest age group is 17%, 30% and 29%
Young Prisoner
Data used for further analysis of young Prisoners is data from studies of HIV and Syphilis prevalence and HIV Risk Behavior among Inmates in prisons/detention center in Indonesia
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which conducted in 2010 across 24 prisons/detention center that systematically selected to represent the entire prison/detention center in Indonesia. Where the percentage of male prisoners respondents aged less than 25 years in adult prison/detention center is 22%, while the female prisoners is 13%.
In general, the education levels of female prisoners are better than male. Percentage of male prisoners aged 25 years and older (6%) who graduated from college, three times higher than the age group below 25 years (2%). Similar situation among female prisoners, where the percentage of 25 years age group who are completed college (16%), 4 times higher than the age group below 25 years (4%). Three out of four male prisoners below 25 years of age are not married; in contrast with the older age groups. Likewise with female prisoners, of which 40% were not married among those aged under 25 years old and only 11% in the age group 25 years and older.
Percentage of male and female prisoners aged under 25 years who have comprehensive knowledge about HIV transmission and prevention (13% and 17%) only half of those aged 25 years and older (22% and 34%).
Percentage of male and female prisoners aged under 25 years who had attended education session about HIV transmission and prevention (38% and 50%) is also less than aged 25 years and older (47% and 61%).
Percentage of male and female prisoners aged under 25 years who ever had HIV test within the past 1 year (24% and 30%) is slightly lower than those aged 25 years and older (31% and 41%). While the male prisoners who received his last HIV test results are relatively similar between the two age groups i.e. 10% and 11%, in contrast with female prisoners where the percentage in the age group below 25 years (17%) is lower than the age group 25 years and older (26 %) Prisoners who had sex in prisons/detention center in the past 1 year have relatively similar percentage between the two age groups and sexes which is ranged between 4% - 6%. None of the prisoners male and female age groups below 25 years who used condom during last sexual intercourse the past 1 year in prison/detention center, while in the age group 25 years and older the percentage is 6% in male and 14% among female.
Two percent of male prisoners aged below 25 years admitted to injecting drugs in prisons/detention center in the past 1 year, higher than prisoners age 25 and older (0.3%), and none of the female prisoners who claimed to have done it. Although the percentage of who had prior history of injecting drugs in prison is relatively equal between male and female in both age groups which is between 6% - 9%. HIV prevalence among male prisoners was relatively similar between the two age groups (1% and 1.1%), whereas in the female prisoners was 0% in the age group below 25 years
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and 6.9% in the older age groups. Syphilis prevalence in male prisoners in sequence from the youngest age group is 2% and 6%, while among female inmate is 10% and 8%
Conclusion
The proportion of young people aged 15-24 years in most-at-risk populations for HIV transmission has significant numbers and vary greatly across populations and locations, and nearly all at-risk populations start the risky behaviors at the young age. The level of knowledge of the correct HIV transmission and prevention and the coverage of various HIV control programs among the younger most-at-risk populations is lower compared to those with older age. The young most-at-risk population also perform several risky behaviors which is overlap, such as young IDUs and MSM who also perform commercial sex and sex with multiple partners.
HIV and Syphilis prevalence is more influenced by duration of performing risky behavior compare to the level of risky behavior, therefore the level of HIV and Syphilis prevalence is higher among the older and the longer duration of performing risky behavior compare to the younger at risk populations.
Recommendation
Findings from this advanced analysis of the survey data and studies require follow-up which should be done immediately to reduce the impact of HIV epidemic among young people. Follow up action ideally should be done by using multi-dimensional approach considering the diversity and the complexity of issues faced. Some of the recommendations need to be followed up are as follows:
Efforts to increase HIV prevention and transmission knowledge among young people in general population should be an integrated part of the HIV and AIDS control program strategies at all government levels and obtain adequate funding allocation. AIDS Commission's central role in all government levels to respond this recommendation through the advocacy and coordination functions will be one of the keys successes.
Development of HIV and AIDS control strategies among young people should consider the variations of socioeconomic and cultural situations that exist in society in order to be widely accepted and implemented by various stakeholders xi | Age Group Disaggregation of Survey and Reseach Data
HIV and AIDS control program among young people in the most at risk populations should be strategically integrated into existing AIDS prevention strategies. The action plan of HIV and AIDS prevention among young people should be develop in the comprehensive way including plan that able to opening access to increased knowledge and access to related services.
The high number of school age children who perform HIV risk behaviors need to get special attention from the Ministry of National Education. Integrated work plan to increase knowledge and reduce risky behaviors among young people may also contribute to the HIV and AIDS control program in the future.
Need for the action plans with targets and effective strategies from various stakeholders to reduce the level of risk behavior among young people within most-at-risk population.
AIDS Commissions needs to formulate the effective measure in order to reduce stigma and discrimination toward young people who have high risk behavior in the community and public facilities. The programs which combine empowerment and increasing comprehensive understanding strategically can be done with the measurable output and outcome.
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TABLE of CONTENT
EXECUTIVE SUMMARY ........................................................................................................................ iii TABLE of CONTENT ............................................................................................................................xiii LIST of FIGURE ....................................................................................................................................xv LIST of TABLE .................................................................................................................................... xvii 1. INTRODUCTION .............................................................................................................................. 1 1.1. Background ............................................................................................................................................................. 1 1.2. Objective ................................................................................................................................................................... 2 1.3. Methodology ........................................................................................................................................................... 2
2. RESULT ........................................................................................................................................... 5 2.1. Youth in General ................................................................................................................................... 5 2.1.1. Profile ............................................................................................................................................................ 6 Distribution ................................................................................................................................................. 6 Education ..................................................................................................................................................... 6 Marital Status ............................................................................................................................................. 7 2.1.2. Knowledge ................................................................................................................................................... 8 2.1.3. Source of Information & Program Coverage ...............................................................................10 2.1.4. Sex Behavior and Condom Use .........................................................................................................12 2.1.5. Drug Use .....................................................................................................................................................15 2.2. Youth in Tanah Papua .......................................................................................................................17 2.2.1. Profile ..........................................................................................................................................................17 Distribution ...............................................................................................................................................17 Education ...................................................................................................................................................18 Marital Status ...........................................................................................................................................18 2.2.2. Knowledge .................................................................................................................................................19 2.2.3. Source of Information & Program Coverage ...............................................................................20 2.2.4. Sex Behavior & Condom Use ..............................................................................................................23 2.2.5. STIs Symptoms and HIV Prevalance ...............................................................................................26 2.3. Young Sex Worker ..............................................................................................................................28 2.3.1. Profile ..........................................................................................................................................................29 Distribution ...............................................................................................................................................29 Age at First Sex and First Commercial Sex ...................................................................................29 Education ...................................................................................................................................................31 Marital Status ...........................................................................................................................................31 2.3.2. Knowledge .................................................................................................................................................32 2.3.3. Program Coverage ..................................................................................................................................33 2.3.4. Sex Behavior & Condom Use ..............................................................................................................35 2.3.5. HIV and STI Prevalence ........................................................................................................................38 2.4. Young Injecting Drug Users ............................................................................................................40 2.4.1. Profile ..........................................................................................................................................................41 Distribution ...............................................................................................................................................41 xiii | Age Group Disaggregation of Survey and Reseach Data
3. SUMMARY & RECOMMENDATION ................................................................................................ 77 Summary .............................................................................................................................................................................77 Recommendation ............................................................................................................................................................78
Education ...................................................................................................................................................42 Marital Status ...........................................................................................................................................43 2.4.2. Knowledge .................................................................................................................................................43 2.4.3. Program Coverage ..................................................................................................................................45 2.4.4. Injecting Behavior ..................................................................................................................................46 2.4.5. Sex Behaviour ..........................................................................................................................................47 2.4.6. HIV & Sifilis Prevalence ........................................................................................................................50 2.5. Young MSM ............................................................................................................................................52 2.5.1. Profile ..........................................................................................................................................................53 Distribution ...............................................................................................................................................53 Education ...................................................................................................................................................55 Steady Partner .........................................................................................................................................55 2.5.2. Knowledge .................................................................................................................................................56 2.5.3. Program Coverage ..................................................................................................................................57 2.5.4. Sex Behaviour ..........................................................................................................................................59 2.5.5. Drug Abuse ................................................................................................................................................62 2.5.6. HIV & Syphilis Prevalence ...................................................................................................................62 2.6. Young Prisoners ..................................................................................................................................64 2.6.1. Profile ..........................................................................................................................................................65 Distribution ...............................................................................................................................................65 Education ...................................................................................................................................................65 Marital Status ...........................................................................................................................................66 Length of Sentence ................................................................................................................................66 Drug Abuse ................................................................................................................................................68 2.6.2. Knowledge .................................................................................................................................................70 2.6.3. Program Coverage ..................................................................................................................................71 2.6.4. Risk Behavior ...........................................................................................................................................73 2.6.5. HIV and STIs .............................................................................................................................................75
4. ATTACHMENT ............................................................................................................................... 79 List of Acronyms ..............................................................................................................................................................79 Permission Letter ............................................................................................................................................................80
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LIST of FIGURE
Figure 1. Distribution Cumulative AIDS Cases Reported Through December 2010 ...................................................... 1 Figure 2. Distribution of Estimated Population Age 15-24 Years Old In Indonesia 2010 .............................................. 6 Figure 3. Percentage of IYARS Respondent by Education Level .................................................................................... 7 Figure 4. Percentage of DHS Respondent Who Ever Married by Rural-Urban and Age Group .................................... 7 Figure 5. Percentage of IYARS Respondent Who Have Comprehensive Knowledge..................................................... 9 Figure 6. Percentage of BSS Among Student Respondent Who Have Comprehensive Knowledge ............................ 10 Figure 7. Percentage of IYARS Respondent Who Ever Had Sex ................................................................................... 13 Figure 8. Percentage of BSS Among Student Respondent Who Ever Had Sex in The Past Year.................................. 14 Figure 9. Number of Sex Partner in The Past Year of BSS Among Student Respondent ............................................. 14 Figure 10. Percentage of BSS Among Student Respondent Who Use Condom .......................................................... 15 Figure 11. Percentage of BSS Among Student Respondent Who Ever Drunk and Use Drug in The Past Year ............ 15 Figure 12. Education Level of BSS Among High School Student When The First Time Use Drug ................................ 16 Figure 13. Age Distribution of Respondent IBBS Tanah Papua ................................................................................... 17 Figure 14. Percentage of IBBS Tanah Papua Respondent by Education Level ............................................................ 18 Figure 15. Percentage of IBBS Tanah Papua Respondent by Marital Status ............................................................... 19 Figure 16. Percentage of IBBS Tanah Papua Respondent Who Have Comprehensive Knowledge According to UNAIDS Standard ........................................................................................................................................ 20 Figure 17. Percentage of IBBS Tanah Papua Respondent Who Reached by BCC Program in The Past Year ............... 21 Figure 18. Percentage of IBBS Tanah Papua Respondent Who Reached by VCT Program in The Past Year ............... 22 Figure 19. Percentage of IBBS Tanah Papua Respondent Who Ever Had Sex ............................................................. 23 Figure 20. Percentage of IBBS Tanah Papua Respondent According to Number of Sex Partner in The Past Year ...... 24 Figure 21. Percentage of IBBS Tanah Papua Respondent Who Had Sex With Casual and Commercial Partner in The Past Year ..................................................................................................................................................... 25 Figure 22. Percentage of IBBS Tanah Papua Respondent Who Used Condom at Last Sex With Steady, Casual and Commercial Partner.................................................................................................................................... 26 Figure 23. Percentage of IBBS Tanah Papua Respondent Who Seek Medical Treatment When Had STIs Symptoms in The Past Year .............................................................................................................................................. 26 Figure 24. HIV Prevalance of IBBS Tanah Papua Respondent ..................................................................................... 27 Figure 25. Distribution of Female Sex Worker and Waria Age 15 24 Years Old ....................................................... 29 Figure 26. Distribution of Female Sex Worker And Waria According to Age Group at First Sex ................................. 30 Figure 27. Distribution of Female Sex Worker And Waria According to Age Group at First Commercial Sex............. 30 Figure 28. Education of Female Sex Worker and Waria .............................................................................................. 31 Figure 29. Marital Status of Female Sex Worker ......................................................................................................... 32 Figure 30. Percentage of Female Sex Worker an Waria Who Have Comprehensive Knowledge ............................... 33 Figure 31.Percentage of Female Sex Worker and Waria Who Were Exposed to HIV Prevention Program in The Last 3 Months .................................................................................................................................................... 34 Figure 32. Percentage of Female Sex Worker and Waria Who Ever Received VCT Services ....................................... 34 Figure 33. Average Length of Selling Sex (Years) and Number of Client/Week of Female Sex Worker and Waria .... 36 Figure 34. Percentage of Female Sex Worker and Waria Who Use Condom at Commercial Sex ............................... 37 Figure 35. Percentage of FSW and Waria Who Had Sex With Casual Partner and Their Condom Use at Last Sex ..... 38 Figure 36. Prevalence of HIV and Syphilis Among Female Sex Worker and Waria ..................................................... 39 Figure 37. Prevalance of N. Gonorhoeae and C. Trachomatis Among Female Sex Worker and Waria ....................... 39 Figure 38. Distribution of IDU Age 15-24 Years Old .................................................................................................... 41 Figure 39. Percentage of IDU by Age Group of First Injecting Drug ............................................................................ 42 Figure 40. Education of IDU ......................................................................................................................................... 42 Figure 41. Marital Status of IDU .................................................................................................................................. 43 Figure 42. Percentage of IDU Who Have Comprehensive Knowledge and Service Provider Location ....................... 44 Figure 43. Percentage of IDU Who Were Exposed to Outreach and Harm Reduction Program ................................. 45 Figure 44. Percentage of IDU Who Received VCT Services ......................................................................................... 46 Figure 45. Distribution of Injecting Behavior of IDU ................................................................................................... 47 Figure 46. Percentage of IDU Who ever Had Sex and Average Number of Sex Partner in The Past Year ................... 48
xv | Age Group Disaggregation of Survey and Reseach Data
Figure 47. Percentage of IDU According to Type of Sex Partner in The Past Year...................................................... 49 Figure 48. Percentage of IDU Who Use Condom at Last Sex With Different Type of Partner..................................... 49 Figure 49. Percentage of IDU Who Always Use Condom at Sex in The Past Year With Different Type of Partner ..... 50 Figure 50. HIV and Syphilis Prevalence Among IDU by Age Group.............................................................................. 51 Figure 51. Distribution of MSM Age 15-24 Years Old .................................................................................................. 53 Figure 52. Distribution of MSM According to Age Group at Firts Sex ......................................................................... 54 Figure 53. Percentage of MSM According to Type of Partner at First Sex .................................................................. 54 Figure 54. Education of MSM ...................................................................................................................................... 55 Figure 55. Percentage of MSM Who Had Steady Partner According to Type of Steady Partner ................................ 56 Figure 56. Percentage of MSM Who Have Comprehensive Knowledge and Feel Risk to HIV Infection ..................... 57 Figure 57. Percentage of MSM Who Were Exposed to HIV Prevention Program in The Last 3 Months..................... 58 Figure 58. Percentage of MSM Who Ever Received VCT Services ............................................................................... 58 Figure 59. Percentage of MSM According to Type of Sex Partner in The Past Year ................................................... 59 Figure 60. Distribution of MSM Who Had Commercial Sex According to Age Group at Firts Commercial Sex........... 60 Figure 61. Average Length of Selling Sex (Years) and Number of Client/Week of MSM Who Sell Sex ...................... 61 Figure 62. Percentage of MSM Who Ever Use Drug and Injecting Drug .................................................................... 62 Figure 63. HIV and Syphilis Prevalance Among MSM by Age Group ........................................................................... 63 Figure 64. Prevalence of N. Gonorhoeae and C. Trachomatis Among MSM ............................................................... 63 Figure 65. Age Distribution of Prisoner ....................................................................................................................... 65 Figure 66. Education Level of Prisoner ........................................................................................................................ 66 Figure 67. Marital Status of Prisoner ........................................................................................................................... 66 Figure 68. Percentage of Prisoner According to Length of Sentence .......................................................................... 67 Figure 69. Percentage of Prisoner According to Time in Prison/Detention Center..................................................... 67 Figure 70. Percentage of Prisoner Who Ever Used Drug and Injecting Drug .............................................................. 68 Figure 71. Percentage of Prisoner With Drug Abuse Case .......................................................................................... 69 Figure 72. Percentage of Prisoner With Drug Abuse Case According Their Role ........................................................ 69 Figure 73. Percentage of Prisoner Who Feel Risk to HIV Infection ............................................................................. 71 Figure 74. Percentage of Prisoner Who Ever Received Information Related to HIV in The Past Year ........................ 71 Figure 75. Percentage of Prisoner Who Ever Reached by BCC Program in The Past Year .......................................... 72 Figure 76. Percentage of Prisoner Who Used Condom at Last Sex in Prison .............................................................. 74 Figure 77. Percentage of Prisoner Who Had STI Symptoms in The Past Year ............................................................. 75 Figure 78. Prevalance of Syphilis and HIV Among Prisoner ......................................................................................... 76
xvi | Age Group Disaggregation of Survey and Reseach Data
LIST of TABLE
Table 1. Percentage of IYARS Respondent Who Have Correct Knowledge ................................................................... 8 Table 2. Percentage of BSS Among Student Respondent Who Have Correct Knowledge ............................................ 8 Table 3. Percentage of IYARS Respondent According to Source of HIV Information .................................................. 11 Table 4. Percentage of BSS Among Student Respondent According to Source of HIV Information............................ 11 Table 5. Ditribution of BSS Among High School Student Respondent Who Exposed to HIV & Drug Abuse Program in The Past Year ................................................................................................................................................. 12 Table 6. Percentage of IBBS Tanah Papua Respondent Who Have Correct Knowledge ............................................. 19 Table 7. Percentage of IBBS Tanah Papua Respondent Who Ever Received HIV Information and Source of HIV Information ................................................................................................................................................... 21 Table 8. Odds Ratio of Comprehensive Knowledge According to BCC Program Coverage ......................................... 22 Table 9. Average of Age at First Sex and Percentage Type of Partner at First Sex IBBS Tanah Papua Respondent .... 24 Table 10. Percentage of Female Sex Worker and Waria Who Have Correct Knowledge ............................................ 32 Table 11. Odds Ratio Program Coverage of Female Sex Worker and Waria Age Group 15-19 to 20-24 and 25 Years Old ................................................................................................................................................................. 35 Table 12. Percentage of IDU Who Have Correct Knowledge....................................................................................... 44 Table 13. Percentage of IDU Who Share Diluted Drug and Buy Drug Together in The Past Week ............................. 47 Table 14. Odds Ratio of HIV Positive Result With Several Risk Factors For HIV Transmission .................................... 51 Table 15. Percentage of MSM Who Have Correct Knowledge .................................................................................... 56 Table 16. Percentage of MSM by Number of Anal Sex Partner in The Past Month and Average of Number of Anal Sex Partner in The Past Year.......................................................................................................................... 60 Table 17. Percentage of MSM Who Use Condom at Sex With Cassual and Commercial Partner .............................. 61 Table 18. Percentage of Prisoner Who Have Correct Knowledge ............................................................................... 70 Table 19. Percentage Source of HIV Information Among Prisoner ............................................................................. 72 Table 20. Percentage of Prisoner Who Ever Received VCT Services ........................................................................... 73 Table 21. Percentage of Prisoner Who Ever Had Risk Behavior in Prison/Detention Center in The Past Year ........... 74
xvii | Age Group Disaggregation of Survey and Reseach Data
1.
1.1. Background
INTRODUCTION
Over the last decade, there have been developments in the recognition of young people aged 10 to 24 years as a different population groups with different needs to infants, children or adults. Although the children more vulnerable to social, economic and health in society, WHO and UNICEF continue emphasizing and promoting the importance of adolescent health, because it is an investment for each country, and failure to do so will result in huge costs both socially, or the economy in the future.
At the end of 2010, the Ministry of Health reported a cumulative number of 24.131 AIDS cases in Indonesia. Most (67%) are in the age group 25 years or older. While the proportion of AIDS cases of children under the age of 15 years was 2.9 percent and young people 15-24 years age group was 27 percent. More than half (52%) of reported AIDS cases transmitted through heterosexual transmission, and the remaining (38%) transmission were due to injecting drug use. Figure 1. Distribution Cumulative AIDS Cases Reported Through December 2010
Millions of young people throughout the world face a high risk of HIV infection and other negative consequences of sexual health as a result of behavior that they adopt, or are forced to do. Three groups of young people considered most at risk of contracting HIV in Indonesia is young men who have sex with other men and young people who sell sex or inject drugs. In addition to these three groups, other young people also have a high risk of HIV infection, especially in areas where the HIV epidemic enters such an advanced level in Papua and prison setting.
1 | Age Group Disaggregation of Survey and Reseach Data
Meanwhile, various programs and policies related to existing HIV control in general is still unable to respond to the special needs of young people in the most-at-risk population. Some programs face challenges because the available data to develop policies do not distinguish by age group, and lack of good examples of effective programs to provide inspiration and guidance. Therefore, to assist all parties in designing the of HIV control program among young people, NAC is technically and financially assisted by UNICEF Indonesia, perform advanced analysis of survey data and existing research in order to obtain a more in-depth information about young age in the most-at-risk populations contracting HIV.Simak
In addition, the Ministry of Health has also been estimated between 132 to 287 thousand Indonesian people aged 15-49 years living with HIV in 2009, and between 5 to 8 million people at risk for HIV transmission. Some of those at risk for HIV transmission are young people who are biologically and socially more vulnerable to contracting HIV.
1.2. Objective
The main objectives of further analysis of existing survey data are:
Categorizing the key indicators of HIV control program, based on age group 15-20, 20-
24 years and above 25 years old. Knowing the distribution of most-at-risk youth population in HIV transmission. Analyzing different level on knowledge, attitude and behavior as well as program coverage among most-at-risk population by age group. Analyzing the difference of HIV and STIs prevalence among most-at-risk population by age group.
1.3. Methodology
Data Source
This further analysis using secondary data from several cross sectional survey data in the period 2007 to 2009, obtained from raw data of reports and other publications, such as Central Bureau of Statistics, Ministry of Health (MoH), the Indonesian Red Cross and Provincial Health Office Nanggroe Aceh Darussalam (NAD). Survey data used in this further analysis are:
Integrated HIV and Behavioral Survey among General Population, Tanah Papua,
conducted by BPS, Ministry of Health, Family Health International (FHI) and World Bank in 2006.
Indonesia Youth and Adolescent Reproductive Health Survey (IYARS) conducted by
Central Bureau of Statistics in 2007 Integrated Biological and Behavioral Survey (IBBS) among female sex workers (FSW) in 17 districts (Deli Serdang, Medan, Batam, West Jakarta, North Jakarta, Karawang, Bandung, Bekasi, Batang, Semarang, Malang, Banyuwangi, Surabaya , Denpasar, Sorong, Merauke and Jayapura) conducted by Central Bureau of Statistics, MoH, and FHI in 2007 IBBS in 3 cities (Jakarta, Bandung and Surabaya) and Behavioral Surveillance Survey (BSS) among Transgender (Waria) in 2 cities (Semarang and Malang) conducted by Central Bureau of Statistics, MoH and FHI in 2007 IBBS in 3 cities (Jakarta, Bandung and Surabaya) and BSS among Men who have sex with men (MSM) in 3 other cities (Medan, Batam and Malang) conducted by Central Bureau of Statistics, MoH, and FHI in 2007 IBBS in 4 cities (Medan, Jakarta, Bandung and Surabaya) and BSS in 2 cities (Semarang and Malang) among injecting drug users (IDUs) conducted by Central Bureau of Statistics, MoH, and FHI in 2007 BSS among high school students in the 2 cities (Jakarta and Surabaya) conducted by Central Bureau of Statistics, MoH, and UNICEF in 2007 Knowledge, attitude and practice of Female Sex Workers and Youth Survey in 3 districts/cities (Langkat, Pematang Siantar dan Tapanuli Tengah) conducted by Indonesian Red Cross -North Sumatra branch and The AIDSina Foundation in 2008 BSS among high school students and FSW in 4 cities (Banda Aceh, Lhokseumawe, Aceh Barat, Aceh Tamiang) conducted by Aceh Provincial Health Office and the AIDSina Foundation in 2008 IBBS among FSW in 9 districts (Palembang, Yogyakarta, Tangerang, Pontianak, Samarinda, Bitung, Makassar, Sorong and Mimika) conducted by Central Bureau of Statistics and MoH in 2009 IBBS among Transgender (Waria) in 3 cities (Palembang, Pontianak and Makassar) conducted by Central Bureau of Statistics and MoH in 2009 IBBS among MSM in 3 cities (Yogyakarta, Tangerang and Makassar) conducted by
IBBS among IDUs in 4 cities (Tangerang, Yogyakarta, Pontianak and Makassar)
conducted by Central Bureau of Statistics and MoH in 2009 BSS among high school students in 4 cities (Tangerang, Yogyakarta, Pontianak and Samarinda) conducted by Central Bureau of Statistics and MoH in 2009 The HIV and Syphilis prevalence and and HIV Risk Behavior Research among Prisoners in prisons and detention center in Indonesia conducted by the Directorate-General of Corrections Ministry of Justice and Human Rights, AusAID, HCPI and UNODC in 2010. The differences of surveillance title conducted by Central Bureau and MoH is associated with the biological examination of respondents, where in the BSS there is no biological examination at all (only data of the interview). Meanwhile, in the IBBS, HIV antibody test is
conducted with 2 reagents which results can be attributed to the interview; In the IBBS the biological specimens (blood, urine, vaginal or anal swabs) also taken from respondent to detect other STIs (gonorrhea, Chlamydia, or syphilis) other than HIV. IBBS/BSS sampling methodology for injecting drug users (IDU) and men who have sex with men (MSM) in several locations and year of survey are not always the same where some data collected by cluster sampling method and some other uses Respondent Driven Sampling. However, the analysis and tabulation for reports was done in a similar way, therefore the same manner is applied for this analysis.
Data Analysis
After the data collected from the data collection process and research activities, the data analysis activities is undertake which consist of 3 stages: 1. Preparation Phase In the preparation phase several activities are carried out: (a) create a variable that will be analyzed from the same question and choices of answer or have the same intent with any survey data that have been collected, (b) examine the content and equate categorization of content as well as sequence of variables from each data set, and (c) compile selected variables into one data set Tabulation activities basically is categorizing data into frequency tables for analysis, consisting of: (a) Coding: creating a code for any data that has been edited and (b) generate some new variables resulting from other existing variables such as age for age groups and 5 variables of knowledge for a comprehensive knowledge Data analysis being used is quantitative descriptive analysis aims to provide a description of the subjects analyzed based on data from the selected variable by using frequency and percentages tabulation technique. Data analysis was performed using computer application program Stata SE for Windows version 10.
2. Tabulation Phase
3. Data Application Phase
2.
2.1. Youth in General
RESULT
The period between childhood and adulthood covers a wide age range and a significant variation in terms of physical, psychological, and social development. Besides age, factors such as marital status and economic independence has implications on how young people's views and how they see themselves. Adolescence is a time when puberty occurs, when the majority of people having sex, and when sexual preferences and identity are formed. Many characteristics of young people need to be considered in the design and delivery of services provided to them. These characteristics include age and gender, whether they are in school, family relations and support, and where they live (in rural or urban area). Program designed need to recognize these factors and, at the same time, take advantage of innovation, passion and optimism inherent in young people. During the second decade of life, young people undergo crucial transition, which usually includes not only sexual initiation but also leaving school, entering labor force, forming partnerships, and having children. This is the first period of experience, taking risks, and experiment with many things, including alcohol and other psychotropic substances. There are number of things, including the fact that their capacity for complex thinking is still evolving, influencing how young people deal with the environment and the challenges that surround them. Changes that occur during adolescence needs to be understood by those responsible for HIV programs because these changes affect:
How do youths understand the information What are the channels of information and how the information influence their behavior How do they think about the future and make decisions in the present How do they perceive risk during their first experiment and experience
How do they form relationships, respond to social values and norms that surround them,
To have further understanding about those issues, further analysis of the 2007 Indonesia Youth and Adolescent Reproductive Health Surveys (IYARS) and BSS result among high school students in 2007 2009 was conducted. IYARS conducted by Central Bureau of Statistics (CBS) at 1,694 census blocks in 33 provinces with number of 8,481 female respondents and 10,830 male respondents aged 15-24 years, while the 2007 BSS among second grade high school students aged 15-19 years conducted by CBS, MoH and FHI in Jakarta and Surabaya and the 2009 BSS in Yogyakarta, Tangerang, Pontianak and Samarinda. Numbers of BSS respondents are 3,043 female and 3,113 male.
and influenced by the attitudes of their peers and the environment that surrounds it.
2.1.1.
Profile
Distribution
In general, the population aged 15-19 years in Indonesia in 2010 was 9.3 percent of total estimated Indonesia population, while the population aged 20-24 years is 9 percent of total population. The lowest proportion of population aged 15-24 years from the total population (14.8%) in the Province of Bali, while the highest proportion in the province of Maluku (22%). Nevertheless, the highest estimated of population aged 15-24 years is in West Java with 7.4 million people, while the lowest is in Gorontalo province (172 thousand people) Figure 2. Distribution of Estimated Population Age 15-24 Years Old In Indonesia 2010
Education
Education in this analysis is referred to the highest level of education ever passed by the respondent. With education a person can improve intellectual maturity, so be able to make decision to act. Education have an important role in determining quality of human being. With education, people are assumed to acquire knowledge and the implication is that the higher education, the better quality of human life. Education level is ought to be acknowledged for its correlation with the ability of each groups to respond a variety if information and communication messages related to HIV transmission. Studies in Africa and Asia with cross sectional method showed that educational level has a relationship with the level of knowledge and risk behavior of contracting HIV. Distribution of educational level among youths is quite varied by province, where in general the percentage of females 15-24 years age group who completed high school or
university is higher compare to the male population. This may reflect that the education level of women aged 15-24 years in Indonesia is higher than men with same age group. Figure 3. Percentage of IYARS Respondent by Education Level
Marital Status
In general, the percentage of women who ever married was much higher than men both at the age group 15-19 years and 20-24 years. In addition, the percentage of young peoples both men and women living in rural areas and ever married were also higher than those who live in urban areas. This indicates an average age of first marriage of women in Indonesia is younger compared to men, especially women who live in rural areas. Distribution of the mean age of first marriage of women who ever married also varies between provinces, ranging from 19.3 years (West Java) to the highest 22.2 years old (Maluku). Figure 4. Percentage of DHS Respondent Who Ever Married by Rural-Urban and Age Group
2.1.2.
Knowledge
Several questions on IYARS and BSS among high school students can be used to measure the level of knowledge on HIV transmission and prevention of HIV among youths. Table 1 show that the percentage of female and male respondents of IYARS age group 15-19 years who have knowledge on HIV prevention and transmission, lower than the 20-24 years age group. Table 1. Percentage of IYARS Respondent Who Have Correct Knowledge
Knowledge % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know condom can prevent HIV infection % who know abstaining from sexual intercourse can prevent HIV infection % who say a healthy-looking person can have AIDS % who know HIV cannot be transmitted by mosquito bites % who know HIV cannot be transmitted by sharing food Female
15-19 20-24 15-19
Male
20-24
56 61 54 69 29 35
65 69 59 77 28 32
47 69 49 57 22 27
54 76 54 64 27 24
Meanwhile the percentage of high school students BSS respondents who know HIV transmission and prevention is relatively not differ between male and female except for the knowledge that condoms use could prevent HIV in which the percentage of female respondents who know (66%) is much lower than male respondents (82 %). Table 2. Percentage of BSS Among Student Respondent Who Have Correct Knowledge
Knowledge % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know condom can prevent HIV infection % who know abstaining from sexual intercourse can prevent HIV infection % who say a healthy-looking person can have AIDS % who know HIV cannot be transmitted by mosquito bites % who know HIV cannot be transmitted by sharing food
Female Male
73 66 68 63 94 72
68 82 61 59 92 77
Percentage of IYARS respondents age groups 15-19 years who have the knowledge of HIV prevention and transmission is generally lower than the percentage of BSS high school student respondent. Even for the knowledge of false HIV transmission such as HIV is transmitted through mosquito bites and sharing eating/drinking dishes with people living with HIV, the percentage of respondent from high school student BSS 2-4 times better than IYARS respondents age group 15-19 years. This is most likely because IYARS respondents are adolescents in the general population with varying levels of education and so represent youth profile as a whole. In addition, IYARS respondents age group 15-19 years comes from urban and rural areas while high school student BSS only done in big cities. 1. 2. 3. 4. 5. UNAIDS also has set the standard to measure the level of comprehensive knowledge on HIV transmission and prevention which is a combination of 5 knowledge, namely: Know that a person's HIV status can NOT be known just by looking at appearance Know that using condoms when having sex can reduce the risk of HIV infection Know that faithful to each other on a single pair can reduce the risk of HIV infection Know that mosquito/insect bites can NOT transmit HIV Know that HIV is NOT transmitted by sharing eating/drinking dishes with people living with HIV
IYARS Results showed that respondents who have comprehensive knowledge are still very low, in which the female respondents have a little better knowledge rather than the male respondents. The low level of comprehensive understanding on IYARS respondents caused by the misconceptions on HIV transmission and prevention. Figure 5. Percentage of IYARS Respondent Who Have Comprehensive Knowledge
While the percentage of BSS high school student male and female respondents who have comprehensive knowledge on HIV transmission and prevention did not differ significantly, but the varied between survey locations and ranged from 17 percent in Surabaya city to 32 percent in Yogyakarta city. Figure 6. Percentage of BSS Among Student Respondent Who Have Comprehensive Knowledge
2.1.3.
Source of Information & Program Coverage
Sources of information about HIV and AIDS most frequently received by the IYARS respondent 15-19 years age group comes from television, followed by teacher/school and then newspapers/magazines. While among IYARS respondents age group 20-24 years, the percentage of source information from newspapers/magazines is higher than the school/teacher. Therefore, HIV and AIDS related information conveyed through the medium of television and newspapers/magazines need to get attention from all parties in order to effectively improve the correct knowledge and reduce as much misunderstanding regarding modes of HIV transmission among young people.
Table 3. Percentage of IYARS Respondent According to Source of HIV Information

