The health of female prisoners in Indonesia.

PURPOSE: Indonesian law provides prisoners with basic rights, including access to education, health care and nutrition. Yet, structural and institutional limitations, notably overcrowding and under-resourcing, prohibits penal institutions from fulfilling these commitments for female prisoners. The purpose of this paper is to explore their health concerns. DESIGN/METHODOLOGY/APPROACH: Six prisons and one detention centre were researched, comprising: female prisoners (n=69); clinical officers (six); clinic heads (seven); wardens (seven); heads of prisons (seven); and a Directorate representative. Data were collected through observation, focus group discussions, in-depth interviews and a semi-structured questionnaire. Raw data were transcribed and analysed thematically, adopting the General Principles of Grounded Theory. FINDINGS: Both "formal" and "informal" health-coping strategies were dependent upon a range of factors which determined access to treatment, medicines and other items procured both inside and outside of the prison, as well as referral services. Informal systems of support existed for women, especially in regard to pregnancy and raising of babies born in detention. Systems that maintain harmony within cell blocks were identified as an important informal coping strategy. ORIGINALITY/VALUE: This research is important in informing policy and practice. There is a clear need for gender-sensitive legislative frameworks, penal policies and prison rules to ensure women's needs are addressed. The identified coping strategies were considered viable, but do not replace the need for a health system providing women prisoners with levels of care as available in the community, including commensurate budgeting, personnel, access and referral to more specialised external health services.

Prevalence over time and risk factors for sexually transmissible infections among newly-arrived female sex workers in Timika, Indonesia.

BACKGROUND: HIV rates are escalating in Indonesia. At Timika in Papua, the world's largest gold mine employs many single and migrant men, who frequently have sex with female sex workers (FSWs). We investigated trends of sexually transmissible infections (STIs) in FSWs in Timika. METHODS: From 1997 to 2002, FSWs at clinics were recruited for their first STI screening. Sociodemographic and sexual behaviour data were obtained and laboratory tests were performed to diagnose STIs. RESULTS: From 1997 to 2002, 3086 FSWs were recruited. Prevalence of gonorrhoea varied from 11% to 19% (P = 0.71). Positive treponemal serology varied from 1.4% to 5.1% (P = 0.50). Trichomoniasis declined from 16% to 11% (P = 0.03). HIV infection increased significantly from 0.0% to 1.4% (P = 0.002). Chlamydia prevalence did not significantly change from 33% in 1997 compared with 41% in 1998 (P = 0.10). Consistent condom use was low, but increased from 8% to 16% (P = 0.001). Any STI was independently associated with younger age, high frequency of sexual activity, and not using contraceptives. CONCLUSIONS: The high rates of STIs, low condom use and increasing prevalence of HIV among these FSWs require enhanced interventions, and consideration of periodic presumptive treatment. A partnership with industry can aid and sustain an intervention program.