Age disaggregation Analysis of BSS Survey Data Among Most At Risk Population for HIV Infection

REPORT Age Group Disaggregation of Survey and Reseach Data

This report was prepared by Aang Sutrisna with valuable inputs from Severine Leonardi, Kemal Siregar, Fonny Silvanus and Irawati A. Inputs were also received from the National AIDS Commission (Suriadi Gunawan), and the UNICEF team in Indonesia. 10th Floor, Wisma Metropolitan 2, Jl. Jenderal Sudirman, Jakarta 12920 Tel: +62 (0)21 2996 8000 Email: [email protected]

ii | Age Group Disaggregation of Survey and Reseach Data

EXECUTIVE SUMMARY Introduction Millions of young people throughout the world face a high risk of HIV infection and other negative consequences of sexual health as a result of behavior that they adopt, or are forced to do. Three groups of young people considered most at risk of contracting HIV in Indonesia is young men who have sex with other men and young people who sell sex or injecting drugs. In addition to these three groups, other young people also have a high risk of HIV infection, especially in areas where the HIV epidemic enters such an advanced level as in Tanah Papua and Prisons.

Therefore, the National AIDS Commission (NAC) with the help of UNICEF Indonesia, perform advanced analysis of survey data and existing research to determine the distribution of young people in most at risk group, as well as differences in the level of knowledge, attitudes and behavior as well as program coverage and prevalence of HIV and STIs among most at risk group of HIV transmission by age group This advanced analysis using secondary data from several cross sectional survey data in the period of 2007 to 2009.

Result Youth Analysis of the group of adolescents in general was use the Indonesia Adolescent Reproductive Health Surveys in Indonesia (IYARS) data conducted in 2007 across 33 provinces with number of 8.481 female respondents and 10.830 male respondents aged 15-24 years, as well as the Behavioral Surveillance Survey (BSS) among second grade high school students as population of 15-19 years age group conducted in 2007 in Jakarta and Surabaya, and in 2009 in Yogyakarta, Tangerang, Pontianak and Samarinda, with total number of 3.043 female and 3.113 male respondents.

One out of five Indonesia's populations are young people aged 15-24 years, of which more than half is high school graduate or have higher education. Percentage of female who graduated from high school or college (69%) is higher than males (51%). One out of four of high school students BSS respondents who have comprehensive knowledge of HIV transmission and prevention is 11 times higher than IYARS respondents age group 15-19 years (2.2%). While the source of information about HIV and AIDS mostly mention by youth is TV (75% of IYARS respondents and 94% of High School Students BSS iii | Age Group Disaggregation of Survey and Reseach Data

respondents), while education session about drug abuse is the most widely accessed by high school students in the past 1 year.

Percentage of female aged 15-19 years who had ever been married (9%) is 6 times higher than male in the same age group (1.5%). In addition, 9% of male and 4% of female respondents of high school students BSS claimed to have had sex, higher than IYARS respondent of 15-19 years age group (4% male and 1.3% female). The mean number of sexual partners in past one year among high school students BSS respondents ranged between 1.6 - 2.7 people, and the level of condom use at last sexual intercourse among high school students BSS respondents ranged between 41% - 73%. 2% - 13% of high school students also have used drugs where half were already using it since junior high, meanwhile those who ever injecting drug is still below 1%.

Youth in Tanah Papua Analysis of youth in Tanah Papua using Tanah Papua IBBS data conducted in 2006 across 10 district / city in the province of Papua and West Papua with number of 3.176 male and 3.129 female respondents aged 15-49 years. 36% of female and 32% of male respondents aged 15-24 years, where levels education among female respondents is generally lower than male. Percentage of female aged 15-19 years who had ever been married (21%) is 2 times higher than male in the same age group (11%). IBBS respondents in Tanah Papua who have comprehensive knowledge on HIV transmission and prevention are relatively similar in all three age groups ranging from 7% -9%. Sources of information about HIV and AIDS most frequently mentioned by respondents 15-19 years age group was Teacher (51% male and 45% female) while among the age group 20-24 and 25 years and older is the TV (54% and 52% ). Percentage of respondents who ever attend the HIV education session in a sequence from the youngest age group was 21%, 19% and 15%, while those who had received IEC materials is 19%, 20% and 15%. The Odds Ratio of respondents who had received IEC materials shows that they are 2.1 times more likely to have a comprehensive knowledge compare to those who did not receive IEC materials.

IBBS respondents in Tanah Papua who have had HIV test is relatively similar across all three age groups which ranged between 2% -3%, same thing also for those who had received HIV test results, ranged between 0.3% - 1.6%. Thirty nine (39%) male and 37% female 15-19 years age group ever had sex or 10-28 times higher than IYARS respondents in the same age group. Percentage of male who have more than one sex partner in the past 1 year, in a sequence, starting from the age group 1519 years, 20-24 years and 25 years and older was 31%, 27% and 20%, while among female respondents is 14% , 11% and 7% or higher in the younger age groups. Levels of condom iv | Age Group Disaggregation of Survey and Reseach Data

use at last sex with steady sex partners relatively similar among all three age groups, all of which are still below 10%. While condom use with casual and non-commercial sex partners is highest among respondents of 20-24 years age group (20% male and 11% of female), followed by 15-19 years age group (11% of male and female ), and the lowest in the age group 25 years and older (10% of male and 2% of female). The condom use among male respondents at last sex with sex worker, in sequence, from the youngest age group is 0%, 17% and 15%. HIV prevalence among male 15-19 years age group (3.2%) is higher than 20-24 years age group (2.5%) and 25 years and older (2.9%). HIV prevalence among female age group 1519 years and 20-24 years is similar, which is 2%, and among 25 years age group was 1.8%.

Young Sex Worker The survey data used in advanced analysis on Sex Workers are IBBS among Female Sex Worker (FSW) in 2007 across 17 District / City and 2009 in 9 district / city as well as BSS in 4 City in 2008 with a total of 9.999 FSW respondents. In addition, data of 2007 IBBS/BSS among transgender (Waria) in 5 cities and 2009 in 3 cities with total number of 1.655 Waria respondents also being used. Percentage of FSW aged 15-19 years ranged between 2% (Malang) - 15% (Bitung) with a mean of 8%, and aged 20-24 years between 13% (Malang) to 41% (Deli Serdang) with a mean of 26%. While Waria respondents aged 15-19 years ranged from 5% (Semarang) to 21% (Makassar) with a mean of 10%, and aged 20-24 years is 13% (Malang) to 27% (Makassar) with a mean of 19%.

Percentage of FSW who started to become sex worker before age 20 years ranged between 10% (Mimika) to 38% (Tangerang) with a mean of 22%, and among Waria between 46% (Pontianak) up to 61% (Semarang) with a mean of 55%. While FSW who started the commercial sex debut age 20-24 years ranged from 21% (Malang) to 39% (Batam & NAD) with a mean 31% and among Waria between 21% (Semarang) up to 35% (Bandung) with a mean 29%. Therefore in general 1 of 3 FSW and 1 of 4 Waria currently under the age of 25 years, and 1 of 2 FSW and 2 of 3 Waria started to become sex workers before the age of 25 years. The mean length of time of becoming Sex Workers among FSW age group 15-19 years is 1.2 years, rising to 1.6 years in age group 20-24 years and 3 years in the age group 25 years and older. While among Waria, the mean length of time of becoming Sex Workers in a sequence from the youngest age group is 2, 4 and 12 years. Percentage of FSW who graduated from junior high or higher sequentially from the youngest age group was 76%, 74% and 54%, while among Waria was 81%, 86% and 75%. Therefore it can be concluded that sex worker from the younger age groups have better educational levels. v | Age Group Disaggregation of Survey and Reseach Data

Percentage of FSW who have comprehensive knowledge about HIV transmission and prevention in sequence from the youngest age group is 16%, 20% and 20%, while among Waria is 20%, 26% and 27%. This indicates that the older Sex Worker has a slightly better comprehensive knowledge than the younger ones.