Source of Information TV School/Teacher News paper/Magazine Friend Radio Poster Health worker Surrounding Internet Female
15-19 20-24 15-19
Male
20-24
76 53 35 35 26 4 5 3 2
83 42 50 35 35 5 5 5 3
74 48 30 37 28 6 5 2 1
80 36 38 37 31 9 6 3 2
Percentage distribution of sources of information received by male and female respondent of high school student BSS are almost equal to distribution of IYARS respondent 20-24 years age group, where newspaper/magazine is slightly higher than school/teacher. In general, the percentage of all sources of information about HIV and AIDS stated by more respondent of high school student BSS rather than IYARS respondents age group15-19 years. Table 4. Percentage of BSS Among Student Respondent According to Source of HIV Information
Source of Information TV News paper/Magazine School/Teacher Friend Family Radio Poster Health Worker Billboard NGO Worker Female Male
94 73 66 54 51 44 40 38 21 16
94 68 56 53 42 41 44 36 26 18
In addition to sources of information on HIV and AIDS, respondent of high school student BSS were also asked about several HIV prevention programs they ever receive at school in the last1 year, where the percentage of respondents who received education about drug abuse is the highest, followed by education about HIV and AIDS. While the STI education, reproductive health educatio/n and peer educators activities only reach less than half the respondents. In general, the percentage of respondents from high school students BSS in Yogyakarta that been exposed to HIV prevention-related programs is higher than other cities. Table 5. Ditribution of BSS Among High School Student Respondent Who Exposed to HIV & Drug Abuse Program in The Past Year
Yogyakarta Tangerang Pontianak Samarinda Jakarta Surabaya
% who participate drug abuse information session % who participate HIV/AIDS information session % who participate reproductive health information session % who participate in life skill education % who participate STI information session % who participate in peer educator
84 77 55 45 42 35
74 64 28 32 16 19
73 67 40 27 27 22
81 66 33 34 23 20
85 56 18 30 14 20
86 50 30 26 16 26
2.1.4.
Sex Behavior and Condom Use
Percentage of SKRRI respondents who had sex can describe the percentage of young people who are not married and had sex in Indonesia, where from Figure 6 can be seen that the percentage of unmarried young men who claimed to have sex is much higher than women. Percentage of women 15-19 years age group who are not married and had sex was 1.3 percent, lower than men the same age group (4%). While the percentage of women aged 20-24 years who were not married and had sex was 1.4 percent, also much lower than male age group 20-24 years (11%).
Figure 7. Percentage of IYARS Respondent Who Ever Had Sex
The reason for first sexual intercourse differs among female and male respondents, where some of the reasons most frequently mentioned by female respondents in a sequence is just happens (38%), forced by partner (21%), out of curiosity and getting married (7 %) and influenced by friends (6%). While among male respondents the reason is because they want to know (51%), just happens (26%), out of curiosity and getting married (7%) and influenced by friends (4%). The high proportion of reason forced by the partner among female respondents need to get attention from all parties, especially for policy makers to be able to design programs that can suppress the incident. Percentage of respondents from high school students BSS who ever had sex is much higher than the percentage of IYARS respondents age group 15-19 years. Percentage of respondents from high school students BSS who ever had sex ranged between 3.1 percent (Tangerang) to 11.1 percent (Surabaya), even 1.9 percent of high school students respondent in the city of Surabaya, claimed they had commercial sex (selling/buying) in the last 1 year. While respondents of high school students BSS who claimed to have anal sex in the last 1 year also exist in all the cities surveyed, which ranged between 0.8 - 3.2 percent.
Figure 8. Percentage of BSS Among Student Respondent Who Ever Had Sex in The Past Year
Aside from many respondents of high school students BSS who ever had sex, it turns out from those who had sex also had more than one partner in the last one year. This can be seen in Figure 8 where the mean number of sexual partners of respondents from high school students BSS who ever had sex ranged from 1.6 (Pontianak) to 2.7 (Surabaya). Even in Surabaya at least half of those who had sex had it with 2 different people in the last 1 year. Figure 9. Number of Sex Partner in The Past Year of BSS Among Student Respondent
While the level of consistent condom use in the last 1 year is still very low and it ranged only between 3 percent (Tangerang) to 18 percent (Pontianak). This indicates that most respondents of high school students BSS who had sex is at risk for HIV and STIs transmission.
Figure 10. Percentage of BSS Among Student Respondent Who Use Condom
2.1.5.
Drug Use
Percentage of respondents from high school students BSS who had drunk from alcohol drinking is quite high, ranging between 15 percent (Samarinda and Pontianak) to 27 percent (Surabaya). In the drunk condition, young people are more likely to have risky behavior, it is shown in the regression analysis between ever having sex and ever drunk that indicate a statistically significant relationship with the Odds ratio 7.11 with 95% Confidence Interval (CI) between 8.8 - 15.4 and p value <0.01 . Figure 11. Percentage of BSS Among Student Respondent Who Ever Drunk and Use Drug in The Past Year
In addition, 2 - 13 percent respondents of high school students claimed they had consumed drugs and 0-6 per cent had injecting drugs, which is as well known that the HIV epidemic in Indonesia is still dominated by injecting drug users (IDUs) with HIV prevalence among 34 56 percent.
Among respondents who claimed to have used drugs, it is known that more than half are using drugs for the first time before high school as can be seen in Figure 12. There's even a small portion of respondents in Jakarta, Surabaya and Tangerang who start using drugs since they are in elementary school. Figure 12. Education Level of BSS Among High School Student When The First Time Use Drug
2.2. Youth in Tanah Papua

