Suicide Behavior Among Indigenous and Non-Indigenous Living with HIV: A Cross-Sectional Study in Indonesia.

Suicide remains a major public health problem, with nearly 1 million deaths per year. The number tends to increase over time and factors leading to suicide suicidal behaviors are complex. However, there is a paucity of evidence on suicidal behaviors and the associated factors among people living with HIV (PLWH) in Indonesia. Therefore, this study aimed to estimate the prevalence and associated factors of suicidal behavior between indigenous and non-indigenous living with HIV who were on Dolutegravir and Efavirenz therapies. The cross-sectional data were collected using questionnaires. Participants completed the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Depression Anxiety Stress Scale-42 (DASS-42), HIV Stigma-Sowell Scale, and demographic information questions. The outcome was low and high self-reported suicidal behaviors, while logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of high suicidal behaviors. A total of 200 PLWH were enrolled and 8.5% of the participants had high levels of suicidal behaviors. The majority of participants were Efavirenz users (84.0%), and Papuans as Indigenous (75.5%). More than half had a high school education (60.5%), were female (58%), married (54%), and unpaid (59%). The multiple logistic regression model showed that indigenous (aOR = 0.122; 95% CI = 0.029-0.514), and people who had children (aOR = 0.221; 95% CI = 0.051-0.957) were more likely to have low suicidal behaviors. Participants who were aged 18-27 years (aOR = 5.894; 95% CI = 1.336-30.579), had high self-blame (aOR = 1.342; 95% CI) = 1.004-1.792), and detectable HIV viral load (aOR = 6.177; 95%CI = 1.118-34.119) had high suicidal behavior. This study identified the risk of suicidality among PLWHs is high and routine suicide assessment is prioritized. The findings are also useful for intervention design and the development of clinical practice guidelines to manage the well-being of PLWH such as using digital intervention to cope with hindrances.

Determinants of quality of life among people with HIV and tuberculosis in an underserved area in Indonesia: a cross-sectional study.

Introduction: human immunodeficiency virus (HIV) and tuberculosis (TB) remain global health problems and impose a substantial reduction in people´s quality of life (QoL). This study aimed to assess and compare the QoL in HIV and TB patients and factors associated with QoL between those groups. Methods: a cross-sectional study was conducted at a hospital clinic in Jayapura, Indonesia, between December 2022 and March 2023. Those who were aged above 18 years, diagnosed with HIV or TB infection, have been taking HIV or TB medications for at least 3 months, and provided informed consent were eligible to participate. Patients´ QoL was measured using the Bahasa Indonesia version of a validated 26-item World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire. Results: a total of 365 patients with HIV and 125 with TB were included. The majority of participants were Papuan (75.9%) and aged 20 - 65 years (92.9%). More than half of the participants were female (56.5%), employed (50.8%), married (65.5%), and had family support (64.9%). Education level and social support were predictors of poor physical health in the HIV group, while ethnicity was a predictor in the TB group. Patients´ age was associated with poor psychological health in HIV, whereas sex was the associated factor in TB patients. Ethnicity was the only predictor of poor social relationships in those with TB. Whereas patients´ age was a predictor of poor environmental health in the HIV group, marital status, and education were predictors in the TB group. Finally, only social support was associated with poor general QoL in TB patients. Conclusion: tuberculosis (TB) patients had poorer QoL than those with HIV. There is a need for more awareness to support those receiving TB treatment. In addition, further research is needed to understand in more detail the determinants of patients with drug-resistant TB, TB with HIV, and drug-resistant TB-HIV, to ensure that interventions are designed to help them.

Understanding reasons for lack of acceptance of HIV programs among indigenous Papuans: a qualitative study in Indonesia.

BACKGROUND: Melanesians are indigenous Papuans racially and culturally different from most Indonesians. The Melanesia region is characterised by high poverty and inequalities, even though it has the highest revenue. Furthermore, Papua has the highest HIV prevalence rate, 24-fold higher than that of other regions. Therefore, this study aimed to examine the resistance of indigenous people residing in eastern Indonesia towards HIV programs. METHODS: This is a qualitative study analysed using grounded theory. Data were collected from July to September 2018 through semi-structured face-to-face interviews involving 23 Papuans. The interviews were conducted in Bahasa Indonesia, audio-recorded, summarised and transcribed for analysis. RESULTS: The results showed that being a good Papuan emerges from four interconnected categories, including culture and religion, dealing with modernisation, integrated HIV program and stigma reduction. As a substantive theory underpinning the indigenous people's experiences with HIV programs, 'Keep being a good Papuan' was a way of overcoming problems and dealing with modernism to eliminate HIV. This largely focuses on the local culture, implying any adjustment should keep their tradition and welcome modernism. CONCLUSIONS: The future of the HIV programs should be agreed upon, funded, implemented, measured and achieved by stakeholders. This could be achieved by elaborating a supportive culture and community-based interventions. Furthermore, the implementation should be prioritised to integrate and improve the programs' quality to take into account community needs and the available resources.

Daily struggle to take antiretrovirals: a qualitative study in Papuans living with HIV and their healthcare providers.

OBJECTIVE: The aim of the study was to explore the experiences of Papuans living with HIV to take antiretroviral therapy (ART) from the patient and the healthcare providers (HCPs) perspective. DESIGN: This was a qualitative study covering all five tribes located in Papua Provinces one of two Indonesian provinces on Papua Island. Semistructured interviews were conducted with Papuans living with HIV and their HCPs. Interviews were transcribed verbatim and coded to find themes. RESULTS: Overall, we conducted interviews with 13 Papuans living with HIV (mean age: 33 years, 61% female) and 14 HCPs (mean age: 42 years, 64% female) within five customary areas. HCPs included three physicians, nine nurses, two others. Two main themes were identified: (1) personal factors and (2) healthcare environment-related factors. Personal factors were beliefs and knowledge of ART, stigma from family, community and HCPs as well as practical problems such as transportation because of long distance. Within the theme of healthcare environment, the competences and attitudes of HCPs were particularly relevant. The findings are important in refining HIV treatment strategies implemented in Papua, especially when extending HIV care provided by community centres. CONCLUSIONS: Despite free access to ART, Papuans living with HIV struggle to remain on treatment. Considering local culture and religion in strategies to reduce stigma should be a priority.