Percentage of FSW who ever reached by field workers in the last 3 months in a sequence from the youngest age group is 40%, 46% and 55%, while among Waria is 50%, 53% and 61%. Odds Ratio of FSW age group 20-24 years and 25 years and older who had been reached by the field workers in the last 3 months were 1.3 and 1.7, while among Waria is 1.3 and 2.5 times more likely to be reach by field worker rather than the age group 15-19 years.

Percentage of FSW ever been tested for HIV in a sequence from the youngest age group was 28%, 40% and 48%, while among the Waria is 41%, 51% and 59%. Odds Ratio of FSW age group 20-24 years and 25 years and older who ever been tested for HIV was 2.1 and 3.0, while among Waria was 2.8 and 4.4 times more likely to have HIV test than age group 1519 years.

The mean number of clients in the past 1 week among FSW age group 15-19 years and 2024 years are relatively similar (7.5 and 7.6 people / week) and more than FSW 25 years and older age group (6.1 people / week). While among Waria it is relatively similar across all age groups i.e. 3.5, 3.8 and 3.6 persons / week.

Percentage of FSW who used condoms during the last commercial sex in a sequence from the youngest age group is 52%, 63% and 68%, while among Waria was 61%, 65% and 58%. HIV prevalence among FSW in sequence from the youngest age group is 5%, 8% and 7%, while the Syphilis prevalence is 6%, 6% and 9%. Meanwhile among Waria, HIV prevalence (5%, 14% and 19%) and Syphilis (10%, 11% and 24%) increased along with the older age group. In contrast occurs with the gonorrhea prevalence and Chlamydia infection, where the younger is the age group of FSW, the higher is the prevalence. Gonorrhea prevalence among FSW in sequence from the youngest age group is 40%, 32% and 24%, while among Waria was 39%, 34% and 24%. While the prevalence of Chlamydia infection among FSW in sequence from the youngest age group is 52%, 43% and 32%, while among Waria was 34%, 35% and 30%.

Young Injecting Drug Users (IDUs) The survey data used in the advanced analysis for young IDUs is the 2007 IBBS and BSS in six cities and the 2009 IBBS/BSS in 4 cities with the total number of 2,085 IDU respondents. Percentage of IDU aged 15-19 who become respondents ranged between 2% vi | Age Group Disaggregation of Survey and Reseach Data

(Surabaya, Malang, Semarang, Bandung and Medan) to 25% (Pontianak) with a mean of 9%, while the percentage of IDUs aged 20-24 years ranged from 23% (Malang and Surabaya) to 37% (Jogjakarta) with a mean of 29%. This indicates that 1 out of 3 IDUs is a young people.

Eight out of 10 IDUs started to injecting drugs before age of 25 years. The percentage of IDUs who first injected drugs before age 15 years ranged between 0% (Semarang) - 15% (Makassar) with a mean 6%, at the age of 15-19 years between 18% (Semarang) - 58% (Banten) with a mean 42 %, and at age 20-24 years was 25% (Makassar and Banten) to 49% (Semarang) with a mean of 35%. Duration of being injecting drug users has a strong relationship with HIV infection, where 1-5 years duration of being IDU is 3.5 times more likely and more than 5 years duration is 9 - 47 times more likely to be infected with HIV compared to those who is being IDU for less than 1 year. The mean duration of being IDU among respondents in sequence from the youngest age group was 1.6, 3.7 and 6.8 years. There is no respondent from the 20-24 years and 25 years and older age groups and only 2% of the age group 15-19 years who did not complete elementary school. While of those only graduated from elementary school are relatively similar across all three age groups and ranged between 4% - 6%.

The older the respondent age group, the higher the percentage who have comprehensive knowledge about HIV transmission and prevention as well as knowing the site of Methadone Maintenance Treatment (MMT) and HIV testing. Percentage who have comprehensive knowledge in a sequence from the youngest age group is 25%, 43% and 49%, while who knows where MMT site is 49%, 60% and 72%, meanwhile who knows where HIV testing is 60%, 66% and 76 %.

Similar with the level of knowledge, percentage who ever been reached by field workers in the last 3 months increased along with the older age group, where the percentage in sequence from the youngest age group is 30%, 53% and 61%, meanwhile those who had received Needle-Syringe Program (NSP) services within the past 1 year was 32%, 43% and 49%, while those who had received MMT service is 17%, 28% and 32%. Same thing for those who ever been tested for HIV, where the percentage in a sequence from the youngest age group is 20%, 36% and 52%, while those receiving the last HIV test results was 16%, 32% and 47%. Almost all IDUs in the age group 15-19 years were not married and the percentage of respondent age group 20-24 years and 25 years and older who were married were 12% and 35%. Although almost all IDUs age group 15-19 years were not married, but more than half have had sex, same thing with the 5 out of 6 IDUs from the older age groups. The mean number of sexual partners in the past 1 year in a sequence from the youngest age group was 3.1, 3.4 and 2.7 people. vii | Age Group Disaggregation of Survey and Reseach Data

Percentage of respondents who had sex with casual and non-commercial partners in the past 1 year is increasing along with the more younger age groups, from 38% in the age group 25 years and older to 48% and 56% in the age group 20-24 years and 15 - 19 years. Meanwhile, the percentage of respondent who had commercial sex in the past 1 year was relatively similar across all three age groups which ranged between 39% - 43%. In general, levels of condom use among IDUs in the last commercial sex are relatively similar across three age groups; in sequence from the youngest age group was 55%, 55% and 48%. Likewise with the percentage of condom use during last sex with casual and noncommercial partners, in sequence was 39%, 47% and 43%. While the percentage of condom use at last sex with steady partners of respondents 15-19 years age group (42%), almost two-fold higher than the 20-24 years age group (23%) and 25 years and older (22%).

The mean frequency of injecting in the past 1 week increased along with the older age group of respondents, ranged from 3.2 times / week in the 15-19 years age group increased to 6.1 and 6.6 times / week in the age group 20-24 years and 25 years and older. However, levels of needle-sharing behavior among IDUs in the age group 15-19 years (52%) were significantly higher than IDUs in the age group 20-24 years (33%) and 25 years and older (30%).

HIV prevalence increased along with the older age group, where in a sequence from the youngest age group is 6%, 30% and 50%, same thing happened with syphilis prevalence which increased from 0% in the age group 15-19 years to 0.8% and 1.3% in age group 2024 years and 25 years and older. The largest Odds Ratio among several factors considered to have relation with HIV infection are 3.7 which generated by duration of drug injecting of more than 2 years.