HIV Epidemic in Papua in general is at the different levels with other regions in Indonesia. This can be seen from the number of reported AIDS cases per hundred thousand population which nearly 17 times higher than the national average. In addition, the highest HIV prevalence among female sex worker (FSW) also reported from the sentinel in Papua. Some studies also indicate many residents of Tanah Papua who have more than one sex partner and started having sex in young age. These situations have put young people in Tanah Papua to be at higher risk of HIV infection than adolescents in other areas in Indonesia. Therefore, further analysis of the 2006 IBBS data of general population in Tanah Papua needs to be done to compare the level of knowledge, program coverage, risk behavior and HIV prevalence by age group.
The IBBS of general population in Tanah Papua conducted by Central Bureau of Statistics, MoH, FHI and the World Bank with the number of 3,176 male and 3,129 female respondents aged 15-49 years which systematically selected from 260 census blocks in 10 districts in Tanah Papua.
2.2.1.
Profile
Distribution
The age distribution of Tanah Papua IBBS respondents in 2006, which amounted to 6,305 people are relatively equal between male and female respondents which is 16 percent of male and female aged 15-19 years, 16 percent of male and 20 percent of female aged 20-24 years and 68 percent of male and 64 percent of female aged 25 years and older. Age distribution of Tanah Papua IBBS respondents could describe the distribution of age in the general population in Tanah Papua. Figure 13. Age Distribution of Respondent IBBS Tanah Papua
Education
Percentage of male and female respondents age group 15-19 years and 20-24 years old who graduated from junior high school upwards relatively similar and higher than respondents 25 years age group and above. This shows that younger respondents have a better educational level than older respondents. However from Figure 13 can be seen that the level of female education in general is lower than male respondents Figure 14. Percentage of IBBS Tanah Papua Respondent by Education Level
Marital Status
Percentage of male and female respondents who ever been married has increased along with growing old age groups of respondents. Nevertheless, percentage of female respondents aged 15-19 years who are married (21%), is two times higher than male respondents (11%). So is the percentage of female respondents 20-24 years age group who are married (57%), much higher than male respondents (35%). While the percentage of female and male age group 25 years and older who are married are relatively similar. This shows that more young women are married compare to young men in Tanah Papua.
Percentage of male respondents aged 15-19 years who are married (11%) in 2006 Tanah Papua IBBS, is 7 times higher than respondents in 2007 DHS with the same age group (1.5%). While female respondents of Tanah Papua IBBS aged 15-19 years are married (21%), 2.3 times higher than female respondents aged 15-19 years in DHS (9%). Comparison of marital status of respondents aged 15-19 years from 2006 Tanah Papua IBBS and 2007 DHS as a national figure confirms the results of previous studies.
Figure 15. Percentage of IBBS Tanah Papua Respondent by Marital Status
2.2.2.
Knowledge
Percentage of respondents who have correct knowledge about HIV transmission and prevention can be seen in Table 4, where generally there is no significant difference between the three age groups and genders. Most of the respondents still thought that knowing someone HIV status can be done just by looking at the appearance and thought that sharing eating/drinking dishes with people living with HIV can transmit HIV. It can be concluded that the wrong perception about HIV transmission and prevention is still high among respondents of Tanah Papua IBBS. Table 6. Percentage of IBBS Tanah Papua Respondent Who Have Correct Knowledge
15-19
% who say a healthy-looking person can have AIDS % who know HIV cannot be transmitted by mosquito bites % who know that having multiple sex partner can be infected by HIV % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know HIV can be transmitted from mother to her baby % who know condom can prevent HIV infection % who know HIV cannot be transmitted by sharing food
Male
17 34 36 51 48 45 25
20-24
25+ 12 30 30 48 43 37 23
15-19 9 27 29 42 41 33 20
Female
20-24 8 29 29 45 41 36 23
25+ 10 27 27 41 39 31 21
11 34 30 48 43 39 23
Therefore, the percentage of male and female respondents who have comprehensive knowledge on HIV transmission and prevention according to UNAIDS standards still very low for all age groups. This can be seen in Figure 15, where the level of comprehensive knowledge of all age groups was still below 10 percent. Figure 16. Percentage of IBBS Tanah Papua Respondent Who Have Comprehensive Knowledge According to UNAIDS Standard
2.2.3.
Source of Information & Program Coverage
In general, more than half of male respondents had received information about HIV and AIDS, where the highest percentage is among 20-24 years age group (61%) followed by 1519 years age group (56%) and 25 years and older (51%). For female respondents, percentage who ever received HIV information relatively the same between age group 1519 years and 20-24 years (51 and 50%), while the percentage of respondents ages 25 years and older who ever received information on HIV and AIDS is slightly lower (47 %). Source of HIV Information that is mostly mentioned by male and female respondent age group 15-19 years old are teacher (51 and 45%), and for respondent age group 20-24 years old is television (54%). While source of HIV information most widely mention by male and female respondent age group 25 years and older is radio (57%) and television (52%). Sources of information about HIV and AIDS that is least mentioned by all respondents, both male and female are community leader.
Table 7. Percentage of IBBS Tanah Papua Respondent Who Ever Received HIV Information and Source of HIV Information 15-19
Received HIV information Teacher Radio TV Friends Brochure Health worker NGO worker Religious leader Family Society leader
Male 20-24
25+
15-19
Female 20-24
25+
56 51 45 36 33 32 32 20 17 15 5
61 21 49 54 37 39 43 20 23 17 7
54 12 57 52 35 42 46 19 26 17 10
51 45 39 36 28 32 43 21 20 16 6
50 21 43 54 23 39 40 20 18 12 5
47 8 47 52 26 42 39 14 22 19 5
Souce of Information (% from respondent who ever received HIV information)
Percentage of male and female respondent who ever attend HIV information session in the last 1 year is higher along with the younger age group. This condition can be seen in Figure 17 where percentage of male and female respondent age group 15-19 years (21 and 22%) higher than age group 25 years and older (16 and 13%). Meanwhile, male respondent who ever received IEC material in the last 1 year have different distribution pattern with female respondent where the highest percentage is among respondent age group 20-24 years old (22%). Figure 17. Percentage of IBBS Tanah Papua Respondent Who Reached by BCC Program in The Past Year
Further analysis of the relationship between IEC program coverage and comprehensive knowledge indicates that respondents who claimed to have exposed to the program has the higher possibility to know about comprehensive HIV transmission and prevention compare to respondents who are not exposed. This is shown by statistically significant odds ration which can be seen in Table 8. Table 8. Odds Ratio of Comprehensive Knowledge According to BCC Program Coverage
OR
Attended HIV information session Received IEC material
95% CI
nilai p
1.3 2.1
1.1 1.7 1.6 2.5
<0.001 0.009
Percentage of respondent who knows HIV testing site relatively the same, ranged between 15-19 percents among male respondents and 12-18 percents among female respondents. While percentage who had HIV test is still very low, ranged between 2-3 percent, and respondent who know the HIV test result is even lower, range from 1 - 1.6 percents among male respondent and 0.3 - 08 percents among female respondent. Figure 18 shows that female respondent who know their last HIV test result for all age group tends to be lower. Figure 18. Percentage of IBBS Tanah Papua Respondent Who Reached by VCT Program in The Past Year
2.2.4.
Sex Behavior & Condom Use
The Same situation also occurs among respondent 20-24 years age group, where more than a half of male respondents and 1 out of 4 female respondent who claimed ever had sex alco claimed that they are never been married. Figure 19. Percentage of IBBS Tanah Papua Respondent Who Ever Had Sex
Percentage male respondent age group 15-19 years olds who ever had sex (39%), 3.5 times higher than who has been married. While among female respondent in the same age group the percentage (37%) 1.7 times higher than who ever been married. This indicates that most of male respondent and 40 percent of female respondent age 15-19 years had extra marital sex.
The mean age of first sex are getting younger along with the younger age groups of respondents. As can be seen in Table 7, where average age of first sex among male respondent age group 15-19, 20-24 and 25 year older sequentially is 15.5 18.1 and 20.2 years. The same distribution pattern also occurred in female respondents. This also indicates the age of first sex in Tanah Papua is getting younger
Most of partner at first sex among male respondent age groups 15-19 and 20-24 years is friend/girlfriend, as well as half the respondents age group 25 years and older. While partners at first sex among female respondents mostly their husband. Percentage of male respondents who had first sex with friends/girlfriend for all age groups is higher than female respondents. This indicates more male respondents who have extra marital sex.
Percentage of male and female respondents who had first sex with girlfriend/boyfriend has increased along with the younger age group. This indicates the younger age of first sex , the
higher probability to have extra marital sex, , that will lead to higher probability of HIV infection risk. Table 9. Average of Age at First Sex and Percentage Type of Partner at First Sex IBBS Tanah Papua Respondent 15-19 Average of age at first sex (year) Type of partner at first sex Wife/Husband Girl/Boy Friend Commercial partner Male 20-24 25+ Female 15-19 20-24 25+
15.5 14% 80% 6%
18.1 23% 73% 4%
20.2 48% 50% 2%
15.3 50% 50% 0%
17.7 63% 37% 0%
19.3 81% 19% 0%
One of three male respondent age group 15-19 years old who had sex claimed to have more than1 sex partner in last 1 year. This figure is higher than male respondent age group 2024 years (27%) and 25 years and older (20%). While among female respondents, percentage who admitted having sex with more than 1 partner in last 1 year is much lower than male respondents. Distribution pattern of the percentage of respondents who have sex with more than 1 partner in last 1 year is similar between male and female, that is increasing in younger age groups as seen in Figure 19. This reinforces previous findings that the respondents in the younger age groups have more risky sexual behavior for HIV transmission. Figure 20. Percentage of IBBS Tanah Papua Respondent According to Number of Sex Partner in The Past Year
Percentage of male respondent who had sex with cassual and commercial sex partner generally higher than female respondent. The distribution pattern of percentage of respondent who had sex with casual and also commercial sex partners are different between male and female. Where among male respondents the highest percentage is in the age group 20-24 years, while among female respondents is in 15-19 years age group. Figure 21. Percentage of IBBS Tanah Papua Respondent Who Had Sex With Casual and Commercial Partner in The Past Year
The level of condom use at last sex with steady sex partners among male and female respondents are relatively similar in the three age groups, where all is still below 10 percent. While the highest percentage of respondent who used condoms at last sex with casual and non-commercial sex partner is in the 20-24 years age group (20 percent male and 11 percent female respondent), followed by 15-19 years age group (11 percent of male and female respondent), and the lowest is in the age group 25 years and older (10 percent male and 2 percent female respondent). Condom use at last sex with sex workers only asked to male respondents, in which there is no single respondents aged 15-19 years who used a condom. While among respondents age group 20-24 years and 25 years and older the rates were 17 and 15 percent. This also indicates that respondents 15-19 years age group is at higher risk than respondents of older age groups during commercial sex.
Figure 22. Percentage of IBBS Tanah Papua Respondent Who Used Condom at Last Sex With Steady, Casual and Commercial Partner
2.2.5.
STIs Symptoms and HIV Prevalance
Percentage of IBBS respondent, who had experienced one of sexually transmitted infections (STIs) symptoms such as abnormal genital discharge, sores around the genitals, pain when urinating in the past year ranged from 8-10 percent among male and female for the three age groups. Although percentage of respondents who have history of STIs symptoms was relatively similar across age groups and genders, but pattern of obtaining treatment is quite different. Respondents in younger age groups tend not to treat the symptoms or seek treatment to non-medical worker or health facilities. Figure 23. Percentage of IBBS Tanah Papua Respondent Who Seek Medical Treatment When Had STIs Symptoms in The Past Year
Figure 23 shows that the percentage of male respondents 15-19 years age group who seek treatment to a medical officer / health facilities when experiencing symptoms of STI in the past 1 year (45%) is much lower than respondents in older age groups. Likewise with female respondents, where the percentage of 15-19 years age group who seek treatment to a medical worker/health facilities (33%) was lower than 25 years and older age group (47%). HIV prevalance among male respondent age 15-19 years (3.2%) is higher than male respondent age 20-24 years (2.5%) and 25 years and older (2.9%). While among female respondent, HIV prevalance among age group 15-19 years and 20-24 years old relatively the same (2%), and lower among respondent age 25 and older (1.8%) HIV prevalence in Figure 23 is inline with behavioral data above, where male and female respondent age 15-19 years has higher risk behavior compare to the older age groups. In addition, male respondents generally have a higher HIV prevalence than female because the percentage of respondent who perform HIV risk behaviors was also higher among male than female. Figure 24. HIV Prevalance of IBBS Tanah Papua Respondent
Cross tabulation between respondents who have reactive HIV antibody with history of HIV testing showed none of the male and female respondents age group 15-19 years and 20-24 years who are HIV positive, ever been tested and know their test results. While among respondents 25 years or older age group there are 2 out of 61 male respondents and 1 out of 36 female respondents who were HIV positive, ever been tested and know their test result. This shows that nearly all respondents with reactive HIV antibody test does not know their HIV status, therefore possibility of HIV spread to the wider population is likely to occur.
2.3. Young Sex Worker

