Background
Methods
Theorectical framework
Study setting and design
Data analysis
Results
Participants’ profile (Table 1)
Characteristics | No. of Respondents N = 42 (%) |
---|---|
Age | |
19 - 25 | 16 (38) |
26 - 30 | 18 (43) |
31 - 35 | 8(19) |
Job | |
Motorcycle taxi drivers (Ojek) | 15 (36) |
Construction workers | 14 (33) |
Port workers | 10(24) |
Unemployed | 3 (7) |
Education | |
High school graduates | 35(83) |
Elementary school graduates | 7(17) |
Condom use with FSWs | |
Never | 18 (43) |
Sometimes | 16 (38) |
Always | 8 (19) |
Number of sexual encounters with FCSWs in the past 6 months | |
1 – 5 times | 5 (12) |
6 – 10 times | 11 (26) |
≥ 11 times | 26 (62) |
Number of FSWs they had sex with in the past 6 months | |
2 - 5 | 13 (31) |
6 - 10 | 22 (52) |
≥ 11 | 7 (17) |
Personal barriers
Lack of knowledge of HIV testing and HIV/AIDS service and lack of knowledge of the existence of HIV infection
“I have been living here for the whole of my life and visited our community health centre too many times but I am not aware of free HIV testing provided by the [local] government ....Nobody told me, the health professionals in the community health centre did not say anything about it” (P11: 19 years old).
“.... The testing might be available at the community health centre but I haven’t heard of such service .... I have often accessed health services at our community health centre but not that one [HIV testing], I do not know anything about it” (P20: 22 years old).
“I never take HIV test because I do not know. Staff from the community health centre often visit communities here but they do not talk about the [HIV] test, they do not tell us to do it” (P32: 23 years old).
The lack of general knowledge about HIV/AIDS services and the lack of knowledge about the existence of HIV infection were barriers for taking HIV prevention measures among participants. For example, a failure to HIV testing meant that clients of FSWs did not know about their HIV status. In the current study, most participants acknowledged that they were unaware of the existence of HIV/AIDS, which seemed to be one of the factors precluding them from accessing available HIV testing services. The testimonials below allude to these assertions:“I do not know anything about it [HIV testing service], maybe because I hardly go to hospitals. Based on my experience, it seems like information about the test does not exist, I have a lot of friends but nobody talks about it, or they might not know about it either ....” (P39: 25 years old).
“I am not a highly educated person, just an elementary school graduate. I do not read newspapers or articles or book. I know nothing about HIV/AIDS and never think of HIV testing either” (P3: 20 years old).
“I would have looked for the [HIV] test if I knew about this disease [HIV/AIDS] and that I could be infected as well. How could I know if nurses and midwives do not provide us information about the disease? I am busy with my work every day, from morning till evening ....” (P7: 28 years old).
“I think it is possible for me to do the [HIV] test but how can I test for HIV if I am not aware that HIV/AIDS exists? I do not know about the disease and the test. Every day I try to earn money, never think of diseases” (P15: 31 years old)
“I never heard of it [HIV/AIDS]. There is no information about that disease in the place like this [the harbour], everybody is busy with loading and unloading the materials. I have not tested for HIV because I do not know about the test and HIV ....” (P28: 21 years old).
Unwillingness to undergo HIV testing and perceived seriousness of HIV infection
“I have heard of the [HIV] test once I attended the HIV information session but I feel okay so far, nothing to worry about. I do not think I need to take HIV test because I am physically fine, I do not have any physical complaints” (P4: 22 years old).
“I do not have sex that often with them [FSWs], only once or twice in a month ....I think I am not at risk of getting HIV infection, so I do not want to test for HIV....I heard of the testing once ....” (P12: 19 years old).
“I do my work every day and physically feel well, I don’t need that test. I think people would like to take a health test if they do not feel well or get sick for a certain period of time” (P27, 32 years old).
“I know about the test but why would I take the [HIV] test if I am not sick? It is weird if I am not sick but taking the test, it would make people assume that I have done something wrong ....” (P25: 23 years old).
Fear of a positive result of HIV testing was another reason supportive of the unwillingness of the clients of FSWs to access HIV testing services available for them. Ten interviewees commented that knowing HIV positive status could make them feel stressful, worried, and depressed; hence not taking HIV testing seemed to be a reasonable choice for them. Some of the assertions indicative of participants’ fear of knowing their HIV status included:“I do not test for it [HIV] because I do not think I can get the infection. I am fine, I feel great. Besides, I do not easily get sick even though my work is physically demanding. I work for the entire day every day, drive passengers from one place to another ....” (P38: 31 years old).
“I once thought of undergoing HIV testing but I am afraid of the result. It would be very stressful if I am positive. I have seen this on one of my neighbours who is HIV positive, he is stressful. I do not want to experience that” (P1: 25 years old)
“I am not afraid of the [HIV] test but worried about the result. I do not know what to do if I get infected. This makes me feel not ready yet to take the test” (P14: 27 years old).
“When the time comes then I will do it [take HIV testing]. I do not want to do it now because I do not want to feel depressed if the result is positive” (P30: 24 years old).
“I do not undergo HIV test because I am scared if I am positive. I think I need to really prepare myself if I want to take the test. It will be a difficult decision because the result can change my life personally and socially” (P2: 22 years old).