Young MSM The survey data used in the advanced analysis for MSM group is 2007 IBBS and BSS in six cities and 2009 IBBS and BSS in 3 cities with total number of 2,050 MSM respondents. Percentage of MSM aged 15-19 years who become respondents in the survey ranged from 4% (Medan) to 41% (Makassar) with a mean of 13%, while the percentage of MSM aged 20-24 years ranged from 18% (Medan) to 40% (Yogyakarta) with a mean of 29%.

There is no respondent age group 20-24 years and 25 years and older and only 1% of the age group 15-19 years who did not complete elementary school. While the percentage of those who only complete elementary school do not differ significantly among the three age groups and ranged between 4% - 8%. Percentage of MSM who have first time sex before age 15 ranges from 5% (Bandung) to 25% (Makassar) with a mean 14%, and in general 2 out of 3 MSM have had sex before age viii | Age Group Disaggregation of Survey and Reseach Data

20. Fifty nine percent (59%) MSM from 15-19 years age group admitted to have regular sex partners, slightly higher than the MSM from 20-24 years age group (55%) and 25 years and older (57%).

Five out of 6 MSM from all age groups had sex with casual and non-commercial partners in the past 1 year. While the percentage who had commercial sex in the past 1 year in a sequence from the youngest age group was 58%, 70% and 60%. Therefore the percentage of MSM who had sex with more than one partner in the past 1 year in a sequence from the youngest age group was 43%, 55% and 52% with a mean number of sex partners 2.5, 4 and 3.5 people. Levels of condom use at last sex with casual and non-commercial partners relatively similar across age groups ranging from 43% - 45%, likewise to condom use with commercial partners that ranged between 55% - 59%.

In general, MSM who have ever injecting drug use is higher than other at-risk population except IDUs and there is no significant difference between age groups. Percentages of MSM who have ever injecting drugs, in a sequence from the youngest age group are 2%, 5% and 3%. Just like any other risk groups, the percentage of MSM 15-19 years age group (23%) who have comprehensive knowledge about HIV transmission and prevention is the smallest compared to the age group 20-24 years (38%) and 25 years and older (37%).

Percentage of MSM who had been reached by the field workers in the past 3 months increased along with the older age group, where in a sequence from the youngest age group was 24%, 35% and 38%. Likewise with who had accessed STI service which is 20%, 27% and 27%. Percentage of MSM from 15-19 years age group (21%) who have had HIV test is also the lowest compared to age group 20-24 years (35%) and 25 years and older (33%). While the percentage who received the last HIV test results in a sequence of the youngest age group is 17%, 30% and 29%

HIV prevalence among MSM respondents is higher along with the older age group, where in a sequence from the youngest age group is 2%, 5% and 7%. So also with the prevalence of syphilis which increased from 2.4% in the 15-19 age group to 5.7% and 7.3% in the age group 20-24 years and 25 years and older. While the prevalence of Gonorrhea among MSM in sequence from the youngest age group is 16%, 22% and 18%, while the prevalence of Chlamydia infection is 17%, 22% and 21%.

Young Prisoner Data used for further analysis of young Prisoners is data from studies of HIV and Syphilis prevalence and HIV Risk Behavior among Inmates in prisons/detention center in Indonesia ix | Age Group Disaggregation of Survey and Reseach Data

which conducted in 2010 across 24 prisons/detention center that systematically selected to represent the entire prison/detention center in Indonesia. Where the percentage of male prisoners respondents aged less than 25 years in adult prison/detention center is 22%, while the female prisoners is 13%.

In general, the education levels of female prisoners are better than male. Percentage of male prisoners aged 25 years and older (6%) who graduated from college, three times higher than the age group below 25 years (2%). Similar situation among female prisoners, where the percentage of 25 years age group who are completed college (16%), 4 times higher than the age group below 25 years (4%). Three out of four male prisoners below 25 years of age are not married; in contrast with the older age groups. Likewise with female prisoners, of which 40% were not married among those aged under 25 years old and only 11% in the age group 25 years and older.

Percentage of male and female prisoners aged under 25 years who have comprehensive knowledge about HIV transmission and prevention (13% and 17%) only half of those aged 25 years and older (22% and 34%).

Percentage of male and female prisoners aged under 25 years who had attended education session about HIV transmission and prevention (38% and 50%) is also less than aged 25 years and older (47% and 61%).

Percentage of male and female prisoners aged under 25 years who ever had HIV test within the past 1 year (24% and 30%) is slightly lower than those aged 25 years and older (31% and 41%). While the male prisoners who received his last HIV test results are relatively similar between the two age groups i.e. 10% and 11%, in contrast with female prisoners where the percentage in the age group below 25 years (17%) is lower than the age group 25 years and older (26 %) Prisoners who had sex in prisons/detention center in the past 1 year have relatively similar percentage between the two age groups and sexes which is ranged between 4% - 6%. None of the prisoners male and female age groups below 25 years who used condom during last sexual intercourse the past 1 year in prison/detention center, while in the age group 25 years and older the percentage is 6% in male and 14% among female.

Two percent of male prisoners aged below 25 years admitted to injecting drugs in prisons/detention center in the past 1 year, higher than prisoners age 25 and older (0.3%), and none of the female prisoners who claimed to have done it. Although the percentage of who had prior history of injecting drugs in prison is relatively equal between male and female in both age groups which is between 6% - 9%. HIV prevalence among male prisoners was relatively similar between the two age groups (1% and 1.1%), whereas in the female prisoners was 0% in the age group below 25 years x | Age Group Disaggregation of Survey and Reseach Data

and 6.9% in the older age groups. Syphilis prevalence in male prisoners in sequence from the youngest age group is 2% and 6%, while among female inmate is 10% and 8%

Conclusion The proportion of young people aged 15-24 years in most-at-risk populations for HIV transmission has significant numbers and vary greatly across populations and locations, and nearly all at-risk populations start the risky behaviors at the young age. The level of knowledge of the correct HIV transmission and prevention and the coverage of various HIV control programs among the younger most-at-risk populations is lower compared to those with older age. The young most-at-risk population also perform several risky behaviors which is overlap, such as young IDUs and MSM who also perform commercial sex and sex with multiple partners.

HIV and Syphilis prevalence is more influenced by duration of performing risky behavior compare to the level of risky behavior, therefore the level of HIV and Syphilis prevalence is higher among the older and the longer duration of performing risky behavior compare to the younger at risk populations.

Recommendation Findings from this advanced analysis of the survey data and studies require follow-up which should be done immediately to reduce the impact of HIV epidemic among young people. Follow up action ideally should be done by using multi-dimensional approach considering the diversity and the complexity of issues faced. Some of the recommendations need to be followed up are as follows:  Efforts to increase HIV prevention and transmission knowledge among young people in general population should be an integrated part of the HIV and AIDS control program strategies at all government levels and obtain adequate funding allocation. AIDS Commission's central role in all government levels to respond this recommendation through the advocacy and coordination functions will be one of the keys successes.

 HIV and AIDS control program among young people in the most at risk populations should be strategically integrated into existing AIDS prevention strategies. The action plan of HIV and AIDS prevention among young people should be develop in the comprehensive way including plan that able to opening access to increased knowledge and access to related services.

 Development of HIV and AIDS control strategies among young people should consider the variations of socioeconomic and cultural situations that exist in society in order to be widely accepted and implemented by various stakeholders xi | Age Group Disaggregation of Survey and Reseach Data

 AIDS Commissions needs to formulate the effective measure in order to reduce stigma and discrimination toward young people who have high risk behavior in the community and public facilities. The programs which combine empowerment and increasing comprehensive understanding strategically can be done with the measurable output and outcome.

