THE INTEGRATION
OF HIV AND AIDS
RESPONSE
INTO THE HEALTH SYSTEM :
Landscaping from nine provinces in
TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesia
ǣIgnatiusPraptoraharjo;IkoSafika;M.Suharni;IgnatiusHersumpana;ChrysantLilyK; ItaPerwira;SatitiRetnoP;SwastiSempulur;EvianaHapsariDewi
Ƭǣ
UniversityTeams:
 ǣǡǡǤǢǤ  ǣǤǡǢǤǡ  ǣǡǡǢǡ
 ǣǤǡǤǢǤǤǡ  ǣǡǡǢǡǡ  ǣǡǡ
ǣ 
TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesiaȀǢǢǤǢ ǢǢǢǢǢ Ȁǣ ȋȌ   ǡ ǤȋȌ
ͳʹͷ Ǣͻʹ
ǡʹͲͳ ǣͻͺǦͲʹǦͲͺͷǦʹǦͺ
ͳǤʹǤ͵ǤͶǤ ͷǤ
I.TheIntegrationofHIVandAIDSResponseintotheHealthSystem:Landscappingfrom nineprovincesinIndonesia
     ȋ Ȍ          ȋȌǡ   ǡǤ  Ǥ
Ǥ
       ǡ ǡ  ǡ ǡ                ǡ     Ǥ
              ȋȌǡ   ǡǤ
 ǣ
Ǥ ʹͲͳǤTheIntegration ofHIVandAIDS Responseinto theHealthSystem: LandscappingfromnineprovincesinIndonesia.ǣ
̹ʹͲͳ
3
Foreword
Ǧ
DFAT
ǦȋȌ ̵ǡ        ǡ     Ǧ       Ǥ
ǡ  ǡ̵                Ǥ
ǡ ǡ Ȁ ǡ    ȋ ǡ ǡ  ǡ ǡ  ǡ  ǡ ǡȌǤ
                  ̵  ǡ     Ǥ ǡ      Ǥ   ǡ   ǡ           Ȁ ǡ            Ȁ     Ǥ
 Ǧ    Ǥ    Ȁ          ȀǤ
4
Foreword
–
Indonesian
Ministry
of
Health
ǡ ̶ ̶ǡ Ǥ  ǡ             ǡ      ǡ   ǡ         ǡ   Ǥ
   ǣȋͳȌ  ǡȋʹȌ                           ǡ      Ǧ Ǥ            ͺ   ͳͳ  Ȁ Ǥ       ǡǦ    ȋ Ȍǡ ǡ ǡǡ Ǧ  Ǥ
                         ǡ ǡ             Ǥ ǡ  ǡǡ     Ǥ
ǡ              ȋȌ   ǡ  ǡǡ           ǡ                   Ǥ
5
Table
of
Contents
ForewordǦDFAT...3
Foreword–IndonesianMinistryofHealth...4
TableofContents...5
ListofTables...8
ListofDiagrams...8
ListofFigures...8
ListofAcronyms...9
ExecutiveSummary...12
I. Introduction...14
Ǥ...14
Ǥ...15
Ǥ  ...17
Ǥ ...17
Ǥ  ...17
Ǥ ...18
Ǥ ...19
Ǥ  ...19
Ǥ ...20
Ǥ ... ....20
Ǥ... ....20
Ǥ...21
Ǥ ... ..21
Ǥ ...23
II. Context...24
Ǥ  ...24
Ǥ ...24
Ǥ...25
Ǥ  ... ...25
Ǥ ...26
Ǥ  ...27
C.LocalResponsetoHIVandAIDS...28
6
A.Introduction... ...31
RolesandInteractionsofStakeholdersinHIVandAIDSResponse...31
    ǡ Ȁ  Ǥ  ǡ  ȋȌͳͲ  Ǥǡ ǡ   ͳͲ Ǥǡ Ȁ    ǤȀ ͻ Ǥ   ͺǡͷǤǡǡǡ Ȁǣ...31
ͳǤ...33
a.HighInterestsandHighPower...33
b.HighInterestandLowPower...35
c.HighPowerandLowInterest...39
d.LowPowerandLowInterest...41
ʹǤ ...43
IV.PatternsofIntegration...46
Ǥ ... ...46
Ǥ  ...46
ͳȌ...46
ʹȌ  ... ...49
͵Ȍ ...52
ͶȌ ...57
ͷȌ   ...59
Ȍ ...61
Ȍ ...63
Ǥ  ...68
Ǥ...70
1....71
2....71
3. ...72
Ǥ ...72
Ǥ   ...73
Ǥ ...75
V. ConclusionsandRecommendations...78
7
Ǥ ...80 Bibliography...82 Appendix1.ResearchInstrument:PrimaryDataCollection...85 Appendix2.SubǦsystem,Dimensions,andQuestionsthatLeadtoMeasurementof Integration...89
8
List
of
Tables
ͳǤ  ...22
ʹǤ   ...33
͵Ǥ Ȁ  ...37
ͶǤǦ  ...42
ͷǤ   ...54
Ǥ  ...63
Ǥ  ...68
ͺǤ...70
ͻǤ  ...72
List
of
Diagrams
Figure1.HIVPrevalenceper100.000peopleinthestudylocations...27
ʹǤ ...28
͵Ǥ ...30
ͶǤ ...32
ͷǤ   ...50
Ǥ ǣ...76
Ǥ...77
List
of
Figures
ͳǤ  ...18
ʹǤ...32
9
List
of
Acronyms
   