In accordance to UN Convention on the Rights of the Child, young people aged between 18 to 24 years old are legally entitled as adults, while those under 18 are defined as children. Therefore, a person who is younger than 18 years old and has sex for exchange is considered victims of commercial sex exploitation. This distinction is crucial in the effort of HIV prevention, support and treatment for those younger than 18 years old as a legal obligation of the Government of Indonesia as the signatory to the convention that goes beyond public health issue. The distinction will strongly influence on the how society shall think and respond to the issue of young people who selling sex. This issue of young people selling sex also involve many dimensions such as law, economic, politic, social, moral and human rights issues. The fall of children and young people into commercial sex may be associated to many factors including poverty, commercial sex exploitation and trafficking, child sexual abuse, homelessness, lack of skills and employment opportunities, desire for better living and bigger income, limiting choices in humanitarian distress situation and drug abuse. Substantial discrepancy in the data availability and quality produces inaccurate estimate regarding the number of young people selling sex. Besides, some of the statistics regarding human trafficking fail to distinguish between victims of commercial sex exploitation to adult sex worker.
There are many reasons why young people who sell sex tend to be more vulnerable to negative physical and psychological effect of sex work, including HIV infection compared to adults. This is because they are biologically more vulnerable for their reproductive systems still developing, besides social reasons inflicted within. Young sex worker also tend to fail negotiating the use of condom to their clients, especially to those who will pay extra to get young male or female sex partner for usually such clients think that they are simply pristine. Therefore, further analysis of survey data on sex workers population needs to be done to see the difference in the level of knowledge, risk behaviors, program coverage and prevalence of STIs and HIV by age group. Survey data used in further analysis for a population of sex workers are:
IBBS among FSW in 17 districts conducted by Central Bureau of Statistics, MOH and FHI
in 2007 with total of 5,959 direct and indirect FSW respondent. IBBS among FSW in 4 cities conducted by the Aceh Provincial Health Office and the AIDSina Foundation in 2008 with a total of 237 FSW respondents IBBS among FSW in 9 districts conducted by Central Bureau of Statistics and MOH in 2009 with total 3,803 direct and indirect FSW respondent
IBBS in 3 cities and BSS in 2 cities with the number of respondents 750 and 400
Transgender (Waria) conducted by Central Bureau of Statistics, MOH and FHI in 2007 IBBS in 3 cities with the number of 505 transgender (Waria) respondents conducted by Central Bureau of Statistics and MOH in 2009
2.3.1.
Profile
Distribution
In total, the percentage of young sex worker widely varies across survey locations, where the percentage of FSW aged 15-24 years old is around 15 percent (Malang) to 58 percent in Tangerang. Meanwhile, among transgender (Waria) group, the sex workers are around 19 percent (Malang) to 48 percent (Makassar). Sex workers aged between 15-19 years are not even in the distribution and in some areas such as in Tangerang, Bitung, Bandung, Palembang, Karawang, and West Jakarta Bars, the proportion of FSW below 20 years of age is more than 10 percent of the total number of FSW in the region. Meanwhile, in Makassar, Pontianak, Jakarta and Bandung, the percentage of transgender (Waria) below 20 years of age is also more than 10 percent. Figure 25. Distribution of Female Sex Worker and Waria Age 15 24 Years Old
Age at First Sex and First Commercial Sex