 Need for the action plans with targets and effective strategies from various stakeholders to reduce the level of risk behavior among young people within most-at-risk population.

 The high number of school age children who perform HIV risk behaviors need to get special attention from the Ministry of National Education. Integrated work plan to increase knowledge and reduce risky behaviors among young people may also contribute to the HIV and AIDS control program in the future.

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TABLE of CONTENT EXECUTIVE SUMMARY ........................................................................................................................ iii TABLE of CONTENT ............................................................................................................................xiii LIST of FIGURE ....................................................................................................................................xv LIST of TABLE .................................................................................................................................... xvii 1. INTRODUCTION .............................................................................................................................. 1 1.1. Background ............................................................................................................................................................. 1 1.2. Objective ................................................................................................................................................................... 2 1.3. Methodology ........................................................................................................................................................... 2

2. RESULT ........................................................................................................................................... 5 2.1. Youth in General ................................................................................................................................... 5 2.1.1. Profile ............................................................................................................................................................ 6 Distribution ................................................................................................................................................. 6 Education ..................................................................................................................................................... 6 Marital Status ............................................................................................................................................. 7 2.1.2. Knowledge ................................................................................................................................................... 8 2.1.3. Source of Information & Program Coverage ...............................................................................10 2.1.4. Sex Behavior and Condom Use .........................................................................................................12 2.1.5. Drug Use .....................................................................................................................................................15 2.2. Youth in Tanah Papua .......................................................................................................................17 2.2.1. Profile ..........................................................................................................................................................17 Distribution ...............................................................................................................................................17 Education ...................................................................................................................................................18 Marital Status ...........................................................................................................................................18 2.2.2. Knowledge .................................................................................................................................................19 2.2.3. Source of Information & Program Coverage ...............................................................................20 2.2.4. Sex Behavior & Condom Use ..............................................................................................................23 2.2.5. STIs Symptoms and HIV Prevalance ...............................................................................................26 2.3. Young Sex Worker ..............................................................................................................................28 2.3.1. Profile ..........................................................................................................................................................29 Distribution ...............................................................................................................................................29 Age at First Sex and First Commercial Sex ...................................................................................29 Education ...................................................................................................................................................31 Marital Status ...........................................................................................................................................31 2.3.2. Knowledge .................................................................................................................................................32 2.3.3. Program Coverage ..................................................................................................................................33 2.3.4. Sex Behavior & Condom Use ..............................................................................................................35 2.3.5. HIV and STI Prevalence ........................................................................................................................38 2.4. Young Injecting Drug Users ............................................................................................................40 2.4.1. Profile ..........................................................................................................................................................41 Distribution ...............................................................................................................................................41 xiii | Age Group Disaggregation of Survey and Reseach Data

Education ...................................................................................................................................................42 Marital Status ...........................................................................................................................................43 2.4.2. Knowledge .................................................................................................................................................43 2.4.3. Program Coverage ..................................................................................................................................45 2.4.4. Injecting Behavior ..................................................................................................................................46 2.4.5. Sex Behaviour ..........................................................................................................................................47 2.4.6. HIV & Sifilis Prevalence ........................................................................................................................50 2.5. Young MSM ............................................................................................................................................52 2.5.1. Profile ..........................................................................................................................................................53 Distribution ...............................................................................................................................................53 Education ...................................................................................................................................................55 Steady Partner .........................................................................................................................................55 2.5.2. Knowledge .................................................................................................................................................56 2.5.3. Program Coverage ..................................................................................................................................57 2.5.4. Sex Behaviour ..........................................................................................................................................59 2.5.5. Drug Abuse ................................................................................................................................................62 2.5.6. HIV & Syphilis Prevalence ...................................................................................................................62 2.6. Young Prisoners ..................................................................................................................................64 2.6.1. Profile ..........................................................................................................................................................65 Distribution ...............................................................................................................................................65 Education ...................................................................................................................................................65 Marital Status ...........................................................................................................................................66 Length of Sentence ................................................................................................................................66 Drug Abuse ................................................................................................................................................68 2.6.2. Knowledge .................................................................................................................................................70 2.6.3. Program Coverage ..................................................................................................................................71 2.6.4. Risk Behavior ...........................................................................................................................................73 2.6.5. HIV and STIs .............................................................................................................................................75

3. SUMMARY & RECOMMENDATION ................................................................................................ 77 Summary .............................................................................................................................................................................77 Recommendation ............................................................................................................................................................78

4. ATTACHMENT ............................................................................................................................... 79 List of Acronyms ..............................................................................................................................................................79 Permission Letter ............................................................................................................................................................80

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LIST of FIGURE Figure 1. Distribution Cumulative AIDS Cases Reported Through December 2010 ...................................................... 1 Figure 2. Distribution of Estimated Population Age 15-24 Years Old In Indonesia 2010 .............................................. 6 Figure 3. Percentage of IYARS Respondent by Education Level .................................................................................... 7 Figure 4. Percentage of DHS Respondent Who Ever Married by Rural-Urban and Age Group .................................... 7 Figure 5. Percentage of IYARS Respondent Who Have Comprehensive Knowledge..................................................... 9 Figure 6. Percentage of BSS Among Student Respondent Who Have Comprehensive Knowledge ............................ 10 Figure 7. Percentage of IYARS Respondent Who Ever Had Sex ................................................................................... 13 Figure 8. Percentage of BSS Among Student Respondent Who Ever Had Sex in The Past Year.................................. 14 Figure 9. Number of Sex Partner in The Past Year of BSS Among Student Respondent ............................................. 14 Figure 10. Percentage of BSS Among Student Respondent Who Use Condom .......................................................... 15 Figure 11. Percentage of BSS Among Student Respondent Who Ever Drunk and Use Drug in The Past Year ............ 15 Figure 12. Education Level of BSS Among High School Student When The First Time Use Drug ................................ 16 Figure 13. Age Distribution of Respondent IBBS Tanah Papua ................................................................................... 17 Figure 14. Percentage of IBBS Tanah Papua Respondent by Education Level ............................................................ 18 Figure 15. Percentage of IBBS Tanah Papua Respondent by Marital Status ............................................................... 19 Figure 16. Percentage of IBBS Tanah Papua Respondent Who Have Comprehensive Knowledge According to UNAIDS Standard ........................................................................................................................................ 20 Figure 17. Percentage of IBBS Tanah Papua Respondent Who Reached by BCC Program in The Past Year ............... 21 Figure 18. Percentage of IBBS Tanah Papua Respondent Who Reached by VCT Program in The Past Year ............... 22 Figure 19. Percentage of IBBS Tanah Papua Respondent Who Ever Had Sex ............................................................. 23 Figure 20. Percentage of IBBS Tanah Papua Respondent According to Number of Sex Partner in The Past Year ...... 24 Figure 21. Percentage of IBBS Tanah Papua Respondent Who Had Sex With Casual and Commercial Partner in The Past Year ..................................................................................................................................................... 25 Figure 22. Percentage of IBBS Tanah Papua Respondent Who Used Condom at Last Sex With Steady, Casual and Commercial Partner.................................................................................................................................... 26 Figure 23. Percentage of IBBS Tanah Papua Respondent Who Seek Medical Treatment When Had STIs Symptoms in The Past Year .............................................................................................................................................. 26 Figure 24. HIV Prevalance of IBBS Tanah Papua Respondent ..................................................................................... 27 Figure 25. Distribution of Female Sex Worker and Waria Age 15 – 24 Years Old ....................................................... 29 Figure 26. Distribution of Female Sex Worker And Waria According to Age Group at First Sex ................................. 30 Figure 27. Distribution of Female Sex Worker And Waria According to Age Group at First Commercial Sex............. 30 Figure 28. Education of Female Sex Worker and Waria .............................................................................................. 31 Figure 29. Marital Status of Female Sex Worker ......................................................................................................... 32 Figure 30. Percentage of Female Sex Worker an Waria Who Have Comprehensive Knowledge ............................... 33 Figure 31.Percentage of Female Sex Worker and Waria Who Were Exposed to HIV Prevention Program in The Last 3 Months .................................................................................................................................................... 34 Figure 32. Percentage of Female Sex Worker and Waria Who Ever Received VCT Services ....................................... 34 Figure 33. Average Length of Selling Sex (Years) and Number of Client/Week of Female Sex Worker and Waria .... 36 Figure 34. Percentage of Female Sex Worker and Waria Who Use Condom at Commercial Sex ............................... 37 Figure 35. Percentage of FSW and Waria Who Had Sex With Casual Partner and Their Condom Use at Last Sex ..... 38 Figure 36. Prevalence of HIV and Syphilis Among Female Sex Worker and Waria ..................................................... 39 Figure 37. Prevalance of N. Gonorhoeae and C. Trachomatis Among Female Sex Worker and Waria ....................... 39 Figure 38. Distribution of IDU Age 15-24 Years Old .................................................................................................... 41 Figure 39. Percentage of IDU by Age Group of First Injecting Drug ............................................................................ 42 Figure 40. Education of IDU ......................................................................................................................................... 42 Figure 41. Marital Status of IDU .................................................................................................................................. 43 Figure 42. Percentage of IDU Who Have Comprehensive Knowledge and Service Provider Location ....................... 44 Figure 43. Percentage of IDU Who Were Exposed to Outreach and Harm Reduction Program ................................. 45 Figure 44. Percentage of IDU Who Received VCT Services ......................................................................................... 46 Figure 45. Distribution of Injecting Behavior of IDU ................................................................................................... 47 Figure 46. Percentage of IDU Who ever Had Sex and Average Number of Sex Partner in The Past Year ................... 48