Ȁ AnggaranPendapatandanBelanjaNasional/Daerahȋ Ȁ Ȍ
  
 Badan Perencanaan Pembangunan Daerah ȋ     Ȍ
 BadanPerencanaanPembangunaKotaȋ Ȍ BadanKepegawaianDaerahȋ  Ȍ
   
 ǡ  DinasKesehatanȋ  Ȍ
 DinasPendidikandanOlahRagaȋ   Ȍ DinasTenagaKerjadanTransportasiȋ 
 Ȍ
 DinasSosialȋ   Ȍ
 DinasSosialdanTenagaKerjaȋ   Ȍ DaerahKhususIbukotaȋ Ȍ
Ȁ DiskusiKelompokTerarahȀ   
DewanPerwakilanRakyatDaerahȋ Ȍ  FasilitasPelayananKesehatanȋ   Ȍ
FakultasKedokteranȋ   Ȍ
 
   
InfeksiMenularSeksualȋ Ȍ InfeksiOportunistikȋ  Ȍ
JaminanKesehatanNasionalȋ Ȍ  JaminanKesehatanMasyarakatȋ Ȍ  JaminanKesehatanDaerahȋ  Ȍ
KelompokDukunganSebayaȋȌ  KementerianKesehatanȋȌ KesehatanIbudanAnakȋȌ
Komunikasi, Informasi, dan Edukasi ȋ ǡ    Ȍ
 KomunikasidanInformatikaȋ  Ȍ ȀȀ KomisiPenanggulanganAIDSNasional/Provinsi/Kota/Kabupaten ȋȀ ȀȀ  Ȍ
Ȁ KonselingdanTesSukarelaȀ LayananJarumdanAlatSuntikSterilȋ Ȍ
LayananKomprehensifBerkesinambungan ȋ    Ȁ Ȍ
ʹ LembagaPengkajianDanPemberdayaanEkonomiMasyarakat ȋ     Ȍ
LelakiSeksdenganLelakiȋȌ
10 
MitraPembangunanInternasionalȋȌ  MusyawaranPerencanaanPembangunanȋȌ Narkoba,PsikotropikadanZatAdiktif ȋ  ǡ   ǡ     Ȍ
OrangDenganHIVdanAIDSȋȌ OrganisasiMasyarakatSipilȋ Ȍ OrganisasiBerbasisSosialȋ Ȍ
OrganisasiBerbasisMasyarakatȋȌ  OrganisasiKemasyarakatanȋȌ
 OtonomiKhususȋ Ȍ
PendapatanAsliDaerahȋ Ǧ Ȍ
Ȁ Perawatan,DukungandanPerawatanȀǡ  PemerintahDaerahȋ Ȍ
 PenggunaNapzaSuntikȋ Ȍ  PeraturanGubernurȋ̵Ȍ  PeraturanDaerahȋ Ȍ
 PeraturanKementrianDalamNegeriȋ̵Ȍ  PeraturanWalikotaȋ̵Ȍ
Ǧ
PusatKesehatanMasyarakatȋȌ
PusatKebijakandanManajemenKesehatanȋ 
Ȍ
PusatKesehatanReproduksiȋ Ȍ
PencegahanHIVMelaluiTransmisiSeksualȋ
Ȍ
 KelompokStudiKhususȋ Ȍ  KelompokKerjaȋȌ
 KepolisianResorKotaBesarȋ Ȍ  PosPelayananKhususȋ Ȍ
Ȁ PusatPenelitianHIVdanAIDSȀ 
Pencegahan Penularan dari Ibu ke Anak ȋ    Ȍ
Program Terapi Rumatan Metadon ȋ    Ȍ
 PusatKesehatanMasyarakatȋ Ȍ  RencanaStrategisȋ Ȍ
Ƭ  Ƭ
 