Health care service provision barriers
Lack of health service trust in fear of disclosure of their HIV status by health professionals
“I do not test because I do not trust their mouths [health professionals]. They would tell their friends and family members if they know someone is infected with HIV” (P8: 32 years old).
“I know they [health professionals] do not keep the secret of the health condition of patients. If I want to test for HIV, I would go to do it somewhere else but not here” (P22: 35 years old).
“Information about HIV positive people spreads so fast here, I am suspicious they [health professionals] are the ones who spread it. This is the reason I do not want to get tested” (P37: 24 years old).
“I do not accuse them [health professionals] but I guess they would tell their families or friends if they know that someone is HIV positive. .... I do not want to test [for HIV]” (P24: 23 years old).
Limited availability of medications including antiretroviral (ARV)
“I have thought of testing for HIV but I have not yet done it because I heard that ARV is very limited here. It would be stressful if I get infected but there is no ARV to treat the infection. I know a few HIV/AIDS positive patients do not take ARV because it is not available” (P16: 29 years old).
Fourteen study participants who had been exposed to information on HIV/AIDS confirmed that treatment to HIV/AIDS or ARV was made available only in one hospital. These participants appeared to know that patients diagnosed with HIV infection in community health centres should receive further treatment at that hospital. This further step needed for accessing ARV seemed to be an additional barrier for voluntarily HIV testing, as could mean that if diagnosed, it would be a process before receiving the required treatment. Testifying assertions included:“Knowing or not knowing my HIV status makes no different to me because even if I am HIV positive I cannot access the treatment regularly because ARV is very limited. I know it is not available in the community health centres” (P31: 26 years old).
“ARV is only available in general hospital of Belu, patients diagnosed with HIV in a community health centre should go the hospital in the city to get the medicine or treatment, this discourages me to take the test ....” (P9: 26 years old).
“Even though someone is tested positive in a community health centre, he or she has to access HIV/AIDS treatment or ARV at the hospital [general hospital of Belu] because treatment for HIV/AIDS is not available at community health centres. That means if I take the test and get diagnosed with the infection, then I need to go the hospital every time I feel sick and people will notice me” (P19: 21 years old).
“I know about HIV testing but one of the reasons that discourages me to do the [HIV] test is the limited availability of ARV. I once read in a newspaper that ARV was not available at the general hospital of Belu for more than six months” (P42: 27 years old).
It was interesting that the cost required for medication and transportation to the health services points seemed to not be barriers to accessing HIV testing among the study participants. Twenty seven participants across age and work group categories commented that they could afford the medical and transportation costs as indicated in the assertions below:“It is difficult to access ARV. HIV patients should go the hospital that provides ARV .... It [the hospital] is quite far from here” (P10: 30 years old).
“.... I can pay for health service or buy medicine, I guess it is not a problem. .... I just do not know about it [HIV testing], haven’t heard of it before” (P6: 20 years old).
“Is there a test for the disease [HIV infection]? Maybe I can try sometime .... I can drive to the community health centre or hospital, I have a motorbike .... the community health centre is not far from here” (P17: 30 years old).
“.... I don’t think it would be difficult for me to access the service [HIV testing], every day I pass through the community health centre. I don’t worry about the buying medicine or the transport .... As I told you before, I haven’t heard of anything about the [HIV] test or the disease [HIV infection] ....” (P21: 22 years old).
“.... I guess maybe it is because I never think of getting tested for HIV .... No, I don’t think the costs to travel to community health centre or to purchase medicine are a big deal for me....I do not do it because I do not know at all ....” (P26: 33 years old).
Social barriers
Fear of stigma and discrimination
“If I go and access the service [HIV testing] or take the [HIV] test then people who see me or know about it would think that I am [HIV] positive and start gossiping about my HIV status. People are very sensitive about this issue [HIV], I have heard of people talking about the HIV status of others who did the HIV counselling and testing” (P18: 21 years old).
“I do not want to be stigmatised. Everybody seems afraid of HIV, they would look at me with one eye [cynical] if they know I do the [HIV] test. This has often happened to many HIV positive people and I have seen it with my own eyes. I do not want the same thing happens to me” (P23: 26 years old).
“I do not want to do it [HIV testing] because people will start staying away from me if they know I do it [take HIV testing] or if I am [HIV] positive. I think people do not want to get close to or make any physical contact with HIV positive ones because they do not want to get infected with HIV ....” (P29: 24 years old).
“Stigma against people living with HIV/AIDS is still prevalent here, that is why I do not want to know my HIV status. If I do the test and the result is positive, then sooner or later people will know it. They will start avoiding me, gossiping about me and this will worsen my condition ....” (P36: 28 years old).
Lack of social supports from friends and family
“I do not feel any support from friends or family in relation to HIV testing. We never talk about this topic” (P5: 28 years old).
“My parents, brothers and sisters do not know about my sexual behaviour, so they never say anything about HIV/AIDS or HIV testing. I think they do not understand about HIV/AIDS or HIV testing” (P13: 33 years old).
“None of health professionals tells me or encourages me to undergo HIV testing. I would do it if a doctor or nurse helps me and if I am convinced that it is safe and confidential. But to be honest, I never seek for help from health professionals” (P34: 25 years old).