xv | Age Group Disaggregation of Survey and Reseach Data

Figure 47. Percentage of IDU According to Type of Sex Partner in The Past Year...................................................... 49 Figure 48. Percentage of IDU Who Use Condom at Last Sex With Different Type of Partner..................................... 49 Figure 49. Percentage of IDU Who Always Use Condom at Sex in The Past Year With Different Type of Partner ..... 50 Figure 50. HIV and Syphilis Prevalence Among IDU by Age Group.............................................................................. 51 Figure 51. Distribution of MSM Age 15-24 Years Old .................................................................................................. 53 Figure 52. Distribution of MSM According to Age Group at Firts Sex ......................................................................... 54 Figure 53. Percentage of MSM According to Type of Partner at First Sex .................................................................. 54 Figure 54. Education of MSM ...................................................................................................................................... 55 Figure 55. Percentage of MSM Who Had Steady Partner According to Type of Steady Partner ................................ 56 Figure 56. Percentage of MSM Who Have Comprehensive Knowledge and Feel Risk to HIV Infection ..................... 57 Figure 57. Percentage of MSM Who Were Exposed to HIV Prevention Program in The Last 3 Months..................... 58 Figure 58. Percentage of MSM Who Ever Received VCT Services ............................................................................... 58 Figure 59. Percentage of MSM According to Type of Sex Partner in The Past Year ................................................... 59 Figure 60. Distribution of MSM Who Had Commercial Sex According to Age Group at Firts Commercial Sex........... 60 Figure 61. Average Length of Selling Sex (Years) and Number of Client/Week of MSM Who Sell Sex ...................... 61 Figure 62. Percentage of MSM Who Ever Use Drug and Injecting Drug .................................................................... 62 Figure 63. HIV and Syphilis Prevalance Among MSM by Age Group ........................................................................... 63 Figure 64. Prevalence of N. Gonorhoeae and C. Trachomatis Among MSM ............................................................... 63 Figure 65. Age Distribution of Prisoner ....................................................................................................................... 65 Figure 66. Education Level of Prisoner ........................................................................................................................ 66 Figure 67. Marital Status of Prisoner ........................................................................................................................... 66 Figure 68. Percentage of Prisoner According to Length of Sentence .......................................................................... 67 Figure 69. Percentage of Prisoner According to Time in Prison/Detention Center..................................................... 67 Figure 70. Percentage of Prisoner Who Ever Used Drug and Injecting Drug .............................................................. 68 Figure 71. Percentage of Prisoner With Drug Abuse Case .......................................................................................... 69 Figure 72. Percentage of Prisoner With Drug Abuse Case According Their Role ........................................................ 69 Figure 73. Percentage of Prisoner Who Feel Risk to HIV Infection ............................................................................. 71 Figure 74. Percentage of Prisoner Who Ever Received Information Related to HIV in The Past Year ........................ 71 Figure 75. Percentage of Prisoner Who Ever Reached by BCC Program in The Past Year .......................................... 72 Figure 76. Percentage of Prisoner Who Used Condom at Last Sex in Prison .............................................................. 74 Figure 77. Percentage of Prisoner Who Had STI Symptoms in The Past Year ............................................................. 75 Figure 78. Prevalance of Syphilis and HIV Among Prisoner ......................................................................................... 76

xvi | Age Group Disaggregation of Survey and Reseach Data

LIST of TABLE Table 1. Percentage of IYARS Respondent Who Have Correct Knowledge ................................................................... 8 Table 2. Percentage of BSS Among Student Respondent Who Have Correct Knowledge ............................................ 8 Table 3. Percentage of IYARS Respondent According to Source of HIV Information .................................................. 11 Table 4. Percentage of BSS Among Student Respondent According to Source of HIV Information............................ 11 Table 5. Ditribution of BSS Among High School Student Respondent Who Exposed to HIV & Drug Abuse Program in The Past Year ................................................................................................................................................. 12 Table 6. Percentage of IBBS Tanah Papua Respondent Who Have Correct Knowledge ............................................. 19 Table 7. Percentage of IBBS Tanah Papua Respondent Who Ever Received HIV Information and Source of HIV Information ................................................................................................................................................... 21 Table 8. Odds Ratio of Comprehensive Knowledge According to BCC Program Coverage ......................................... 22 Table 9. Average of Age at First Sex and Percentage Type of Partner at First Sex IBBS Tanah Papua Respondent .... 24 Table 10. Percentage of Female Sex Worker and Waria Who Have Correct Knowledge ............................................ 32 Table 11. Odds Ratio Program Coverage of Female Sex Worker and Waria Age Group 15-19 to 20-24 and 25 Years Old ................................................................................................................................................................. 35 Table 12. Percentage of IDU Who Have Correct Knowledge....................................................................................... 44 Table 13. Percentage of IDU Who Share Diluted Drug and Buy Drug Together in The Past Week ............................. 47 Table 14. Odds Ratio of HIV Positive Result With Several Risk Factors For HIV Transmission .................................... 51 Table 15. Percentage of MSM Who Have Correct Knowledge .................................................................................... 56 Table 16. Percentage of MSM by Number of Anal Sex Partner in The Past Month and Average of Number of Anal Sex Partner in The Past Year.......................................................................................................................... 60 Table 17. Percentage of MSM Who Use Condom at Sex With Cassual and Commercial Partner .............................. 61 Table 18. Percentage of Prisoner Who Have Correct Knowledge ............................................................................... 70 Table 19. Percentage Source of HIV Information Among Prisoner ............................................................................. 72 Table 20. Percentage of Prisoner Who Ever Received VCT Services ........................................................................... 73 Table 21. Percentage of Prisoner Who Ever Had Risk Behavior in Prison/Detention Center in The Past Year ........... 74

xvii | Age Group Disaggregation of Survey and Reseach Data

1.