 ResikoTinggiȋȌ  RumahTahananȋȌ
RumahSakitȋȌ
RumahSakitUmumDaerahȋ  Ȍ
RencanaPembangunanJangkaMenengahȋǦȌ RencanaPembangunanJangkaMenengahDaerahȋ Ǧ
Ȍ
SurveiCepatPerilakuȋȌ SumberDayaManusiaȋ Ȍ SuratKeputusanȋ Ȁ Ȍ
SistemKesehatanNasionalȋȌ
SatuanKerjaPemerintahDaerahȋ Ȍ SistemInformasiHIV/AIDSȋȀȌ
11
SistemInformasiPerkumpulanKeluargaBerencanaIndonesia ȋ    Ȍ
Ȁ SistemInformasiKesehatanNasional/DaerahȋȀ 
Ȍ
 
StrategiRencanaAksiNasionalȋ  Ȍ
ȀIBBS SurveilansTerpaduBiologisdanPerilaku/      
 
 
ǦǦ
 
ȀMMT TerapiRumatanMetadon/   TugasPokokdanFungsiȋ  Ȍ
WawancaraMendalamȋǦȌ WargaPeduliAIDSȋ Ȍ WanitaPekerjaSeksȋ Ȍ
WanitaPekerjaSeksLangsungȋ  Ȍ WanitaPekerjaSeksTidakLangsungȋ  Ȍ
 
