Behavioral HIV-prevention Interventions for Men who have Sex with Men and Transgender Women in Indonesia

Despite alarming HIV prevalence, programmatic coverage for men who have sex with men (MSM) and transgender women (transwomen) populations remains inadequate in Indonesia. The aim of this thesis is to contribute to systematic evidence-based research in determining effective intervention components and evidence-based recommendations in order to develop effective HIV-prevention interventions for these two populations. The two main questions addressed in this thesis are: 1) What are essential elements to consider in developing effective HIV prevention interventions and management for care for MSM and transwomen in Indonesia? 2) How can effective HIV prevention interventions be designed and applied to improve their effectiveness for these two groups in Indonesia?

This thesis is divided into two parts. In part I, four studies explored the problem analysis, behavioral determinants, and existing interventions. Chapter two describes a qualitative study that evaluated an outreach approach in HIV prevention programs from the perspective of the outreach workers (OWs). Chapter three presents a qualitative study that elaborated an overview of strengths and challenges of an outreach approach from the perspective of the clients. Chapter four describes a cross-sectional study investigating determinants of retention in care among MSM and transwomen living with HIV in Indonesia. Chapter five describes a systematic review of the literature on behavioral HIV prevention interventions for MSM and transwomen in Southeast Asia countries.

Part II consist of two studies that show our attempt in applying findings from the previous chapters in intervention development and implemented intervention trials. Chapter six reports a quasi-experimental pilot study on how a training package was developed, implemented, and evaluated for increasing the knowledge and skills of OWs for outreach to MSM and transwomen groups in Indonesia. Chapter seven presents a quasi-experimental pilot study investigating the use of a social media campaign to increase HIV testing among Indonesian MSM. We describe the systematic development of an intervention-based intervention by means of a social media campaign. In Chapter eight, we provide and discuss answers to the research questions. We also included an overall discussion and a summary of the main findings. At the end of the chapter, we provide several recommendations for future research and practice. In addition, as this thesis highlights the use of behavioral theories for developing an internet-based intervention, we also provide an example of applying such an approach to the development of a future internet-based intervention among Indonesian MSM as an annex.