INTRODUCTION

1.1. Background Over the last decade, there have been developments in the recognition of young people aged 10 to 24 years as a different population groups with different needs to infants, children or adults. Although the children more vulnerable to social, economic and health in society, WHO and UNICEF continue emphasizing and promoting the importance of adolescent health, because it is an investment for each country, and failure to do so will result in huge costs both socially, or the economy in the future.

Millions of young people throughout the world face a high risk of HIV infection and other negative consequences of sexual health as a result of behavior that they adopt, or are forced to do. Three groups of young people considered most at risk of contracting HIV in Indonesia is young men who have sex with other men and young people who sell sex or inject drugs. In addition to these three groups, other young people also have a high risk of HIV infection, especially in areas where the HIV epidemic enters such an advanced level in Papua and prison setting.

At the end of 2010, the Ministry of Health reported a cumulative number of 24.131 AIDS cases in Indonesia. Most (67%) are in the age group 25 years or older. While the proportion of AIDS cases of children under the age of 15 years was 2.9 percent and young people 15-24 years age group was 27 percent. More than half (52%) of reported AIDS cases transmitted through heterosexual transmission, and the remaining (38%) transmission were due to injecting drug use. Figure 1. Distribution Cumulative AIDS Cases Reported Through December 2010

1 | Age Group Disaggregation of Survey and Reseach Data

In addition, the Ministry of Health has also been estimated between 132 to 287 thousand Indonesian people aged 15-49 years living with HIV in 2009, and between 5 to 8 million people at risk for HIV transmission. Some of those at risk for HIV transmission are young people who are biologically and socially more vulnerable to contracting HIV.

Meanwhile, various programs and policies related to existing HIV control in general is still unable to respond to the special needs of young people in the most-at-risk population. Some programs face challenges because the available data to develop policies do not distinguish by age group, and lack of good examples of effective programs to provide inspiration and guidance. Therefore, to assist all parties in designing the of HIV control program among young people, NAC is technically and financially assisted by UNICEF Indonesia, perform advanced analysis of survey data and existing research in order to obtain a more in-depth information about young age in the most-at-risk populations contracting HIV.Simak

1.2. Objective The main objectives of further analysis of existing survey data are:

 Categorizing the key indicators of HIV control program, based on age group 15-20, 20-

24 years and above 25 years old.  Knowing the distribution of most-at-risk youth population in HIV transmission.  Analyzing different level on knowledge, attitude and behavior as well as program coverage among most-at-risk population by age group.  Analyzing the difference of HIV and STIs prevalence among most-at-risk population by age group.

1.3. Methodology Data Source This further analysis using secondary data from several cross sectional survey data in the period 2007 to 2009, obtained from raw data of reports and other publications, such as Central Bureau of Statistics, Ministry of Health (MoH), the Indonesian Red Cross and Provincial Health Office Nanggroe Aceh Darussalam (NAD). Survey data used in this further analysis are:

 Integrated HIV and Behavioral Survey among General Population, Tanah Papua,

conducted by BPS, Ministry of Health, Family Health International (FHI) and World Bank in 2006. 2 | Age Group Disaggregation of Survey and Reseach Data

 Indonesia Youth and Adolescent Reproductive Health Survey (IYARS) conducted by

Central Bureau of Statistics in 2007  Integrated Biological and Behavioral Survey (IBBS) among female sex workers (FSW) in 17 districts (Deli Serdang, Medan, Batam, West Jakarta, North Jakarta, Karawang, Bandung, Bekasi, Batang, Semarang, Malang, Banyuwangi, Surabaya , Denpasar, Sorong, Merauke and Jayapura) conducted by Central Bureau of Statistics, MoH, and FHI in 2007  IBBS in 3 cities (Jakarta, Bandung and Surabaya) and Behavioral Surveillance Survey (BSS) among Transgender (Waria) in 2 cities (Semarang and Malang) conducted by Central Bureau of Statistics, MoH and FHI in 2007  IBBS in 3 cities (Jakarta, Bandung and Surabaya) and BSS among Men who have sex with men (MSM) in 3 other cities (Medan, Batam and Malang) conducted by Central Bureau of Statistics, MoH, and FHI in 2007  IBBS in 4 cities (Medan, Jakarta, Bandung and Surabaya) and BSS in 2 cities (Semarang and Malang) among injecting drug users (IDUs) conducted by Central Bureau of Statistics, MoH, and FHI in 2007  BSS among high school students in the 2 cities (Jakarta and Surabaya) conducted by Central Bureau of Statistics, MoH, and UNICEF in 2007  Knowledge, attitude and practice of Female Sex Workers and Youth Survey in 3 districts/cities (Langkat, Pematang Siantar dan Tapanuli Tengah) conducted by Indonesian Red Cross -North Sumatra branch and The AIDSina Foundation in 2008  BSS among high school students and FSW in 4 cities (Banda Aceh, Lhokseumawe, Aceh Barat, Aceh Tamiang) conducted by Aceh Provincial Health Office and the AIDSina Foundation in 2008  IBBS among FSW in 9 districts (Palembang, Yogyakarta, Tangerang, Pontianak, Samarinda, Bitung, Makassar, Sorong and Mimika) conducted by Central Bureau of Statistics and MoH in 2009  IBBS among Transgender (Waria) in 3 cities (Palembang, Pontianak and Makassar) conducted by Central Bureau of Statistics and MoH in 2009  IBBS among MSM in 3 cities (Yogyakarta, Tangerang and Makassar) conducted by  IBBS among IDUs in 4 cities (Tangerang, Yogyakarta, Pontianak and Makassar)

conducted by Central Bureau of Statistics and MoH in 2009  BSS among high school students in 4 cities (Tangerang, Yogyakarta, Pontianak and Samarinda) conducted by Central Bureau of Statistics and MoH in 2009  The HIV and Syphilis prevalence and and HIV Risk Behavior Research among Prisoners in prisons and detention center in Indonesia conducted by the Directorate-General of Corrections Ministry of Justice and Human Rights, AusAID, HCPI and UNODC in 2010. The differences of surveillance title conducted by Central Bureau and MoH is associated with the biological examination of respondents, where in the BSS there is no biological examination at all (only data of the interview). Meanwhile, in the IBBS, HIV antibody test is 3 | Age Group Disaggregation of Survey and Reseach Data

conducted with 2 reagents which results can be attributed to the interview; In the IBBS the biological specimens (blood, urine, vaginal or anal swabs) also taken from respondent to detect other STIs (gonorrhea, Chlamydia, or syphilis) other than HIV. IBBS/BSS sampling methodology for injecting drug users (IDU) and men who have sex with men (MSM) in several locations and year of survey are not always the same where some data collected by cluster sampling method and some other uses Respondent Driven Sampling. However, the analysis and tabulation for reports was done in a similar way, therefore the same manner is applied for this analysis.