Almost all sex workers have had sex before age 25 years and there are 3-34 percent of FSW who had first sex when they were less than 15 years, while the percentage is even higher among transgender (Waria) ranged between 12-56 percent.
Figure 26. Distribution of Female Sex Worker And Waria According to Age Group at First Sex
Age distribution of commercial sexual debut quite varied across the survey locations, where among FSW there is 10 percent (Mimika) - 38 percent (Tangerang) who have commercial sex for the first time before age 20. In fact, nearly in all survey locations except Medan, FSW is already having a commercial sex before age 15. Unfortunately because there are restrictions on age of survey respondents (at least 15 years), FSW aged under 15 are not included in all behavioral survey ever conducted.
Age of commercial sexual debut among transgender (Waria) tends to be younger than FSW, where percentage of who had commercial sex debut under 20 years old of age is about 46 percent (Pontianak )to 61 percent (Malang and Semarang). Therefore, the average age of commercial sex debut among transgender (Waria) is 20 years old, while among FSWs is 25. Figure 27. Distribution of Female Sex Worker And Waria According to Age Group at First Commercial Sex
Education
Most of 15-19 years age group FSW only graduated from junior high school and lower, the same as age group 25 years and older, while 20-24 years age group FSW posses higher education from junior high school or higher. While among transgender (Waria) the existing mode of education trends are relatively similar between the three age groups, so that educational level did not differ with the older age. In addition, from Figure 27 it can be concluded that education level among transgender (Waria) is higher than FSW for all age groups. Figure 28. Education of Female Sex Worker and Waria
Marital Status
Marital status were asked exclusively to FSW respondents, while it is not asked to transgender (Waria) respondent since from several surveys/studies it is known that almost all of Waria never been married.
Percentage of FSW age group 15-19 years (69%) who were not married is 2 times higher than the 20-24 years age group (35%) and almost 12 times higher than 25 years and older (6%). Meanwhile, FSW with married and divorce status is increasing along with the older group of age.
Figure 29. Marital Status of Female Sex Worker
2.3.2.
Knowledge
Percentage of FSW who know condom can prevent HIV; know that taking antibiotics before having sex does not prevent HIV infection and know that the person who looks healthy may have HIV infection are relatively similar between age groups. While percentages of FSW who knows that to be faithful with 1 sex partner and mosquito bites do not transmit HIV are increasing along with the older group of age.
In general, level of knowledge on HIV transmission and prevention among FSW respondents is lower than Waria. Percentage of younger Waria who knows condom use and mutually faithful to one sexual partner can prevent HIV, also know that mosquito bites do not transmit HIV is lower than the older age group of Waria. Table 10. Percentage of Female Sex Worker and Waria Who Have Correct Knowledge
Knowledge
% who know condom can prevent HIV infection % who know drink antibiotic before have sex will not prevent HIV % who say a healthy-looking person can have AIDS % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know HIV cannot be transmitted by mosquito bites
15-19
FSW
64 44 71 71 51
20-24
25+
15-19
Waria
77 59 79 72 73
20-24
25+
65 44 68 64 47
65 44 68 71 52
71 67 83 61 73
79 64 82 74 77
Therefore, the level of comprehensive knowledge about modes of transmission and prevention of HIV according to UNAIDS standards among FSW respondents generally lower than Waria. Percentage of the youngest age groups of FSW who have comprehensive knowledge was slightly lower than the older age groups, while among Waria the percentage is relatively similar between age groups.
Percentage of distribution pattern among FSW and Waria who feel at risk of contracting HIV is very similar to the distribution percentage of who have comprehensive knowledge about HIV transmission and prevention, as can be seen in Figure 30. Figure 30. Percentage of Female Sex Worker an Waria Who Have Comprehensive Knowledge
2.3.3.
Program Coverage
In general, the percentage of FSW aged15-19 years who ever been reached by field worker, receiving STI clinic services and receive free condoms in the last 3 months is lower than the older age groups of FSW. This condition also occurs among Waria respondents except for the coverage of those who receive STI services, where percentage among Waria aged 1519 is equals to 25 years and older age group.
Figure 31.Percentage of Female Sex Worker and Waria Who Were Exposed to HIV Prevention Program in The Last 3 Months
Differences program coverage by age group as in Figure 31 also occurs in the coverage Percentage of FSW and Waria who are older and ever been tested for HIV, receive counseling services and receive HIV test results higher than the younger age groups. This indicates that the older the age groups of FSW and Waria the more who knows their HIV status.
The lower coverage of HIV Voluntary Counseling and Testing (VCT) among younger FSW led to the possibility of such continued access to care, support and treatment for them are also becoming smaller. Figure 32. Percentage of Female Sex Worker and Waria Who Ever Received VCT Services
Further analysis on the correlation between several program coverage with age group using odds ratio reveals that statistically, the difference of several program coverage to each age group is fairly significant (p value < 0.05 and OR or CI does not exeed 1). As seen in Table 11, FSW age group 25 years old and older has 1.7 times bigger opportunity to be reached by the field worker than those of 15-19 years old group. As well as FSW aged 25 years and older who have ever received condom and STI services have odds ratio of 1.4 times compared to 15-19 years age group. Meanwhile, the odds ratio of FSW aged 20-24 and 25 years and older compared to aged 15-19 who have had HIV test is 2.1 and 3.0 respectively with p value of 0.01 which indicates that the ratio is statistically significant.
Odds ratio of several program coverage based on Waria age group which statistically have strong correlation is ever been reached by field worker and have had HIV test. Meanwhile, the odds ratio of the group who ever received free condom and STI clinic service is statistically insignificant which means that there is no difference in program coverage toward Waria aged 15-19, 20-24 or 25 years and older. Table 11. Odds Ratio Program Coverage of Female Sex Worker and Waria Age Group 15-19 to 20-24 and 25 Years Old
FSW OR 95% CI p value 0.06 < 0.01 0.53 < 0.01 0.42 0.01 < 0.01 < 0.01 Waria OR 95% CI p value 0.51 < 0.01 0.18 0.18 0.45 0.42 < 0.01 < 0.01
Ever reached by outreach worker 20-24 years old 25 + years old 25 + years old 25 + years old 25 + years old 20-24 years old 20-24 years old 20-24 years old 1.3 1.0 - 1.7 1.7 1.3 - 2.1 0.9 0.7 - 1.2 1.4 1.1 - 1.8 1.1 0.9 - 1.4 1.4 1.1 - 1.7 2.1 1.6 - 2.9 3.0 2.3 - 3.9 1.3 0.6 - 2.5 2.5 1.4 - 4.6 0.6 0.3 - 1.2 1.4 0.8 - 2.4 0.8 0.4 - 1.5 1.3 0.7 - 2.3 2.8 1.4 - 5.7 4.4 2.3 - 8.2
Ever received free condom
Ever received STI services
Ever had HIV test
2.3.4.
Sex Behavior & Condom Use
As expected, the older the sex worker, the longer time they have been selling sex. The mean length of time for being Sex Worker among FSW age group 15-19 are 1.2 years, increased to 1.6 years in age group 20-24 and 3 years in age group 25 years and older. While among
Waria, the average length of time for being Sex Workers in sequence from the youngest age group is 2.2, 4 and 12.3 years. This may suggest that older Waria have also begun to become sex workers at the early age. Figure 32 shows that length of time for selling sex among Waria for each age group is much longer than FSW, even for 25 years and older Waria , length of time is four times longer than FSW with the same age group.
The mean number of clients in the last 1 week among FSW age group 15-19 years and 2024 years are relatively similar (7.5 and 7.6 persons / week) and more than FSW age group 25 years and older which is only 6.1 people per week. While the average number of clients in the last 1 week among Waria respondents relatively similar in all age groups and much less than the average number of FSW clients in the last 1 week. Figure 33. Average Length of Selling Sex (Years) and Number of Client/Week of Female Sex Worker and Waria
The level of condom use among FSWs during the last commercial sex and its consistency in the last 1 week increases along with the higher age group. This can be seen from Figure 33 below where the percentage of FSWs aged 15-19 who always use condom in their last commercial sex is only 24 percent, lower than FSW aged 20-24 (30 percent) and 25 years and older (35 percent). Meanwhile, among Waria, the lowest percentage of those who always use condom in their last commercial sex is in age group of 25 years and older as well as the percentage of Waria who use condom in the last commercial sex.
Figure 34. Percentage of Female Sex Worker and Waria Who Use Condom at Commercial Sex
Meanwhile, the percentage of FSWs aged 15-19 (62%) who had sex with casual and non commercial partner is nearly twice higher than 25 years old group FSW (35%). While, the percentage of FSW aged 20-24 who had sex with casual and non commercial partner is in between (51 %). Therefore, it can be concluded that the younger FSW the more likely to have sex with casual and non-commercial partner. On the other hand, the level of condom use in the last sex with casual partner and non-commercial among FSW from 15-19 years age group is higher than the older age group.
From Figure 33 and Figure 34, it can be concluded that younger FSW have more risky sexual behaviors than older FSW, due to the bigger number of clients while the level of condom use is lower. This is in line with findings from many qualitative studies which indicate that young are much more preferred by clients while its ability to negotiate condom use is lower than the older FSW
The percentage of Waria who had sex with casual and non-commercial partner in the last 1 years is relatively the same between all age group and overall is much higher than FSW. This description also applies to the level of condom use in the last sex with casual and noncommercial partner, where the percentage is ranging from 73-75 percent, far higher than FSW which is only 35-62 percent.
Figure 35. Percentage of FSW and Waria Who Had Sex With Casual Partner and Their Condom Use at Last Sex
2.3.5.
HIV and STI Prevalence
Overall, HIV and Syphilis prevalence among Waria is far higher than among FSW, however the HIV prevalence among 15-19 years FSW and Waria relatively similar, though biologically anal sex that commonly practiced by Waria is far more risky than genitogenital sex which commonly practiced by FSs. This may be due to the average number of clients for 15-19 years old group FSWs is bigger while the level of condom use is lower than Waria of the same age group, hence the infection risk among FSW of 15-19 years old group becoming similar to Waria of the same age group.
HIV prevalence among FSW of 20-24 years age group is higher than the other 2 age groups, while Syphilis prevalence is highest among 25 years old group. Meanwhile, the HIV and Syphilis prevalence among Waria is increasing along with the older age group. This can be seen from HIV prevalence among Waria aged 15-19 where the percentage is 5.4 and increases to 14.5 percent among aged 20-24 and 19.2 percent among aged 25 years old and older. This also applies to Syphilis prevalence among Waria where the pattern is quite similar to HIVs.
HIV and Syphilis are chronic diseases with hardly identifiable initial infection symptom by the society including FSW and Waria. Both infections may not reveal any symptom for years but at this initial stage it is far more infectious than it is after the symptoms reveals.
Figure 36. Prevalence of HIV and Syphilis Among Female Sex Worker and Waria
The characteristic of Gonorrhea and Chlamydia infection is different from HIV and Syphilis, where most of it cause symptoms in a short period of time and will be more severe if not treated immediately. In addition, Gonorrhea and Chlamydia are biologically more easily transmitted than HIV and syphilis and can be treated to full recovery. Therefore, Gonorrhea and Chlamydia infection is often used as an indicator of the level of risk or the success of condom use program in risky sex behavior. From Figure 37 shows that the younger age group of sex workers, the higher prevalence of gonorrhea and Chlamydia infection will be. This illustrates clearly that younger sex workers have higher risk behaviors. Figure 37. Prevalance of N. Gonorhoeae and C. Trachomatis Among Female Sex Worker and Waria
2.4. Young Injecting Drug Users

Narcotics and other psychotropics are illegal substances and is the common term used by the society and the law authorities to call the substance/drugs categorized as dangerous and illegal to be used, produced, supplied, traded and distributed outside the law. There are many operational concept and definition of drugs abuse such as new initiation stage which is defined as the usage of 5 times or less per year. The use of more than 5 times per year will be considered as above initiation and called as regular user when using drugs everyday for minimum 2 consecutive weeks and the use of more than once a day for 10 to 14 days or more is considered as drug dependence. Injecting drug may transmit HIV when it is done by sharing injecting paraphernalia or dissolved drug contained with blood that already contaminated by HIV . Injecting drug use also have other serious health risk including Hepatitis and overdose.
Among young IDU, sense of curiosity, availability, and imitate of other IDUs contribute to the pattern of the first injection. Young injecting drug users are usually looking for their peers who had experience in injecting drugs and ask them for help. The first injection rarely occur alone, and usually occurs in social situations in which new IDUs injected by a friend or their sex partners who are more experienced. Young people who become IDUs generally is because they want to become a member and being recognized for their existence within a group and are often do not aware of the health consequences that could arise from their risky behavior. In addition, because drug use is illegal, IDU tend to be more suspicious to the environment or people outside the group.
Meanwhile, policies associated with drug use and control programs generally fall into three major categories of supply reduction, demand reduction and harm reduction. Law enforcement agencies have the primary responsibility for supply reduction. Health, education and social service institution are mostly responsible for demand reduction and harm reduction. More often, the approach of the law enforcement agencies and social or health services runs into a conflict in the implementation. For example, police may arrest IDU in the needle-syringe program site or that young IDU is taken to prison where they might be more at risk than if they were outside the prisons
Therefore, to see to see the difference in the level of knowledge, risk behaviors, program coverage and prevalence of STIs and HIV in IDUs by age group, further analysis of survey data on IDU population are made. Survey datas used in the further analysis for IDU population are:
IBBS in 4 cities and BSS in 2 cities among injecting drug users (IDUs) with 1,003 and 401
respondents conducted by Central Bureau of Statistics, MoH, and FHI in 2007 Integrated HIV and Behavioral Surveys among IDUs in 4 cities with 681 respondent conducted by Central Bureau of Statistics and MoH in 2009
2.4.1.
Profile
Distribution
Similar with Sex Workers, the distribution of young IDU is uneven in several survey locations. Percentage of IDUs aged 15-19 years who become survey respondents ranged between 2 percent (Surabaya, Malang, Semarang, Bandung and Medan) to 25 percent (Pontianak), while the percentage of IDUs aged 20-24 years ranged between 23 percent (Malang and Surabaya) to 37 percent (Yogyakarta). Figure 38. Distribution of IDU Age 15-24 Years Old
The distribution of the earliest age injecting drugs before 25 years old is ranging from 68 percent (Semarang) to 89 percent (Banten). Meanwhile, the percentage of the earliest age injecting drugs of below 15 years old is ranging from 0 percent (Semarang) to 15 percent (Makassar). It means that 1 out of 7 IDUs in Makassar starts to inject drugs while they still at junior high school or even at elementary school. Therefore, the mean number of earliest age of injecting drugs in Makassar is 19 years old, younger than other survey locations which is ranging from 20-23 years old.
Figure 39. Percentage of IDU by Age Group of First Injecting Drug
Education
Education level attended by IDUs in general is relatively higher than other at risk groups. Most of them finish senior high school and the older is the IDUs age group , the higher is the education level. More or less, education strongly influences someones decision to engage in risky behavior. The percentage of IDUs within 15-19 years old age group who did not finish elementary school, finish elementary school or only finish junior high school is higher than IDUs from the older group of age. Figure 40. Education of IDU
Marital Status
The percentage distribution of IDUs who are or ever been married based on the age group as seen in Figure 41 is relatively similar with the distribution of marital status oamong general population in urban areas. The percentage of IDUs of below 20 years old who ever been married is around 1 percent, while those of 20-24 years old is 15 percent.
Marrital status is an important variable to be known since there are only 14 percent of IDUs who are married and have sex partner where 60 percent of IDUs steady partners do not know that their spouses are IDUs. Therefore, most of the IDUs steady partners do not know that they are also vulnerable for HIV infection from their spouses. Figure 41. Marital Status of IDU
2.4.2.
Knowledge
In general, the level of knowledge on HIV infection and prevention among young IDUs is lower than the older IDU. This can be seen in Table 12 below where in all knowledge parameters questioned in the survey, the 15-19 years old IDUs group who have the correct knowledge is lower than IDU aged 20-24 and 25 years and older. There are even only half of the IDUs aged 15-19 years know that sharing dissolved drugs in one needle-syringe with other IDU is have a high risk of HIV infection.
Table 12. Percentage of IDU Who Have Correct Knowledge