Ȁ
  ̵         
UndangUndangȋȌ
   
 
12
Executive
Summary
    Ǥ       ǡ                   Ǥ
             Ǥ                     Ǥ  ǣͳȌ  ǢʹȌ   ͷǦͳͲǤ                 ͳͳ Ȁ Ǥ    etalǤǯǡȋʹͲͳͲȌǤ
  Ǥǡ                   Ǥ ǡ                        ǡ      Ǥ                 Ǥ    Ǥǡ                 Ǥ
   Ǥ        continuumofcare     ǡ ǡ    ȋȌ      Ǥ                        Ǥ   ǡ            Ǥ ǡ         ǡ    ǡ               Ǥ
      Ǥ                      Ǥ ǡ               Ǥ          ǡ        ǯ Ǥ ǡ      ǯ  Ǥ          ǡ   Ǥ
13
 ǡǡ           Ǥ          ǡ    ǡ    ǡ ǡ    Ǥ ǡ       ǡ  ǡ       ǡ Ǥ
 ǡ ǡ        ǡ  ǡ               Ǥ        Ǥ                          Ǥ
ǡ       ǡ              ǣ ͳȌ       ȋǤǤ     ǡ Ȁǡ     Ǧ      Ȍ          Ǣ ʹȌ            Ǣ ͵Ȍ                       ȋ Ȍǡ ǡǡ   ǢͶȌ                   ǢͷȌ       Ǧ      Ǣ Ȍ      ǢȌ                                  Ǥ
ǡ                     Ǥ  ǡ                Ǥ       Ǥ
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 14
I.
Introduction
A. HIV
and
AIDS
Response
in
Indonesia
   ȋͳͻͺȌǡ   Ǥ    ǦͳͻͻͲǤ ǡ            Ǥ              Ǧ  ȋǡ ʹͲͳͶȌǤ
             Ǥ͵ͳͻͻͶ  ǡǤǤ    ȋKomisiPenanggulanganAIDSNasional Ǧ ȌǤ   Ǥ ǡ ȋStrategiRencanaAksi NasionalǦȌǡ ͳͻͻͷʹͲͲͲǤ ǡ                 Ǥ ǡ        ǡ        ǡ  ȋǣ Ȍǡ               Ͳ        Ǥ             ʹͲ   ȋǡ ʹͲͳͶȌǤ        Ǥ
    ʹͲͲͲ     Ǥ     Ǥǡ    Ǥ  ǡ    ȋ Ȍ        ʹͲͲ͵     ȋ ͳȌǤ  ͳͻ ʹͲͲͷ ʹͲͳͲ ȋ  ͶȌǤ    ǡ      ǡ ͳͲȋǡʹͲͳͳȌǤ
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 15
   ǡ     ȋƬȌǡ     ǡ              Ǥ
ʹͲͳʹ    ǡǡ   Ǥ               ȋǡʹͲͳʹȌǤ                   ȀȋȌǤ  Ǥ        ȋȌ Ǧ      Ǥ          Ǥ  ǡ            Ǥ                Ǧ     Ǧ            Ǥ
B. The
Health
System
and
HIV
and
AIDS
Response
                                     Ǥ              ǡ                            ͶͲΨ      ȋǡ ʹͲͳ͵ȌǤ                 ȋ  Ǥǡ ʹͲͳͲǢ Ǣ   Ǥǡ ʹͲͳ͵Ǣ   Ǥǡ ʹͲͳͲǢ   Ǥǡ ʹͲͲͺǢ   Ǥǡ ʹͲͳʹǢ ǤǡʹͲͳͲȌǤǡ         ȋǡʹͲͲͲȌǤ
                ǣȋͳȌǡǤǤ ǢȋʹȌ  Ǣȋ͵Ȍ     Ǣ ȋͶȌ  ǡ      ǢȋͷȌ      Ǥ
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 16
 ȋȌ Ǥ  ǡƬǡǡǡ               ȋetalǤǡʹͲͳͲǢetalǤǡʹͲͳͲȌǤ         ͳͻͺ  ʹͲͳ͵ ȋǡ ʹͲͳͷȌ      ǣȋͳȌ                  ǢȋʹȌ ǡ           ǡ   ǡ ǡ     Ǣ ȋ͵Ȍ               Ǣ                ǡ ǡǢȋͶȌ    Ǥ
                        Ǥ      ȋ   Ȍǡ ȋǡʹͲͳͳǡetal.ǡʹͲͳͲȌǤ DzdzDz   Ǥ         Ǥ ǡ              ǡ        ȋ ǡʹͲͳʹȌǤ
ǡ      Ǥ   Ǥǡ  ȋ ǡ ʹͲͳʹ  etalǤǡ ʹͲͳͲȌǤ             Ǥ ǡ                                  Ǥ          ǡ ǡ   ȋ  ǡ ʹͲͳͳǢ etal., ʹͲͳͲȌǤ                ǡ    Ǥ