Data Analysis After the data collected from the data collection process and research activities, the data analysis activities is undertake which consist of 3 stages: 1. Preparation Phase

In the preparation phase several activities are carried out: (a) create a variable that will be analyzed from the same question and choices of answer or have the same intent with any survey data that have been collected, (b) examine the content and equate categorization of content as well as sequence of variables from each data set, and (c) compile selected variables into one data set

2. Tabulation Phase

Tabulation activities basically is categorizing data into frequency tables for analysis, consisting of: (a) Coding: creating a code for any data that has been edited and (b) generate some new variables resulting from other existing variables such as age for age groups and 5 variables of knowledge for a comprehensive knowledge

3. Data Application Phase

Data analysis being used is quantitative descriptive analysis aims to provide a description of the subjects analyzed based on data from the selected variable by using frequency and percentages tabulation technique. Data analysis was performed using computer application program Stata SE for Windows version 10.

4 | Age Group Disaggregation of Survey and Reseach Data

2.

RESULT

2.1. Youth in General The period between childhood and adulthood covers a wide age range and a significant variation in terms of physical, psychological, and social development. Besides age, factors such as marital status and economic independence has implications on how young people's views and how they see themselves. Adolescence is a time when puberty occurs, when the majority of people having sex, and when sexual preferences and identity are formed. Many characteristics of young people need to be considered in the design and delivery of services provided to them. These characteristics include age and gender, whether they are in school, family relations and support, and where they live (in rural or urban area). Program designed need to recognize these factors and, at the same time, take advantage of innovation, passion and optimism inherent in young people. During the second decade of life, young people undergo crucial transition, which usually includes not only sexual initiation but also leaving school, entering labor force, forming partnerships, and having children. This is the first period of experience, taking risks, and experiment with many things, including alcohol and other psychotropic substances. There are number of things, including the fact that their capacity for complex thinking is still evolving, influencing how young people deal with the environment and the challenges that surround them. Changes that occur during adolescence needs to be understood by those responsible for HIV programs because these changes affect:  How do youths understand the information

 What are the channels of information and how the information influence their behavior  How do they think about the future and make decisions in the present

 How do they perceive risk during their first experiment and experience

 How do they form relationships, respond to social values and norms that surround them,

and influenced by the attitudes of their peers and the environment that surrounds it.

To have further understanding about those issues, further analysis of the 2007 Indonesia Youth and Adolescent Reproductive Health Surveys (IYARS) and BSS result among high school students in 2007 – 2009 was conducted. IYARS conducted by Central Bureau of Statistics (CBS) at 1,694 census blocks in 33 provinces with number of 8,481 female respondents and 10,830 male respondents aged 15-24 years, while the 2007 BSS among second grade high school students aged 15-19 years conducted by CBS, MoH and FHI in Jakarta and Surabaya and the 2009 BSS in Yogyakarta, Tangerang, Pontianak and Samarinda. Numbers of BSS respondents are 3,043 female and 3,113 male. 5 | Age Group Disaggregation of Survey and Reseach Data

2.1.1.

Profile

Distribution In general, the population aged 15-19 years in Indonesia in 2010 was 9.3 percent of total estimated Indonesia population, while the population aged 20-24 years is 9 percent of total population. The lowest proportion of population aged 15-24 years from the total population (14.8%) in the Province of Bali, while the highest proportion in the province of Maluku (22%). Nevertheless, the highest estimated of population aged 15-24 years is in West Java with 7.4 million people, while the lowest is in Gorontalo province (172 thousand people) Figure 2. Distribution of Estimated Population Age 15-24 Years Old In Indonesia 2010

Education Education in this analysis is referred to the highest level of education ever passed by the respondent. With education a person can improve intellectual maturity, so be able to make decision to act. Education have an important role in determining quality of human being. With education, people are assumed to acquire knowledge and the implication is that the higher education, the better quality of human life. Education level is ought to be acknowledged for its correlation with the ability of each groups to respond a variety if information and communication messages related to HIV transmission. Studies in Africa and Asia with cross sectional method showed that educational level has a relationship with the level of knowledge and risk behavior of contracting HIV. Distribution of educational level among youths is quite varied by province, where in general the percentage of females 15-24 years age group who completed high school or 6 | Age Group Disaggregation of Survey and Reseach Data

university is higher compare to the male population. This may reflect that the education level of women aged 15-24 years in Indonesia is higher than men with same age group. Figure 3. Percentage of IYARS Respondent by Education Level

Marital Status In general, the percentage of women who ever married was much higher than men both at the age group 15-19 years and 20-24 years. In addition, the percentage of young peoples both men and women living in rural areas and ever married were also higher than those who live in urban areas. This indicates an average age of first marriage of women in Indonesia is younger compared to men, especially women who live in rural areas. Distribution of the mean age of first marriage of women who ever married also varies between provinces, ranging from 19.3 years (West Java) to the highest 22.2 years old (Maluku). Figure 4. Percentage of DHS Respondent Who Ever Married by Rural-Urban and Age Group

7 | Age Group Disaggregation of Survey and Reseach Data

2.1.2.

Knowledge

Several questions on IYARS and BSS among high school students can be used to measure the level of knowledge on HIV transmission and prevention of HIV among youths. Table 1 show that the percentage of female and male respondents of IYARS age group 15-19 years who have knowledge on HIV prevention and transmission, lower than the 20-24 years age group. Table 1. Percentage of IYARS Respondent Who Have Correct Knowledge Knowledge

Female

Male

15-19

20-24

15-19

20-24

% who know limiting sexual intercourse to one uninfected partner can prevent HIV infection

56

65

47

54

% who know condom can prevent HIV infection

61

69

69

76

% who know abstaining from sexual intercourse can prevent HIV infection

54

59

49

54

% who say a healthy-looking person can have AIDS

69

77

57

64

% who know HIV cannot be transmitted by mosquito bites % who know HIV cannot be transmitted by sharing food

29

28

22

27

35

32

27

24

Meanwhile the percentage of high school students BSS respondents who know HIV transmission and prevention is relatively not differ between male and female except for the knowledge that condoms use could prevent HIV in which the percentage of female respondents who know (66%) is much lower than male respondents (82 %). Table 2. Percentage of BSS Among Student Respondent Who Have Correct Knowledge Knowledge

Female

Male

% who know limiting sexual intercourse to one uninfected partner can prevent HIV infection

73

68

% who know condom can prevent HIV infection

66

82

% who know abstaining from sexual intercourse can prevent HIV infection

68

61

% who say a healthy-looking person can have AIDS

63

59

% who know HIV cannot be transmitted by mosquito bites % who know HIV cannot be transmitted by sharing food

94

92

72

77

8 | Age Group Disaggregation of Survey and Reseach Data

Percentage of IYARS respondent’s age groups 15-19 years who have the knowledge of HIV prevention and transmission is generally lower than the percentage of BSS high school student respondent. Even for the knowledge of false HIV transmission such as HIV is transmitted through mosquito bites and sharing eating/drinking dishes with people living with HIV, the percentage of respondent from high school student BSS 2-4 times better than IYARS respondent’s age group 15-19 years. This is most likely because IYARS respondents are adolescents in the general population with varying levels of education and so represent youth profile as a whole. In addition, IYARS respondent’s age group 15-19 years comes from urban and rural areas while high school student BSS only done in big cities. UNAIDS also has set the standard to measure the level of comprehensive knowledge on HIV transmission and prevention which is a combination of 5 knowledge, namely:

1. 2. 3. 4. 5.

