Chasing targets in a pandemic: The impact of COVID-19 on HIV outreach workers for MSM (men who have sex with men) in Jakarta, Indonesia

ABSTRACT

The COVID-19 pandemic has had a significant impact on HIV services globally, including community-based outreach programmes. This article draws on a qualitative study of HIV outreach workers for men who have sex with men (MSM) in Jakarta, Indonesia undertaken between July and September 2020. The research documented the impact of the COVID-19 pandemic on HIV outreach programmes for MSM based on interviews, focus group discussions and video diaries collected from outreach workers. As a result of the pandemic, and in response to the guidelines issued by international donors and the Indonesian government, outreach workers shifted activities to ‘virtual outreach’ where possible. However, outreach workers consistently performed in-person work to address what they referred to as ‘urgent’ cases (e.g. required them to attend the clinic). Regardless of delivery mode, the steps comprising outreach work during the pandemic aligned with the ‘cascade of care’, which forms the dominant policy narrative for the management of HIV. Outreach work during the pandemic therefore continued to be based primarily on the objective of maintaining testing and treatment rates. Although outreach workers responded innovatively to the pandemic, including to the risk of COVID-19 infection, they were limited by the prevailing emphasis on targets in HIV programmes.

KEYWORDS:

• COVID-19
• outreach work
• men who have sex with men (MSM)
• Indonesia
• virtual outreach

Acknowledgements

We would like to acknowledge the participants in the study for their time and engagement in the research project, in addition to the tireless dedication that they show to their community through their work. We would like to dedicate this article to one participant who passed away after contracting the COVID-19 virus following the completion of the study. We thank the Indonesian Democracy and Human Rights Hallmark Initiative administered by the Melbourne Law School for funding the project, and to Dr Helen Pausacker for her administrative support. Helpful comments and questions from two anonymous reviewers sharpened the analysis contained in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In addition to broad interruptions globally, HIV/AIDS organisations and activists in Indonesia reported shortages in antiretroviral medications, with only two weeks supply available in some areas as of April 2020 (Luis et al., 2020).

2 The COVID-19 pandemic takes place after at least a decade of concerted calls for and investment in community-based responses as a critical component of part of global HIV programs.

3 National health data has documented significant increases in new HIV infections found among MSM in Jakarta and several other Indonesian cities (HIV and AIDS Data Hub for Asia Pacific, 2017).

4 Rates of COVID-19 transmission and hospitalisation were high during the period of data collection for this research, with a seven-day average of 2817 new infections reported on 1 September 2020. From late June until mid-July in 2021 there was a significant surge in new COVID-19 infections, with a seven-day average of 48,821 on 17 July 2021 (World Health Organization, 2021). The Indonesian government imposed its most widespread public health measures since the beginning of the pandemic on 3 July 2021, which encompassed the whole of the most populous island of Java and international tourist destination Bali (Indonesian Government COVID-19 Website, n.d.). The widespread closure of clinics and hospitals in 2021 had a severe impact on outreach workers in this study. Since the data for this article was collected, one participant has sadly passed away from COVID-19 and several dozen have tested positive to the virus. Although access to adequate testing services remains a challenge, vaccination rates among outreach workers are high.

5 The Jakarta government imposed measures at the regional level during the period that the data for this study was collected in 2020, ranging from mask mandates and restrictions on access to public spaces (e.g. a 50% cap on entry to malls and other buildings). More localized neighbourhood closures both with and without official endorsement represented another feature of the public health response at this time (Kuno, 2020).

6 The two main programs that funded outreach activities at the time of the study were the Global Fund (GF) and the USAID-funded Linkages program. Despite some differences, both programs focus on increasing access to HIV testing and anti-retroviral therapy uptake and adherence (Sustainable HIV Financing in Transition (SHIFT) Programme, 2017, p. 12). These were adjusted at various points during the pandemic to accommodate changes in modes of outreach.

7 During the pandemic, the information that outreach workers used to verify targets was adjusted to reflect the increased reliance on online outreach. Participants described needing to provide five variables in reports for new contacts (name, age or birth year, and a number to verify identity; either a phone number or the name given in a dating application).

Additional information

Funding

This work was supported by Indonesia Democracy Hallmark Research Initiative (IDeHaRI) Collaborative Research Grant, The University of Melbourne [grant number: n/a].