HIV risk conduct and solutions among men

There has been a limited focus on HIV among men who purchase sex (MWPS) in many

countries. Systematic information is lacking on the HIV prevalence in this population, and on

interventions conducted to reduce HIV risk. Looking specifically to Indonesia, MWPS are

understood to be at higher risk of HIV infection compared with men in the general population

but there has been a relative lack of attention put towards identifying characteristics such as

the rate of condom use and HIV testing in this population and developing appropriate

interventions. Accordingly, the studies included in the Book contribute to filling the

knowledge gap for this population in regard to estimation of rate of condom use and HIV

testing and evaluation of control strategies among MWPS in Indonesia.

A range of research designs and analytical approaches was applied. The first study is a metaanalysis

of the burden of HIV among MWPS in low- and middle-income countries (LMICs). We

found that HIV prevalence was elevated compared to the population as a whole, and that

there was a strong association (RR 1.95) between purchasing sex and HIV prevalence. The

second study is a systematic review of HIV interventions conducted among MWPS, or groups

often used as proxies for MWPS, in LMICs to reduce their risk of HIV infection. We observed

that only a few studies had evaluated the impact of interventions on HIV testing rates. The

third study is a survey in Bali, Indonesia, which identifies rates and predictors of condom use

and HIV testing among MWPS in this setting. The study found a high condom use (88.5%), but

low HIV testing rates (8.1%) among this group. The fourth study explores in more detail why

such a low HIV testing phenomenon among MWPS occurs in this setting and the preferences

for testing strategies. Men's preference for HIV self-testing over HIV testing at the clinic was

expressed. The fifth study is a study piloting the HIV self-testing strategies to identify whether

this method could improve HIV testing rates among this group. A pilot single-arm nonrandomised

trial study was conducted among men presenting at the brothels area and found

high acceptability of this testing strategy to improve HIV testing rates among MWPS; HIV

testing acceptance was 6-7 times higher than the HIV testing history of less than 8.1% found

in the third study.