Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach
BackgroundIndonesia’s vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting int...
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JMIR Publications
2025-01-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2025/1/e56820 |
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| author | Pande Putu Januraga Endang Lukitosari Lanny Luhukay Rizky Hasby Aang Sutrisna |
| author_facet | Pande Putu Januraga Endang Lukitosari Lanny Luhukay Rizky Hasby Aang Sutrisna |
| author_sort | Pande Putu Januraga |
| collection | DOAJ |
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BackgroundIndonesia’s vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting interventions and allocating resources to address the changing dynamics of the epidemic.
ObjectiveWe examine the 2022 mapping of Indonesia’s KPs to develop improved HIV and AIDS interventions.
MethodsIn 2022, a district-based mapping of KPs was conducted across 201 districts and cities chosen for their HIV program intensity. This multiphase process included participatory workshops for hotspot identification, followed by direct hotspot observation, then followed by a second direct observation in selected hotspots for quality control. Data from 49,346 informants (KPs) were collected and analyzed. The results from individual hotspots were aggregated at the district or city level, and a formula was used to estimate the population size.
ResultsThe mapping initiative identified 18,339 hotspots across 201 districts and cities, revealing substantial disparities in hotspot distribution. Of the 18,339 hotspots, 16,964 (92.5%) were observed, of which 1822 (10.74%) underwent a second review to enhance data accuracy. The findings mostly aligned with local stakeholders’ estimates, but showed a lower median. Interviews indicated a shift in KP dynamics, with a median decline in hotspot attendance since the pandemic, and there was notable variation in mapping results across district categories. In “comprehensive” areas, the average results for men who have sex with men (MSM), people who inject drugs, transgender women, and female sex workers (FSWs) were 1008 (median 694, IQR 317-1367), 224 (median 114, IQR 59-202), 196 (median 167, IQR 81-265), and 775 (median 573, IQR 352-1131), respectively. “Medium” areas had lower averages: MSM at 381 (median 199, IQR 91-454), people who inject drugs at 51 (median 54, IQR 15-63), transgender women at 101 (median 55, IQR 29-127), and FSWs at 304 (median 231, IQR 118-425). “Basic” areas showed the lowest averages: MSM at 161 (median 73, IQR 49-285), people who inject drugs at 7 (median 7, IQR 7-7), transgender women at 59 (median 26, IQR 12-60), and FSWs at 161 (median 131, IQR 59-188). Comparisons with ongoing outreach programs revealed substantial differences: the mapped MSM population was >50% lower than program coverage; the estimates for people who inject drugs were twice as high as the program coverage.
ConclusionsThe mapping results highlight significant variations in hotspots and KPs across districts and cities and underscore the necessity of adaptive HIV prevention strategies. The findings informed programmatic decisions, such as reallocating resources to underserved districts and recalibrating outreach strategies to better match KP dynamics. Developing strategies beyond identified hotspots, integrating mapping data into planning, and adopting a longitudinal approach to understand KP behavior over time are critical for effective HIV and AIDS prevention and control. |
| format | Article |
| id | doaj-art-0caa256ec5d24574a63bb89d6c5d423b |
| institution | Kabale University |
| issn | 2369-2960 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JMIR Publications |
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| series | JMIR Public Health and Surveillance |
| spelling | doaj-art-0caa256ec5d24574a63bb89d6c5d423b2025-01-30T15:46:12ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602025-01-0111e5682010.2196/56820Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City ApproachPande Putu Januragahttps://orcid.org/0000-0002-2926-0856Endang Lukitosarihttps://orcid.org/0009-0004-7763-3671Lanny Luhukayhttps://orcid.org/0009-0000-5311-4886Rizky Hasbyhttps://orcid.org/0009-0003-9135-5885Aang Sutrisnahttps://orcid.org/0000-0003-0506-556X BackgroundIndonesia’s vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting interventions and allocating resources to address the changing dynamics of the epidemic. ObjectiveWe examine the 2022 mapping of Indonesia’s KPs to develop improved HIV and AIDS interventions. MethodsIn 2022, a district-based mapping of KPs was conducted across 201 districts and cities chosen for their HIV program intensity. This multiphase process included participatory workshops for hotspot identification, followed by direct hotspot observation, then followed by a second direct observation in selected hotspots for quality control. Data from 49,346 informants (KPs) were collected and analyzed. The results from individual hotspots were aggregated at the district or city level, and a formula was used to estimate the population size. ResultsThe mapping initiative identified 18,339 hotspots across 201 districts and cities, revealing substantial disparities in hotspot distribution. Of the 18,339 hotspots, 16,964 (92.5%) were observed, of which 1822 (10.74%) underwent a second review to enhance data accuracy. The findings mostly aligned with local stakeholders’ estimates, but showed a lower median. Interviews indicated a shift in KP dynamics, with a median decline in hotspot attendance since the pandemic, and there was notable variation in mapping results across district categories. In “comprehensive” areas, the average results for men who have sex with men (MSM), people who inject drugs, transgender women, and female sex workers (FSWs) were 1008 (median 694, IQR 317-1367), 224 (median 114, IQR 59-202), 196 (median 167, IQR 81-265), and 775 (median 573, IQR 352-1131), respectively. “Medium” areas had lower averages: MSM at 381 (median 199, IQR 91-454), people who inject drugs at 51 (median 54, IQR 15-63), transgender women at 101 (median 55, IQR 29-127), and FSWs at 304 (median 231, IQR 118-425). “Basic” areas showed the lowest averages: MSM at 161 (median 73, IQR 49-285), people who inject drugs at 7 (median 7, IQR 7-7), transgender women at 59 (median 26, IQR 12-60), and FSWs at 161 (median 131, IQR 59-188). Comparisons with ongoing outreach programs revealed substantial differences: the mapped MSM population was >50% lower than program coverage; the estimates for people who inject drugs were twice as high as the program coverage. ConclusionsThe mapping results highlight significant variations in hotspots and KPs across districts and cities and underscore the necessity of adaptive HIV prevention strategies. The findings informed programmatic decisions, such as reallocating resources to underserved districts and recalibrating outreach strategies to better match KP dynamics. Developing strategies beyond identified hotspots, integrating mapping data into planning, and adopting a longitudinal approach to understand KP behavior over time are critical for effective HIV and AIDS prevention and control.https://publichealth.jmir.org/2025/1/e56820 |
| spellingShingle | Pande Putu Januraga Endang Lukitosari Lanny Luhukay Rizky Hasby Aang Sutrisna Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach JMIR Public Health and Surveillance |
| title | Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach |
| title_full | Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach |
| title_fullStr | Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach |
| title_full_unstemmed | Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach |
| title_short | Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach |
| title_sort | mapping key populations to develop improved hiv and aids interventions multiphase cross sectional observational mapping study using a district and city approach |
| url | https://publichealth.jmir.org/2025/1/e56820 |
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