HIV and Syphilis Prevalence and Risk Behaviour Survey Among Prisoners 2010 in Prisons and Detention Centres in Indonesia ACKNOWLEDGEMENTS Special thanks to the respondents who took part in this survey. Thank you to all the Heads of Prisons and Detentions Centers, and other prison officials and administrative staff from the Ministry of Justice and Human Rights who facilitated the survey processes. Research Advisor: Untung Sugiono, Bc.IP, SH, MM1 Principal Investigator: Muqowimul Aman, Bc.IP, SH1 Research Director: Pujo Harinto, Bc.IP, SSos, M.Si1 Technical Supervisor: Prof. Budi Utomo2 Research Team: Diah Ayu N.H1, Endar Tri A1, Harto1, Suzanne Blogg2, Nurlan Silitonga2, Aang Sutrisna3, Ratna Soehoed2, Adhe Aprasasti2, Alia Hartanti2, Sugih Hartono3, Nasrun Hadi3, Shinta Devita3, Gray Sattler4, Ade Aulia 4, Oscar Baraneche5, Wenita Indrasari6, Mashadi6, Deni Ahmad Fauzi7, Endang Budi Hastuti8, Naning Nugrahini8 and Lea Suganda9 ACASI Operator: Lamganda Sihombing, Ken Wijayanti, Wirawan Nugrahadi, Sarya Sutisna, Ignatius Supriyanto, Aminudin, Plamularsi Swandari and Husen al Habsy. Laboratory staff: Suyono, Dede Ahmad Maulana, Novriel Imamsyah, Dian Ari Yuana, Deddy Ujang Nuryadi, Agus Surya Hidayat, Sri Mulyati and Tri Setiyono. Field Coordinators: Bambang Mardi, Djoni Praptomo, Mutia Sari, Dyah Wandansari and Emi Sulistyati. Ministry of Justice and Human Rights1, Secretariate National AIDS Commission6, the Ministry of Health8, HCPI2, UNODC4, WHO5, UNAIDS Secretariate7, AIDSina Foundation3 and AusAID9. Funding for this survey was provided by UNODC and WHO through UNAIDS Program Acceleration Fund Mechanism, AusAID and HIV Cooperation Program for Indonesia (HCPI). 1 HIV and Syphilis Prevalence and Risk Behaviour Survey Among Prisoners 2010 in Prisons and Detention Centres in Indonesia LIST OF ABBREVIATIONS AIDS Aquired Immunodeficiency Syndrome AusAID Australian Agency for International Development ART Anti Retroviral Therapy BNN National Narcotics Bureau (Badan Narkotika Nasional) BPS Central Bureau Statistics (Badan Pusat Statistik) HCPI HIV Cooperation Program for Indonesia HIV Human Immunodeficiency Virus IDU Injecting Drug User IEC Information, Education and Communication IHPCP Indonesia HIV/AIDS Prevention and Care Project Lapas Prison (Lembaga Pemasyarakatan) MMT Methadone Maintenance Therapy NAC National AIDS Commission NS Needle syringe NSP Needle Syringe Program A measure of effect size, describing the strength of association or non- Odds Ratio independence between two binary data values PLHIV People Living with HIV The probability that a variate would assume a value greater than or equal to p value the observed value strictly by chance. PPS Proportional Probability to Size Rutan Detention centre STI Sexually Transmitted Infections TB Tuberculosis UNAIDS Joint United Nations Programme on HIV/AIDS UNGASS United Nation General Assembly on AIDS Special Session UNODC United Nations Office on Drugs and Crime USAID United States Agency for International Development VCT Voluntary Counseling and Testing WHO World Health Organization 2 HIV and Syphilis Prevalence and Risk Behaviour Survey Among Prisoners 2010 in Prisons and Detention Centres in Indonesia CONTENTS Acknowledgements .......................................................................................................................................................... 1 List of Abbreviations ........................................................................................................................................................ 2 Contents ................................................................................................................................................................................ 3 List of Tables ....................................................................................................................................................................... 5 List of Figures ..................................................................................................................................................................... 6 PREFACE ............................................................................................................................................................................... 7 FOREWORD ......................................................................................................................................................................... 8 Executive Summary .......................................................................................................................................................... 9 1. Introduction .................................................................................................................................................................. 12 1.1 Background .......................................................................................................................................................... 12 1.2 Aim and Objectives of Study .......................................................................................................................... 13 1.2.1 Aim ............................................................................................................................................................... 14 1.2.2 Objectives .................................................................................................................................................. 14 1.3 Implementation Process ................................................................................................................................. 14 2. Method ............................................................................................................................................................................ 14 2.1 Research Plan and Population ...................................................................................................................... 14 2.2 Sampling Strategy .............................................................................................................................................. 14 2.3 Study Process and Training of Survey Staff ............................................................................................ 15 2.4 Data Collection Process ................................................................................................................................... 16 2.5 Statistical Analysis of Survey ........................................................................................................................ 16 2.6 Ethics Approval .................................................................................................................................................. 16 3. Results ............................................................................................................................................................................. 16 3.1 Number and Profile of Respondents ......................................................................................................... 17 3.1.1 Refusal Rate and Number of Respondents .................................................................................. 17 3.1.2 Age ................................................................................................................................................................ 18 3.1.3 Education ................................................................................................................................................... 18 3 HIV and Syphilis Prevalence and Risk Behaviour Survey Among Prisoners 2010 in Prisons and Detention Centres in Indonesia 3.1.4 Marital Status ........................................................................................................................................... 19 3.1.5 Length of Imprisonment ..................................................................................................................... 20 3.1.6 Type of Violation and History of Imprisonment ....................................................................... 20 3.2 HIV/AIDS Knowledge ....................................................................................................................................... 22 3.3 Risk Behaviour .................................................................................................................................................... 24 3.3.1. Drug Use .................................................................................................................................................... 24 3.3.2 Sexual Practices and STIs .................................................................................................................... 26 3.3.3 Other Risk Factors ................................................................................................................................. 27 3.4 Program Exposure and Use of Services .................................................................................................... 29 3.4.1 Information Education and Communication Program ........................................................... 29 3.4.2 HIV Counseling and Testing ............................................................................................................... 33 3.4.3 Methadone Maintenance Therapy Program ............................................................................... 35 3.4.4 Needle Syringe Programs ..................................................................................................................