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25 Apr 2022
Social Behaviour Change Communication of HIV Testing and Treatment for HIV-positive Pregnant Women in Banjarmasin, South Kalimantan Province, During the COVID-19 Pandemic
Project leader: Ms Juniati Rahmadani
Level of education and university: Master, The University of New South Wales
Collaborating Organisations: -
Project Location: Kalimantan Selatan
Activity Type: Research & Development and innovation
Sector: -
Project Rationale:
The WHO estimates that there are approximately 37.7 million HIV-positive people worldwide, including an estimated 1.3 million HIV-positive pregnant women, 85% of whom will have received ARV treatment by 2020. (World Health Organization, 2021). As of March 2021, Indonesia reported 427,000 HIV cases, but only 63% had ever received ARV treatment and less than half were still on treatment, with approximately 68,500 people living with HIV discontinuing treatment (loss to follow-up) and 61,912 cases dying (Ministry of Health) (Indonesian Health). Adherence to antiretroviral therapy is critical for treatment success and HIV prevention (Robbins et al., 2014). Due to noncompliance with treatment, ARVs are unable to effectively suppress the amount of virus in the bodies of HIV-positive individuals, increasing the risk of death and transmission (Putri et al., 2015).
HIV testing of 520,974 pregnant women as of March 2021 revealed 1,590 HIV positive individuals, with seven infants born infected. 24% of HIV-positive pregnant women, on the other hand, received antiretroviral therapy (Ministry of Health, 2021). Meanwhile, in 2021, South Kalimantan Province discovered 34 HIV-positive pregnant women and one HIV-positive infant. Until July 2021, only 82% of the 3,020 HIV-positive individuals discovered had received ARV treatment, and only 59% were still receiving treatment (South Kalimantan PHO, 2021). Pregnant HIV-positive women receiving ARV at a low rate has an effect on HIV-infected infant births. HIV-positive pregnant women face an increased risk of death and HIV transmission to their unborn children during pregnancy, delivery, and breastfeeding (WHO, 2010). Prenatal ARV treatment is critical for preventing death and transmission.
Counselling following HIV testing, as well as an understanding of and confidence in the effectiveness of ARVs, all contribute to pregnant women initiating and maintaining ARV treatment. Meanwhile, doubts about the effectiveness of ARVs, particularly among pregnant women with HIV who have no symptoms, as well as concerns about stigma and discrimination, prevent them from accessing ARV treatment (Lumbantoruan et al, 2018). According to Nuraeni et al. (2013), awareness of HIV encouraged pregnant women to seek HIV testing at a public health centre. Pregnant women's ability to access prevention mother-to-child transmission of HIV (PMTCT) services is influenced by their knowledge of HIV and the critical nature of PMTCT (Sitohang, 2017). Purnamawati et al. (2020) explained that success in increasing HIV testing and treatment coverage for HIV-positive pregnant women was partly due to pregnant women's empowerment through increased HIV knowledge, as well as support from increased HIV and PMTCT capacity among health workers (prevention mother to child transmission). Health workers with this capacity will be able to communicate to pregnant women the importance of HIV testing and encourage them to get tested. Additionally, health workers' knowledge of HIV can help reduce the incidence of stigma and discrimination against people living with HIV in health facilities. Appropriate capacity for health workers to administer ARV treatment can also encourage HIV-positive pregnant women to initiate treatment.
According to information from a PLHIV support group, Borneo Plus, pregnant women with HIV who are concerned about the impact of ARV treatment on their infants are less likely to access PMTCT services. This demonstrates the importance of psychosocial support for PLHIV. According to Okonji et al. (2020), it is critical to have access to comprehensive and high-quality psychosocial assistance services, particularly for people living with HIV who are just starting treatment. Psychosocial support can help maintain ARV treatment adherence, thereby preventing LTFU (WHO, 2006). HIV counsellors and peer support groups can provide these psychosocial assistance services (KDS). KDS Borneo Plus has a presence in Banjarmasin, providing psychosocial support to people living with HIV and their families. To ensure that people living with HIV receive treatment and psychosocial support, effective communication and partnerships between health facilities and peer support groups are required (Indonesia MOH & PKMK FK UGM, 2015).
Audiovisual media interventions will engage emotions, attitudes, and motivations, enhancing the ability to recall messages or information communicated (Fresia, 2017), thereby encouraging a change in attitude (Mundorf et al., 2018), including changes in pregnant women’s attitudes toward HIV testing and ARV treatment. Audiovisual media can be used to convey comprehensive information and can be accessed at any time and in accordance with its intended use in the COVID-19 pandemic situation. Wahyuniar (2021) recommended the availability of media, such as audiovisual material, to help pregnant women overcome the issue of lengthy wait times for maternal and child health services. Audiovisual media containing information about HIV and PMTCT can be used as a starting point or introduction in HIV testing counselling sessions for pregnant women.
Project Beneficiaries:
In general, this project directly benefits peer support and health workers in maternal and child health services, as well as pregnant women who seek care at health facilities located throughout Banjarmasin City. The project will provide capacity building for health workers and peer support providers in the areas of HIV and PMTCT, while pregnant women will receive HIV education through audiovisual media and communication from trained health workers and peer support providers.
Priority Development Area:
Health Security
Link with Australian organisation: -
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