15-19 % who say a healthy-looking person can have AIDS % who know share used needle can transmit HIV % who know condom can prevent HIV infection % who know HIV cannot be transmitted by mosquito bites % who knows share diluted drug in 1 syringe can transmit HIV % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection 20-24 25+
68 82 73 73 53 74
80 94 87 77 66 82
82 95 87 81 64 87
Therefore, the percentage of IDUs aged 15-19 years old who have comprehensive knowledge on HIV infection and prevention based on UNAIDS standard is far lower than IDUs aged 20-24 and 25 years and older.
In addition, percentage of IDUs aged 15-19 years old who know sites of Methadone Maintenance Therapy and HIV test is also lower than IDUs from the older groups. Therefore, from Figure 42 below it can be concluded that the younger is the age of IDUs, the lower is their level of comprehensive knowledge on HIV transmission and prevention as well as service sites related to harm reduction program and and also HIV test. Figure 42. Percentage of IDU Who Have Comprehensive Knowledge and Service Provider Location
2.4.3.
Program Coverage
The percentage of IDUs aged 15-19 years old who have been reached and have discussed about the risk of HIV transmission with the field worker in the last 3 months is 30 percent or less than half of the percentage of IDUs aged 25 years old andn older who have been reached (61%) and far lower than IDUs aged 20-24 years old (53%). This has become the cause of the low percentage of young IDUs having comprehensive knowledge and knowing the service sites related to harm reduction.
Similar situation also occurs among IDUs who have received Sterile Needle and Syringe from Needle-Syringe Program (NSP) and Methadone Maintenance Treatment (MMT) in the last 1 year, where from Figure 43 it can be concluded that the younger is the age group of IDUs the lower is the percentage of those who have ever received NSP and MMT. This situation is related to IDUs who know where the services site located, where the younger age group of IDUs who know the MMT service sites is lower than the older ones. Figure 43. Percentage of IDU Who Were Exposed to Outreach and Harm Reduction Program
VCT program coverage is also relatively similar with the outreach program, NSP and MMT coverage, where the percentage of IDUs of the younger age group who had HIV test, received counseling services and HIV test result is lower than IDUs from the older age group. This may cause the risk of HIV transmission among younger IDUs is bigger than the older ones.
Figure 44. Percentage of IDU Who Received VCT Services
2.4.4.
Injecting Behavior
However, the level of needle-syringes sharing behavior among IDUs aged 15-19 years old (52%) is far higher than IDUs of 20-24 years age group (33%) and of 25 years and older IDU (30%). Meanwhile, the mean number of injecting frequency in the last 1 week seems to be strongly related to the duration of being IDU as described in Figure 45 below.
The mean of injecting duration among IDUs aged 15-19 years old is 1.6 years and getting longer along with older age group which is 3.7 years among 20-24 years age group and 6.8 years among the 25 years and older group of age. In Indonesia, the longer people are becoming IDU the bigger is the chance for them to be exposed to HIV virus. This is shown by the odds ratio of 3.5 (95% CI 1.4 8.4 and p value <0.01) among IDU with injecting duration less than 1 year and odds ratio of 20.2 (95% CI 8.6 47.2 and p value <0.01) among IDU with injecting duration more than 5 years. This suggests that a person who has been IDU in Indonesia for more than 5 years has 8.6 47 times bigger opportunity to be infected by HIV compared to those injecting for less than 1 year.
Figure 45. Distribution of Injecting Behavior of IDU
Other drug injecting behavior needs to get attention is the collective drugs purchase due to possibility to share dissolved drugs with only one needle-syringe is bigger compared to if they purchase the drugs individually. The percentage of IDUs aged 15-19 years old who have ever purchased drugs collectively is 81 percent which is slightly higher than aged 2024 years old (79 percent) and 10 percent higher than the 25 years and older group.
The percentage of IDUs aged 15-19 years old who have ever share dissolved drugs in one needle-syringe (wet setting) is relatively similar with aged 20-24 years old which is 65 percent, while the 25 years and older group is 9 percent lower (56%). Table 13. Percentage of IDU Who Share Diluted Drug and Buy Drug Together in The Past Week
15-19 % who share diluted drug in the same needle in the past week % who joint with other IDU in buying drug 20-24 25+
65 81
65 79
56 71
2.4.5.
Sex Behaviour
Even though the percentage of IDUs aged 15-19 years old who have ever been married is very low (1%), but more than half of it (57%t) in fact have ever had sex in the last 1 year. Meanwhile, the percentage of IDUs aged 20-24 years old who have ever had sex in the last
1 year is relatively similar with the 25 years and older which is 82 and 83 percent. Meanwhile, the mean number of sex partners among young IDUs (aged 15-19 years old) in the last 1 year is much bigger than the age group 25 years and older. Figure 46. Percentage of IDU Who ever Had Sex and Average Number of Sex Partner in The Past Year
Contradictive situation is found in sex intercourse with non-commercial casual partner where the percentage of IDUs aged 15-19 years old who have ever had sex with non commercial casual partner is 56 percent, higher than the 20-24 years old age group (48%) and the 25 years and older age group (38%). Meanwhile, the percentage of young IDUs (15-19 years old) who have ever had commercial sex (buying/selling) is 4 percent higher than the 25 years and older (39%).
Percentage of IDUs who have ever had sex with steady partner (wife/husband/lover) in the last 1 year is higher along with the older age group. This can bee seen from Figure 47 below where the percentage of IDUs aged 15-19 years old who have ever had sex with steady partner in the last 1 year is 46 percent, increases to 54 percent among the 20-24 years old age group and 61 percent among the age group 25 years and older.
Therefore, it can be conclude that young IDUs have more risky sex behavior with noncommercial casual partner also with commercial partner. Nearly all of the two type of sexual partners have other sex partners in which they are infected with HIV from IDUs, they may transmit it to the other sex partners who are not IDU and therefore will increase HIV infection through sexual transmission route.
Figure 47. Percentage of IDU According to Type of Sex Partner in The Past Year
The level of condom use in the last sex with any sex partner has different distribution where the percentage of IDUs aged 15-24 years old who use condom in the last sex with commercial partner (55%) is higher than 25 years old age group (48%). Meanwhile, the level of condom use during sex with the non-commercial casual partner among IDUs aged 15-19 years old is the lowest (39%) compared to the other two groups. On the contrary, in the last sex with steady partner, the percentage of IDUs aged 15-19 years old who use condom (42%) is nearly 2 times fold than 20-24 years old group (23%) and 25 years and older (22%). Figure 48. Percentage of IDU Who Use Condom at Last Sex With Different Type of Partner
In general, the consistency of condom use in the last 1 year with any sex partner in all age groups is lower than that in the last sex. The percentage of IDUs of 15-19 years old age group who reported always use condom in commercial sex in the last 1 year is 49 percent, much higher compared to 20-24 years old age group (28%) and 25 years and older age group (27%). On the contrary, the consistency of condom use in the last sex withthe noncommercial casual partners and steady partners among IDUs of 15-19 years old age group (14 and 16%) is the lowest compared the older age group. Figure 49. Percentage of IDU Who Always Use Condom at Sex in The Past Year With Different Type of Partner
2.4.6.
HIV & Sifilis Prevalence
HIV prevalence among IDUs is getting higher along with the older age groups. It can be seen in Figure 50, where HIV prevalence among 15-19 years old group (6.4%) lower than it is among 20-24 years old age group (29.8%) and 25 years and older (49.9%. Similar situation applies in Syphilis prevalence where among 15-19 years old age group, it is remain 0 percent, while among the 20-24 is 0.8 percent slightly lower than it is among the 25 years and older age group (1.3%). Distribution of HIV prevalence by age group among IDU respondent almost equal with Waria respondent where the older is the age group the high is the HIV prevelence.
Figure 50. HIV and Syphilis Prevalence Among IDU by Age Group
Comparison of HIV and Syphilis prevalence among IDUs is contradictive with risky behavior of HIV infection which show that younger IDUs tend to engage to more risky behavior than the older ones. This indicates that older IDUs with longer period of injecting drugs have equal risk level when they were younger and just started injecting. Therefore, period of injecting is the most influential factor for HIV prevalence among IDUs statistically as it seen in Table 14, where odds ratio of injecting period of 2 or more years is 3.4 with 95% CI of 2.3 5.2 and p value of <0.01. In the other words, IDUs who have been injecting drugs for 2 years or more have 3.4 times bigger possibility to be infected with HIV compared to those been injecting for less than 2 years. Several parameters suspected to have influence on HIV transmission among IDUs such as needle sharing, sharing dissolved drugs from 1 needle-syringes and having commercial sex in fact have lower Odds ratio and statistically insignificant. Table 14. Odds Ratio of HIV Positive Result With Several Risk Factors For HIV Transmission
OR Inject more than 2 years Wet Setting 1in the past week Share needle in the past week Had Commercial sex in the past year 95% CI p Value
3.4 0.8 1.0 0.8
2.3 - 5.2 0.6 - 1.1 0.7 - 1.2 0.6 - 1.0
0.00 0.25 0.72 0.08
2.5. Young MSM