              ǣȋͳȌ  ȋʹȌ             Ǣ       ǡ    Ȁ ǡ   Ǧ      Ǥ
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 17
 Ǥ
C. Research
Questions
and
Objectives
a. ResearchQuestions
             ǫ
   ǣ
ͳǤ    ǡ             ǫ
ʹǤ              ǡ  Ȁ  ǡ    ǫ
͵Ǥ   ǫ
ͶǤ      ǡ ǡ       ȋe.g.ǡȀ Ȍ  ǫ
ͷǤ ǡ   Ǧ    ǫ Ǥ             
 ǫ      ̵ ̵        ǫ
Ǥ  ǡ  ǡ      ȋJaminanKesehatanNasionalǦȌǫ ͺǤ    
ǫ
ͻǤ   ǡ  ǫ
b.ResearchObjectives
                     ͷǦͳͲ Ǥ   ǡ        ǣ
ͳǤ  ǡ     Ǣ
ʹǤ          ǡ   ǡ   Ǣ
͵Ǥ  Ǣ ͶǤ   ǡ ǡ      
ȋe.gǤ  ǡ Ȁ      Ȍ    Ǣ
ͷǤ    ǡ        Ǧ   Ǣ Ǥ  
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 18
Ǥ ǡ ǡ        Ǣ
ͺǤ     Ǣ ͻǤ 
 ǡ  Ǥ
D. Conceptual
Model
  Ǥ   etal., ȋʹͲͳͲȌ   ȋʹͲͳͲȌ                ȋ ͳȌǤ
Figure1.ConceptualFramework
 etal., ȋʹͲͳͲȌǡ                             Ǥ         Ǥ  ȋ  Ȍ   ǡ    Ǥ   ǡ            ȋǡ ʹͲͲȌǤ     ǡ        Ǣ Ǣ Ǣ Ǣ  Ǣ ǡ  ȋ ǤʹʹͲͳʹȌǤ
HealthIssues Law
Politics Economics
Strategi c Info
Communi ty Provisionof
Drugs and Human
Resour Management
and Financing
HealthSystem
Strategi c Info
Communi ty Provisionof
Drugs and Human
Resour Management
and
Financing
HIV&AIDSServiceDelivery Prevention CST and Impact Mitigation
HIV&AIDSProgression
s
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 19
         ǣ ȋͳȌ                ǡ ǡ     Ǣ ȋʹȌ   Ǣ ȋ͵Ȍ          Ǣ  ȋͶȌ   ǡ   ǡ               Ǥ ǡ                 ǡ ǡ ǡ    ǡ ǡ     Ǥ
ǡ                           ȋǡ   ǡ    ȌǤ              ǣȋͳȌ  ȋ ȌǢȋʹȌ    ȋ ȌǢȋ͵Ȍ    Ǧ   Ǥ
E. Research
Methods
   ʹͲͳ͵ ʹͲͳǤ  ǡǡǡǡ    Ǥ        ǡ   Ȁ     Ǥ
                      Ǥ                                         Ǥ
a. ResearchDesignandProcedure
   Ǥ    ȋʹͲͲ͵Ȍǡ  ǣ
ͳǤ Thefirstphase:  maindata(primary)additionaldata(secondary)Ǥ     Ǧ   Ǥ
ʹǤ Thesecondphase:         ȋ  ͳȌǡ ǤǤǣ ȋȌ    Ǣ ȋȌ            Ǣ ȋ Ȍ          Ǣ  ȋȌ          Ǥ      ǦǤ
͵Ǥ Thethirdphaseǣ  Ǥ
TheIntegrationofHIV/AIDSResponseintotheHealthSystem:PKMKFKUGMͲDFAT 20
ͷǤ Thefifthphase:     Ǥ                Ǥ
Ǥ Thesixthphaseǡ   ͳ
 Ǥ                Ǥ      Ǥǡ        Ǥ
b. Studylocations
   ǡ ǣͳȌ    ǢʹȌ Ǣ͵Ȍ   Ǥ
   ǣǡǡǡǡ ǡǤ  ǡ Ȁ      ͳ͵   Ȁ      ȋǡ ʹͲͳͲȌǤ ǡ  Ǥǡ  ͳͳ  Ȁ  Ǥ
ǡ  ǡǡ              Ǥ ǡ             Ǥ
               ǣ     ȋȌǡ   ȋȌǡ   ȋȌǡ ȋȌǡȋ ȌǡǤ
c. Participants
             Ǥ          ǡ           Ȁ      Ǥ   ǣ
ͳǤ  Ȁ  
ʹǤ    ȋSatuanKerjaPemerintahDaerahǦȌ  Ǣ
͵Ǥ      ȋOrganisasiMasyarakatSipil Ǧ Ȍ   ȋOrganisasiBerbasisMasyarakatǦȌ  Ǣ
ͶǤ ȋǤǤ �