Know that a person's HIV status can NOT be known just by looking at appearance Know that using condoms when having sex can reduce the risk of HIV infection Know that faithful to each other on a single pair can reduce the risk of HIV infection Know that mosquito/insect bites can NOT transmit HIV Know that HIV is NOT transmitted by sharing eating/drinking dishes with people living with HIV

IYARS Results showed that respondents who have comprehensive knowledge are still very low, in which the female respondents have a little better knowledge rather than the male respondents. The low level of comprehensive understanding on IYARS respondent’s caused by the misconceptions on HIV transmission and prevention. Figure 5. Percentage of IYARS Respondent Who Have Comprehensive Knowledge

9 | Age Group Disaggregation of Survey and Reseach Data

While the percentage of BSS high school student male and female respondents who have comprehensive knowledge on HIV transmission and prevention did not differ significantly, but the varied between survey locations and ranged from 17 percent in Surabaya city to 32 percent in Yogyakarta city. Figure 6. Percentage of BSS Among Student Respondent Who Have Comprehensive Knowledge

2.1.3.

Source of Information & Program Coverage

Sources of information about HIV and AIDS most frequently received by the IYARS respondent 15-19 years age group comes from television, followed by teacher/school and then newspapers/magazines. While among IYARS respondents age group 20-24 years, the percentage of source information from newspapers/magazines is higher than the school/teacher. Therefore, HIV and AIDS related information conveyed through the medium of television and newspapers/magazines need to get attention from all parties in order to effectively improve the correct knowledge and reduce as much misunderstanding regarding modes of HIV transmission among young people.

10 | Age Group Disaggregation of Survey and Reseach Data

Table 3. Percentage of IYARS Respondent According to Source of HIV Information Source of Information

Female

Male

15-19

20-24

15-19

20-24

TV

76

83

74

80

School/Teacher

53

42

48

36

News paper/Magazine

35

50

30

38

Friend

35

35

37

37

Radio

26

35

28

31

Poster

4

5

6

9

Health worker

5

5

5

6

Surrounding

3

5

2

3

Internet

2

3

1

2

Percentage distribution of sources of information received by male and female respondent of high school student BSS are almost equal to distribution of IYARS respondent 20-24 years age group, where newspaper/magazine is slightly higher than school/teacher. In general, the percentage of all sources of information about HIV and AIDS stated by more respondent of high school student BSS rather than IYARS respondents’ age group15-19 years. Table 4. Percentage of BSS Among Student Respondent According to Source of HIV Information Source of Information TV News paper/Magazine School/Teacher Friend Family Radio Poster Health Worker Billboard NGO Worker

Female

Male

94 73 66 54 51 44 40 38 21 16

94 68 56 53 42 41 44 36 26 18

11 | Age Group Disaggregation of Survey and Reseach Data

In addition to sources of information on HIV and AIDS, respondent of high school student BSS were also asked about several HIV prevention programs they ever receive at school in the last1 year, where the percentage of respondents who received education about drug abuse is the highest, followed by education about HIV and AIDS. While the STI education, reproductive health educatio/n and peer educators activities only reach less than half the respondents. In general, the percentage of respondents from high school students BSS in Yogyakarta that been exposed to HIV prevention-related programs is higher than other cities. Table 5. Ditribution of BSS Among High School Student Respondent Who Exposed to HIV & Drug Abuse Program in The Past Year

% who participate drug abuse information session % who participate HIV/AIDS information session % who participate reproductive health information session % who participate in life skill education % who participate STI information session % who participate in peer educator

2.1.4.

Yogyakarta

Tangerang

Pontianak Samarinda

Jakarta

Surabaya

84

74

73

81

85

86

77

64

67

66

56

50

55

28

40

33

18

30

45

32

27

34

30

26

42

16

27

23

14

16

35

19

22

20

20

26

Sex Behavior and Condom Use

Percentage of SKRRI respondents who had sex can describe the percentage of young people who are not married and had sex in Indonesia, where from Figure 6 can be seen that the percentage of unmarried young men who claimed to have sex is much higher than women. Percentage of women 15-19 years age group who are not married and had sex was 1.3 percent, lower than men the same age group (4%). While the percentage of women aged 20-24 years who were not married and had sex was 1.4 percent, also much lower than male age group 20-24 years (11%).

12 | Age Group Disaggregation of Survey and Reseach Data

Figure 7. Percentage of IYARS Respondent Who Ever Had Sex

The reason for first sexual intercourse differs among female and male respondents, where some of the reasons most frequently mentioned by female respondents in a sequence is just happens (38%), forced by partner (21%), out of curiosity and getting married (7 %) and influenced by friends (6%). While among male respondents the reason is because they want to know (51%), just happens (26%), out of curiosity and getting married (7%) and influenced by friends (4%). The high proportion of reason forced by the partner among female respondents need to get attention from all parties, especially for policy makers to be able to design programs that can suppress the incident. Percentage of respondents from high school students BSS who ever had sex is much higher than the percentage of IYARS respondents’ age group 15-19 years. Percentage of respondents from high school students BSS who ever had sex ranged between 3.1 percent (Tangerang) to 11.1 percent (Surabaya), even 1.9 percent of high school students respondent in the city of Surabaya, claimed they had commercial sex (selling/buying) in the last 1 year. While respondents of high school students BSS who claimed to have anal sex in the last 1 year also exist in all the cities surveyed, which ranged between 0.8 - 3.2 percent.

13 | Age Group Disaggregation of Survey and Reseach Data

Figure 8. Percentage of BSS Among Student Respondent Who Ever Had Sex in The Past Year

Aside from many respondents of high school students BSS who ever had sex, it turns out from those who had sex also had more than one partner in the last one year. This can be seen in Figure 8 where the mean number of sexual partners of respondents from high school students BSS who ever had sex ranged from 1.6 (Pontianak) to 2.7 (Surabaya). Even in Surabaya at least half of those who had sex had it with 2 different people in the last 1 year. Figure 9. Number of Sex Partner in The Past Year of BSS Among Student Respondent

While the level of consistent condom use in the last 1 year is still very low and it ranged only between 3 percent (Tangerang) to 18 percent (Pontianak). This indicates that most respondents of high school students BSS who had sex is at risk for HIV and STIs transmission. 14 | Age Group Disaggregation of Survey and Reseach Data

Figure 10. Percentage of BSS Among Student Respondent Who Use Condom

2.1.5.

Drug Use

Percentage of respondents from high school students BSS who had drunk from alcohol drinking is quite high, ranging between 15 percent (Samarinda and Pontianak) to 27 percent (Surabaya). In the drunk condition, young people are more likely to have risky behavior, it is shown in the regression analysis between ever having sex and ever drunk that indicate a statistically significant relationship with the Odds ratio 7.11 with 95% Confidence Interval (CI) between 8.8 - 15.4 and p value