HIV epidemic is also influenced by of Men who Have Sex with Men (MSM) ever since the beginning of the pandemic. Stigma, discrimination, homophobia and harasshment to MSM impede this population to have access to and rarely make use of the services they need for HIV prevention, treatment and care. Though HIV prevention program coverage seems to improve in several regions, but its benefit rarely gets to MSM population, particularly young male who have sex with other male.
Distinct definition of this population also very important to be acknowledged to design the effective program. The Asia Pacific Coalition in Male Sexual Health (APCOM) defines MSM as a specific term in public health issue that is used to determine the sexual behavior of men who have sex with men regardless any gender identity, motivation to engage into sex, or certain community identification. Sex is also specifically interpreted in various way depends on culture and society and even to the engaged individuals. Therefore, MSM term may refer to the followings:
In order to describe the HIV epidemic and the influencing factors among young MSM in Indonesia, further analysis by age group of IBBS data was conducted. IBBS data used are:
IBBS among MSM in 3 cities with 600 MSM respondents conducted by BPS and MoH in
Man who identifies himself as gay, bisexual or someone with sex orientation and has sex with man. Man who does not identify himself as gay, bisexual or someone with sex orientation in to other man but has sex with other man for economic reason (e.g. sex worker), environment (e.g. prisoner/inmates), experiment (particularly among young man), or simply for pleasure. Man who resembles his appearance to woman and has sex with man (Waria).
IBBS among Men who Have Sex with Men (MSM) in 3 cities and BSS on MSM in 3 other
cities with 748 and 702 MSM respondents conducted by the CBS, MoH and FHI in 2007. 2009.
Although Waria was included in the definition of MSM, they not included in further analysis of MSM groups. This was done considering nearly all Waria respondents for IBBS and BSS are Sex Workers thus are more suited to be categorized with further analysis on FSW
2.5.1.
Profile
Distribution
Distribution of young MSM (15-19 years old) quite varies across survey locations, where the lowest percentage (21%) is in Medan and the highest (66%) is in Makassar. Besides, percentage of MSM aged 15-19 years old in several survey locations is fairly high and tends to be higher compared to Sex Worker population and IDUs. Even in Makassar, almost half of MSM who are appointed to be the respondents using RDS sampling methodology are between 15-19 years old of age. While in Bandung, 1 of 5 MSM is also around 15-19 years old of age. Figure 51. Distribution of MSM Age 15-24 Years Old
Nearly all MSM who are appointed to be the respondents admit to have been having sex where the earliest age of their sex debut is mostly below 25, and the percentage of those admitting having sex before the age of 15 is around 5 percent (Bandung) to 25 percent (Makassar). Meanwhile, the percentage of those admitting to have been having sex at around 15-19 years old of age is the highest in all survey locations. Therefore, average of earliest age of having the first sex among MSM is 16 years old (Makassar) to 19 years old (Bandung, Tangerang and Medan).
Figure 52. Distribution of MSM According to Age Group at Firts Sex
In total, 57-66 percent of MSM admit that their first sex partner was a man, 31-36 percent was woman and 2-7 percent was Waria. There is no significant difference on the percentage of sex partner type in the first sex between age groups. Figure 53. Percentage of MSM According to Type of Partner at First Sex
Education
The percentage of the highest education finished by MSM aged between 20-24 years old and above 25 years old is relatively similar where mostly graduated from High School or higher. Meanwhile, MSM aged 15-19 years old who graduated from high school or higher have lower percentage since most of them are still attending High School and have not yet finished it. Figure 54. Education of MSM
Steady Partner
More than half of MSM admitted to have steady sex partner during the interview. Where 59 percent of MSM aged 15-19 years old admitted to have steady sex partner, a little higher compare to those aged 20-24 years old (55%) and those 25 years and older (57%). Not all of MSM steady partner were male, because there are 41 percent MSM aged 15-49 years, 24 percent MSM aged 29-24 years and 30 percent MSM from age group 25 years and older who admitted to have female steady sex partner. Meanwhile percentage who admitted to have Waria steady partner, sequentially from the youngest group of age are 6, 2 and 3 percent.
Figure 55. Percentage of MSM Who Had Steady Partner According to Type of Steady Partner
2.5.2.
Knowledge
Percentage of MSM aged 15-19 years old answering all survey questions related to the knowledge on HIV transmission and prevention correctly is a little bit lower than those of aged 20-24 years old and 25 years old or older, as shown in the following Table 15. Table 15. Percentage of MSM Who Have Correct Knowledge
Knowledge
% who know condom can prevent HIV infection % who know drink antibiotic before have sex will not prevent HIV % who say a healthy-looking person can have AIDS % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know HIV cannot be transmitted by mosquito bites
15-19
20-24
25+
74 48 79 68 70
82 55 81 81 71
83 54 80 82 68
Therefore, level of comprehensive knowledge on HIV transmission and prevention according to the UNAIDS standard among MSM aged 15-19 years old are lower than older MSM.
Similar with the feeling of at risk for HIV infection where percentage of MSM aged 15-19 years old who are feel at risk of HIV infection (52%) is lower than those aged 20-24 years old (68%) and those of aged 25 years and older (66%). Feel of not being at risk may occur because the feel of not having done any risky behavior or not knowing that such behavior put them at risks of HIV infection. Figure 56. Percentage of MSM Who Have Comprehensive Knowledge and Feel Risk to HIV Infection
2.5.3.
Program Coverage
Similar to program coverage among other most-at-risk populations, program coverage for younger MSM is lower than older MSM. This can be observed on the following Figure 57, in which the percentage of MSM aged 16-19 years old who were reached by field workers (24%) are lower compared MSM aged 20-24 years old (35%) and aged 25 years and older (38%). Same situation also applies to MSM who have undergone examination at the STI clinic and accepted free condoms within the last 3 months.
Figure 57. Percentage of MSM Who Were Exposed to HIV Prevention Program in The Last 3 Months
The percentage of MSM aged 15-19 years old who have taken an HIV test (21%) is also lower than aged 20-24 years old (35%) and aged 25 years and older (33%). As such, MSM aged 15-19 years old who are aware of their HIV status (17%) is also lower compared to MSM aged 20-24 years old (30%) and aged 25 years and older (29%). Therefore, possibility of younger MSM to receive further treatments for HIV infection is lower compared to the older MSM. Figure 58. Percentage of MSM Who Ever Received VCT Services
2.5.4.
Sex Behaviour
It is fairly complicated to describe MSM sexual behavior since they are not only having sex with male but a great number of them also have female steady sex partners, giving/receiving payment from sexual relationship with a man, a woman or Waria, also have the male or female non-commercial casual partner. More than 80 percent of MSM of all age groups admitted to have had anal sex with noncommercial casual partner steady partner and non-commercial partner. The percentage of MSM aged 15-19 years old who have had commercial sex is 58 percent, lower than MSM aged 20-24 years old (70 %) and those who are aged 25 years and older (60%).
A relatively similar situation also applies to the percentage of MSM who admitted to have had sexual relationship with a steady partner within the last year, in which 31 percent of MSM aged 15-19 years old admitted to have done it, where it is lower than MSM aged 2024 years old (41%) and those aged 25 years and older (38%). This indicate that not all of MSM who admit to have steady partner is having sex with their stady partner for the last 1 year. Figure 59. Percentage of MSM According to Type of Sex Partner in The Past Year
The percentage of MSM who did not do anal sex within the last month is relatively equal among all age groups, while the lowest percentage of MSM who have done anal sex with more than 1 partner within the last month found among 15-19 years old age group (43%), followed by 25 years and older (52%), and the highest can be found among 20-24 years (55%). Therefore, the mean number of anal sex partners of MSM within the last year has
similar distribution as those who have had sex with more than 1 partner within the last year: 2.5 people among the 15-19 years old age group, followed by those of 25 years and older with 3.5 people and the highest rate can be found among 20-24 years old with mean number of 4 partners per year. Table 16. Percentage of MSM by Number of Anal Sex Partner in The Past Month and Average of Number of Anal Sex Partner in The Past Year
15-19 % who had no anal sex in the past month % who Had anal sex with 1 sex partner % who Had anal sex with > 1 sex partner Average number of anal sex partner in the past year 20-24 25+
23 33 43 2.5
22 24 55 4.0
20 28 52 3.5
Most MSM who have had commercial sex admitted to have done it for the first time before they reached 25 years of age, the number ranging between 72 percent (Tangerang) to 92 percent (Makassar). Meanwhile, the percentage of MSM who have had commercial sex and admitted to have done it for the first time before they reached 15 years of age is around 1-9 percent. Thus, the mean age of first commercial sex by a MSM ranges between 18 years old (Makassar) to 22 years old (Batam). Figure 60. Distribution of MSM Who Had Commercial Sex According to Age Group at Firts Commercial Sex
Similar to other Commercial Sex Workers groups, the older the MSM who having sex for reward, the longer the time they spent for selling sex. In the following Figure 61, we can see
that the mean number of years of MSM selling sex increases by the age where the mean number of years of selling sex among MSM aged 15-19 is 1.6 years, increases to 2.8 years among those aged 20-24 and 8.5 years among MSM who selling selling sex of those aged 25 years and older. Meanwhile, the mean number of clients within the last week is 2.4 among MSM aged 15-19 years, 3.4 persons among MSM aged 20-24 years old, and 3.1 persons among MSM aged 25 years and older. Figure 61. Average Length of Selling Sex (Years) and Number of Client/Week of MSM Who Sell Sex
Meanwhile, levell of condom use in a commercial sex and sex with the non-commercial casual partner is relatively similar among different age groups, even though the rate is slightly lower among15-19 years old MSM compared to older MSM. In general, level of condom use among MSM in a commercial sex is lower compared to other Sexual workers (Female Sex Worker and Waria). Table 17. Percentage of MSM Who Use Condom at Sex With Cassual and Commercial Partner 15-19
Cassual Sex % who use condom at last sex Commercial Sex
20-24
25+
% who always use condom at sex in the past month % who use condom at last sex % who always use condom at sex in the past week
43 26 55 28
45 31 59 29
45 30 58 25
2.5.5.
Drug Abuse
Drug abuse among MSM respondents is relatively higher than other populations at risk in addition to IDU. Percentage of MSM respondent from 15-19 years age group who had used drugs within the past 3 months ranged from 4 percent (Yogyakarta) to 39 percent (Batam), while the MSM from age group 20-24 years and 25 years and older ranged from 3 percent (Jogyakarta ) up to 39 percent (Makassar) and 3 percent (Malang) to 28 percent (Jakarta). Therefore the average percentage of MSM respondent age group 15-19 years and 20-24 years (18%) who use drugs in the past 3 months is higher than MSM aged 25 years and older group (12%).
Percentage of MSM respondents from15-19 years age group who had injecting drug ranged from 0 percent (7 of 9 cities) to 11 percent (Makassar) with a mean of 2 percent, while in the age group 20-24 years ranged from 0 percent (Yogyakarta) to 18 percent (Makassar) with a mean of 5 percent, and in the age group 25 years and older ranged from 1% (4 of 9 cities) to 7 percent (Makassar) with a mean of 3 percent. Figure 62. Percentage of MSM Who Ever Use Drug and Injecting Drug
2.5.6.
HIV & Syphilis Prevalence
The distribution of HIV and Syphilis Prevalence based on age group among MSM is relatively similar to other most-at-risk populations, in which HIV and Syphilis prevalence gets higher along with age, such as shown in the following Figure 63.
Figure 63. HIV and Syphilis Prevalance Among MSM by Age Group
Meanwhile, the highest Gonorrhea prevalence and Chlamydia infection rate can be found among MSM aged 20-24 years old which is 22 percent. This is in line with the risky behavior of the same age group, which is higher compared to other MSM age groups. Figure 64. Prevalence of N. Gonorhoeae and C. Trachomatis Among MSM
2.6. Young Prisoners

Prisoners are people who are undergoing punishment for a crime and have been known as one of the populations at high risk for HIV transmission in Indonesia. By the end of 2009 no less than 74 prisons/detention center which became the sentinel of HIV surveillance with the surveillance results ranged between 0-32 percent. Therefore, since 2002, Resident of Correctional Institution (Warga Binaan Pemasyarakatan/WBP) consist of Prisoners and Detainees, always become as one of the most at risk populations of HIV infection being estimated for the population number and the HIV prevalence. The report of estimation conducted by the Ministry of Health in 2009 estimated there were 140 thousand WBP in Indonesia, where almost 5 thousand WBP or 3.6 percent have been infected with HIV. Estimation number of HIV prevalence among WBP was 24 times higher than the estimate number of HIV prevalence among the adult general population in Indonesia. This is in line with the findings of various studies in many countries that show the HIV prevalence rate in WBP is much higher than the HIV prevalence in the general population.
The high prevalence of HIV among WBP in several prisons/detention centers in Indonesia mostly caused by high number of IDUs who became WBP. Integrated Biological and Behavioral Surveys (IBBS) in 2007 and 2009 showed more than one third of IDUs have been in prison and more than half of IDUs who had been in prison, also HIV positive. Twelve percent of IDUs are also claimed to have been in prison in the past 1 year, and as is well known that the HIV epidemic in Indonesia is still dominated by IDUs, thus it gives direct impact to HIV prevalence in prisons/detention centers.
From the previous discussion, it is known that younger IDUs have more risky behavior for HIV transmission and fewer are covered by various HIV control program than IDUs in older age groups. Therefore, the further analysis to see the difference in knowledge, behavior and program coverage by age group over the results of HIV and Syphilis prevalence studies as well as Risk Behavior of HIV infection among Prisoners studies in Indonesia prisons/detention centers in 2010 needs to be done. The research itself is conducted by Directorate General for Prison System (Ditjenpas) in 24 prisons/detention centers were randomly selected to represent all prisons/detention centers for adults who meet the criteria in Indonesia. There are nine hundred male prisoners and 400 female prisoners aged 18 and older who were randomly selected to
On the other hand, the number of WBP with drug abuse cases significantly increased to more than 5 times, from 7,122 (10% of the total WBP) in 2002 to 37,295 (26% of the total WBP) by the end of September 2009. National Narcotics Board (BNN) and the Central Bureau of Statistics (BPS) studies among prisoners with drug abuse cases in 9 prisons spread across 9 provinces found that nearly 90% of drug cases prisoners had consumed drugs and more than a third had consumed heroin/Putaw which commonly injected.
participate in the study. This further analysis only distinguish the respondents into 2 age groups (under 25 and 25 years and older) because there is only few number of respondents age below 20 years old.
2.6.1.
Profile
Distribution
Percentage of female prisoner respondents (13%) aged below 24 years is much lower than the male respondents (22%). This indicates that there are more of young male who become prisoners compare to young female. Figure 65. Age Distribution of Prisoner
Education
In general, respondents educational level among female prisoners is better than male prisoners for below 25 years and 25 years and older age group. This can be seen from the percentage of male respondents below 25 years age group and did not complete primary school (23 percent) is 6 times higher than female respondents at the same age group.
Distribution comparison of the last education attained between age groups among male respondents indicate relatively similar distribution. While among female prisoners, the percentage of respondents 25 years or older age groups who did not completed primary school (12%) 3 times higher than the age group below 25 years (4%). On the other hand, the percentage of female respondents ages 25 years and older who graduated from colleges / universities (16%) 4 times higher than the age group under 25 years old.
Figure 66. Education Level of Prisoner
Marital Status
Percentage of male respondents under 25 years age group who never married is 22 percent or only a third of male respondents ages 25 years or older. While among the female respondents the percentage difference between the two age groups are not as big as among the male respondents. This indicates that female respondents age group below 25 years who had married far more than male respondents. Figure 67. Marital Status of Prisoner
Length of Sentence
The length of sentence distribution based on court decisions among male respondents are generally longer than female respondents. So is the group of respondents aged 25 years
and older compare to the age group below 25 years old. This can be seen from the percentage of respondents who were convicted for less than one year where the rates are higher among younger age groups and vice versa occurred in the percentage of respondents who were convicted with more than 5 years sentences. Figure 68. Percentage of Prisoner According to Length of Sentence
The pattern of distribution of length of sentence already undergone by female respondents was relatively similar between age groups below 25 years and 25 years and older of age where most of the female respondent only serving the sentences for less than 2 years. Male respondents age group under 25 years who are just serving a sentence for less than 1 year is 56 percent, much higher than the percentage of age group 25 years and older (39%). While among female respondents, the percentage of who are serving sentences for less than 1 year was relatively similar between age groups under 25 years (42%) and age group 25 years and older (44%). Figure 69. Percentage of Prisoner According to Time in Prison/Detention Center
Drug Abuse
Distribution of respondents who had using drugs and injecting drugs are relatively similar between age groups and genders. This can be seen from Figure 69 where the percentage of male respondents age group below 25 years who had using drug (41%) did not vary much with age group 25 years and older (38%). So is the percentage of female respondents who drug use history is equally 42 percent in both age groups. While the percentage of respondents who had injecting drugs is much smaller and ranged between 6-9 percent only. Figure 70. Percentage of Prisoner Who Ever Used Drug and Injecting Drug
Percentage of male respondents below 25 years age group who were convicted for drug use cases (26%) smaller than the group aged 25 years or older (40%). The same percentage difference also occurred among female respondents with a smaller level of difference than the male respondents. Nevertheless, the percentage of female respondents who were convicted for drug use is much higher than male respondents for both age groups.
Figure 71. Percentage of Prisoner With Drug Abuse Case
Most respondents with the drugs cases convicted as drug users and the percentage among female respondents was relatively similar between the two age groups. While among the male respondents, the percentage of respondents below 25 years age group who were convicted as a user (86%) were significantly higher than respondents 25 years or older age group (66%). This indicates that male respondents below 25 years age group more likely to be victims of drug user than respondents of older age groups. Figure 72. Percentage of Prisoner With Drug Abuse Case According Their Role
2.6.2.
Knowledge
Percentage of male respondents who have some knowledge about modes of HIV transmission and prevention did not differ significantly between age groups, except for the level of comprehensive knowledge according to UNAIDS standards. Percentage of male respondents age group below 25 years who have comprehensive knowledge (13%) only almost a half of respondents 25 years or older age group. While among female respondents, the percentage of below 25 year age group who gives the correct answers over the questions on HIV transmission and prevention was lower in almost all the questions asked. Even the percentage of respondents under 25 years age group who have knowledge about using condoms and faithful to each other with 1 sex partner can prevent HIV, nearly 20 percent lower than the older age groups. So it is obvious when the level of comprehensive knowledge about HIV transmission according to UNAIDS standards on respondent age group below 25 years only half of the older age groups. Table 18. Percentage of Prisoner Who Have Correct Knowledge
Male <25 25+ % who say a healthy-looking person can have AIDS % who know condom can prevent HIV infection % who know limiting sexual intercourse to one uninfected partner can prevent HIV infection % who know drink antibiotic before have sex will not prevent HIV % who know HIV cannot be transmitted by mosquito bites % who know share used needle can transmit HIV % who knows share diluted drug in 1 syringe can transmit HIV % who has comprehensive knowledge on HIV prevention and transmission Female <25 25+
88 60 62 56 63 87 64 13
87 64 72 52 62 89 65 22
96 48 56 60 77 87 58 17
88 67 77 65 76 94 55 31
Regression analysis of comprehensive knowledge between the two age groups of respondents showed odds ratio of 1.9 with a range of 95 percent confidence level between 1.4 to 2.8. This shows that the older age group respondent is almost 2-fold more likely to have a comprehensive knowledge than younger age groups. Difference of possibility level is statistically significant which is shown by the p value less than 0.001.
Feeling at risk for HIV transmission is a combination of knowledge of HIV transmission and prevention and awareness of have been engage in risky behavior. In general, the percentage of male respondents who felt at risk of contracting HIV is higher than female respondents. While the percentage of respondents below 25 years age group of men and
women who feel at risk of contracting HIV (37% and 31%) were also slightly higher than respondents 25 years or older age group (34% and 20%). Figure 73. Percentage of Prisoner Who Feel Risk to HIV Infection
2.6.3.
Program Coverage
Percentage of male respondents age group below 25 years who had received HIV-related information in the past 1 year was 45 percent, lower than respondents 25 years or older age group (52%). The difference percentage who had received HIV information in both age groups also occurred in female respondents in which respondents below 25 years age group only 48 percent, far lower than respondents 25 years or older age group (66%) as can be seen in Figure 73. Figure 74. Percentage of Prisoner Who Ever Received Information Related to HIV in The Past Year
Distribution of HIV-related information resources in the last 1 year between the age group of respondents was relatively similar for both male and female, except for sources of information from NGO workers where among male and female respondent of 25 years and older age groups the rates are higher than the age group below 25 years old. Table 19. Percentage Source of HIV Information Among Prisoner
Source of Information Prison Staffs NGO worker Radio/TV Newspaper/Magazine Poster Other prisoner Counselor/ Case Manager Male <25 25+ 40 34 31 28 15 9 1 41 41 31 28 17 9 3 Female <25 32 36 36 32 24 16 8 25+ 35 47 25 33 18 13 10
One of the HIV control programs that are mostly implemented in the prisons is a program to improve knowledge and understanding of HIV modes of transmission and prevention among WBP. This program is usually conducted in the form of discussion or counseling session or provision of information from peers (peer educators). In general, the percentage of female respondents who have been exposed by both programs is higher than men. So is among the male and female respondent of 25 years and older age group, where the percentage who had received HIV counseling and discussion session with fellow WBP is higher than respondents of younger age groups. Figure 75. Percentage of Prisoner Who Ever Reached by BCC Program in The Past Year
In general, coverage of HIV voluntary counseling and testing program is among male respondents was higher than female respondents. While the percentage of who had been offered HIV test within the past 1 year in male and female age group 25 years and older (31% and 41%) was higher than below 25 year age group (24% and 30%). Nevertheless, the percentage of male respondents who are received the last HIV test results relatively similar between the two age groups. This is different to the female respondents; where the percentage of respondents below 25 years age group who received the last results of HIV test (17%) was lower than respondents of 25 years or older age group (26%). Table 20. Percentage of Prisoner Who Ever Received VCT Services
<25 Offered HIV test Ever had HIV test Received counselling services Received last HIV test result 24 23 10 10 Male 25+ 31 28 15 11 Female <25 25+ 30 31 17 17 41 41 28 26
2.6.4.
Risk Behavior
Percentage of male respondents who had conducted risk behaviors for HIV transmission in prisons in general is higher than female respondents. While among the male respondents, the respondents in the younger age groups were also more likely to perform risky behaviors. This can be seen in Table 19, where the percentage of male respondents age group below 25 years who had injecting drug users in prisons in the past 1 year (2%) was higher than male respondents ages 25 years or older. Likewise with other risky behaviors such as tattooing and body piercing. Among female respondents, there is no difference in the percentage between the two age groups who ever conducted risk behavior in prisons such as injecting drug user, put in genital accessory and have unsafe sex. While the percentage of female respondents age group below 25 years who had a tattoo (4%) and body piercing (6%) was higher than older age groups.
Table 21. Percentage of Prisoner Who Ever Had Risk Behavior in Prison/Detention Center in The Past Year
Male <25 Injecting drug Tattoo Body piercing Sex accesories Having Sex 25+ Female <25 25+
2 23 9 16 6
0.3 18 5 16 5
0 4 6 0 4
0 1 3 0 4
Regression analysis of HIV transmission risky behavior by respondent age groups showed odds ratio 1.7 with a range of 95 percent confidence level between 1.2 to 2.3, and the p value less than 0.001. This indicates that respondents below 25 year age group 1.7 times more likely to do one of risk behavior for HIV transmission than respondents of 25 years and older age groups. Regression analysis was also in line with the percentage of respondents who felt at risk of contracting HIV, where respondent below 25 years age group have a higher percentage than the respondents of 25 years and older age groups. Percentage of respondents who used condom during the last sex in prisons is still very low and male respondents generally have lower levels of condom use than female respondents. While the comparison between age groups showed none of the male and female respondents age groups below 25 years who use condoms during the last time of having sex in prison/detention centers. Figure 76. Percentage of Prisoner Who Used Condom at Last Sex in Prison
2.6.5.
HIV and STIs
Percentage of male respondents below 25 years age group who claimed to have suffered one of STI symptom questioned (13%) was slightly higher than the age group 25 years and older (10%). In contrast to female respondents, the percentage of 25 years and older age group (5%) is slightly higher than the below 25 year age group (2%). Overall, the percentage of male respondents who claimed to have suffered STIs symptoms is 2 times higher than female respondents. This is in line with other studies stating that the early STIs symptoms among female is more difficult to recognize and to sense it than in men. So the percentage who claimed to have suffered the STIs symptoms which is lower among female respondents did not necessarily indicate a lower prevalence of STIs. Figure 77. Percentage of Prisoner Who Had STI Symptoms in The Past Year
Syphilis and HIV prevalence in female respondents is higher than male respondents. Prevalence of syphilis in the male respondents 25 years or older age group (6%) 3 times higher than the age group below 25 years (2%). In contrast to female respondents, the prevalence of syphilis respondents below 25 years age group (9.6%) was slightly higher than the group aged 25 years or older (8.3%). HIV prevalence among male respondents below 25 years age group (1%) was relatively similar to the age group 25 years or older. While among female respondents, none of whom HIV positive in the age group below 25 years, while HIV prevalence in the age group 25 years and older is 6.9 percent.
Figure 78. Prevalance of Syphilis and HIV Among Prisoner
The result of cross tabulation between the HIV tests result and have been received HIV test results of the last HIV testing and counseling services accessed showed that no one group of respondents below 25 years of age who are HIV positive receive the VCT services before. While among 32 respondents of age group 25 years or older who are HIV positive, 15 of them have never tested for HIV previously, 3 respondents had HIV test but did not receive the result and only 14 respondents who had HIV test and receive the latest test results. This shows that most respondents who are HIV positive do not know their HIV status.
3. SUMMARY & RECOMMENDATION

Summary
The results of the advanced analysis of survey data and quantitative research among the most at risk of population of HIV infection showed that the proportion of young people aged 15-24 years has a significant numbers and varies between populations and locations.
Almost all populations at risk also initiate risky behavior when they were young. So that young people are the center of the HIV epidemic in Indonesia, both for the contribution of new HIV infections as well as to alter the course of the epidemic.
The level of correct knowledge of HIV transmission and prevention is really lower among the younger most at risk populations than the older. Likewise with the coverage of various HIV and AIDS control programs which lower along with the younger age group of most at risk populations. Therefore the young most at risk populations of HIV infection who received prevention services such as free condoms, STI services, MMT, NSP and VCT have much smaller percentage than the older most at risk population. The lower level of knowledge and program coverage among the young most at risk populations resulted to the younger age of the most at risk population, the more risky the behavior of HIV infection. Therefore the rapid raises of STIs prevalence that caused symptoms and can be treated as Gonorrhea and Chlamydia infections are higher among young sex workers than older ones. The young most at risk populations are also undertake several risky behaviors that overlap, such as young IDUs and MSM who also perform commercial sex and sex with multiple partners.
HIV and Syphilis prevalence is more influenced by duration of performing risky behavior than the level of risky behavior so that the HIV and Syphilis prevalence is higher in the older at risk populations and in the longer duration of performing risky behaviors than the younger most at risk populations. The level of knowledge of HIV transmission and prevention among young people in the general population is much lower than high school students. Although, there are more high school students who perform risky behaviors than younger people in general population.
Recommendation
Findings from further analysis on survey data and research require further measures which must be immediately carried out to reduce the impact of HIV epidemic on youths. The ideal follow up would be to use multidimensional approach in response to various issues and complicated problems at hand. The followings are some recommendations for such problems:
Any effort to improve knowledge on the transmission and prevention of HIV among youths of the general population must be an integrated part of the HIV and AIDS control strategy at all government levels with sufficient budget allocation. The central role of AIDS Commission at all levels to response such recommendations shall be advocating and coordinating its resources as one of the key successes to this program.
NAC must formulate an effective attempt to reduce stigma and discrimination among youths practicing risky behavior in the society and the public facilities. Programs which combine the empowerment and improvement of comprehensive understanding can be carried out with measurable output and impact. The number of school-age children performing risky behavior to HIV infection requires great attention from the National Education Ministry. Integrated work plan to improve the knowledge and mitigate their risky behavior can also help control HIV and AIDS in the future. The needs for an action plan with effective target and strategy from various stakeholders to mitigate risky behaviors among young people.
Strategic development of HIV and AIDS program among youths must pay attention to the variety of socioeconomic and cultural situations occurring amidst the society in order to be widely accepted and applied by various stakeholders.
HIV and AIDS prevention and control for young most-at-risk must strategically be integrated into the existing AIDS program strategy. The HIV and AIDS action plan comprehensively consists of plans which are able to open access to improvement of knowledge and related services.
4.
List of Acronyms
AIDS APCOM BPS CI FHI HIV IMS KemKes KPAN KTS LJASS LSL NAD Napza Nilai p
ATTACHMENT
ODHA Penasun PTRM Rasio Odds RDS SD SKRRI SLTA SLTP SSP STBP STHP UNAIDS UNICEF VCT WBP WHO WPS UNGASS
Acquired Immune Deficiency Syndrome The Asia Pacific Coalition on Male Sexual Health Badan Pusat Statistik Confidence Interval Family Health International Human Immuno-deficiency Virus Infeksi Menular Seksual Kementerian Kesehatan Komisi Penanggulangan AIDS Nasional Konseling dan Tes Sukarela HIV Layanan Jarum dan Alat Suntik Steril Laki-laki yang Suka berhubungan seks dengan Laki-laki Nanggroe Aceh Darussalam Narkotika, Psikotropika dan Zat Adiktif adalah tingkat keberartian terkecil sehingga nilai suatu uji statistik yang sedang diamati masih berarti, atau dapat pula diartikan sebagai besarnya peluang melakukan kesalahan apabila kita memutuskan untuk menerima hipotesa/dugaan Orang dengan HIV dan AIDS Pengguna Napza Suntik Program Terapi Rumatan Metadon adalah perbandingan nilai odds untuk kategori 1 terhadap odds untuk kategori 0, di dalam variabel bebas yang sama dengan menganggap variabel lainnya adalah konstan Respondent Driven Sampling Sekolah Dasar Survei Kesehatan Reproduksi Remaja di Indonesia Sekolah Lanjutan Tingkat Atas Sekolah Lanjutan Tingkat Pertama Survei Surveilans Perilaku Survei Terpadu Biologi dan Perilaku Survei Terpadu HIV dan Perilaku Joint United Nations Program on HIV/AIDS United Nations Children's Fund Voluntary Counselling and Testing Warga Binaan Pemasyarakatan World Health Organization Wanita Penjaja Seks United Nation General Assembly Special Session
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Age Disaggregation Analysis of BSS Survey Data Among Most at Risk Population For HIV Infection

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Age Disaggregation Analysis of BSS Survey Data Among Most at Risk Population For HIV Infection

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Age Group Disaggregation of Survey and Reseach Data

ii | Age Group Disaggregation of Survey and Reseach Data

Youth in Tanah Papua

Young Sex Worker

Young Injecting Drug Users (IDUs)

xii | Age Group Disaggregation of Survey and Reseach Data

xiv | Age Group Disaggregation of Survey and Reseach Data

xv | Age Group Disaggregation of Survey and Reseach Data

xvi | Age Group Disaggregation of Survey and Reseach Data

xvii | Age Group Disaggregation of Survey and Reseach Data

1 | Age Group Disaggregation of Survey and Reseach Data

Indonesia Youth and Adolescent Reproductive Health Survey (IYARS) conducted by

3. Data Application Phase

4 | Age Group Disaggregation of Survey and Reseach Data

7 | Age Group Disaggregation of Survey and Reseach Data

8 | Age Group Disaggregation of Survey and Reseach Data

9 | Age Group Disaggregation of Survey and Reseach Data

Source of Information & Program Coverage

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Table 3. Percentage of IYARS Respondent According to Source of HIV Information

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Sex Behavior and Condom Use

12 | Age Group Disaggregation of Survey and Reseach Data

Figure 7. Percentage of IYARS Respondent Who Ever Had Sex

13 | Age Group Disaggregation of Survey and Reseach Data

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16 | Age Group Disaggregation of Survey and Reseach Data

2.2. Youth in Tanah Papua

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18 | Age Group Disaggregation of Survey and Reseach Data

Figure 15. Percentage of IBBS Tanah Papua Respondent by Marital Status

19 | Age Group Disaggregation of Survey and Reseach Data

Source of Information & Program Coverage

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Souce of Information (% from respondent who ever received HIV information)

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1.1 1.7 1.6 2.5

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Sex Behavior & Condom Use

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15.5 14% 80% 6%

18.1 23% 73% 4%

20.2 48% 50% 2%

15.3 50% 50% 0%

17.7 63% 37% 0%

19.3 81% 19% 0%

24 | Age Group Disaggregation of Survey and Reseach Data

25 | Age Group Disaggregation of Survey and Reseach Data

STIs Symptoms and HIV Prevalance

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2.3. Young Sex Worker

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Age at First Sex and First Commercial Sex

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Figure 29. Marital Status of Female Sex Worker

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34 | Age Group Disaggregation of Survey and Reseach Data

Ever received free condom

Ever received STI services

Ever had HIV test