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Assessing the impact of COVID-19 on access to health services for key populations and people living with HIV in Indonesia

The study was conducted in October 2020 in Jakarta with 15 respondents from Jakarta and Bekasi. This study involves a participatory approach to try to understand the impact of Covid-19 on nine specific indicators, namely:

  1. HIV test;
  2. Treatment;
  3. HIV-related services (drug harm reduction, maternal and child health, STIs, etc.);
  4. Employment and income;
  5. Food security;
  6. Safe place to live;
  7. Violence, stigma, discrimination;
  8. Mental health; and
  9. Public trust about government accountability.
  10. The study used the instrument to collect:
    (a) The rating felt by participants on each indicator before and during the Covid-19 pandemic;
    b) Open narrative responses to each indicator before and during the Covid-19 pandemic; and
    (c) open narrative responses about services that need to be maintained and services that need to be improved. Qualitative data analysis used thematic coding, while the rankings were analyzed using descriptive statistics.

RESULTS

LIMITED OR NON AVAILABILITY OF HIV TESTING AND PATIENT EDUCATION

Participants mentioned the hours of service, the number of patients per day, or the duration of service being limited during the pandemic. In addition, the provision of information (for example, for pregnant women) and counseling which usually runs on a regular basis is also limited. Participants felt that the Government prioritized Covid-19 over other diseases.

LIMITED SERVICE HOURS

There is no denying that most HIV-related service hours have had to be shortened due to the pandemic. However, for single parents who have to help their child in the morning, accessing HIV-related services will remain a challenge. Methadone services, for example, are limited to 8-10am, making it impossible for single parents who have no one to rely on to access services..

COVID-19 AND INFORMAL WORKERS

All of the participants in this study were informal workers prior to the Covid-19 pandemic and so do not have the protection usually offered by formal sector employers. Since March 2020, Jakarta and its surroundings have imposed Large-Scale Social Restrictions (PSBB) making it difficult for participants to earn a stable income. Some participants claimed to have no income at all to support their families for several months.

COVID-19 PANDEMIC CAUSES FOOD TROUBLE AND HEALTH VULNERABILITY

Some participants could not fulfill their 3 meals a day, and the food supplied by the government included instant noodles and sardines in cans. Their families have to live with unhealthy food choices. In the long term, the risk of having more immune system disorders and micronutrient deficiencies was evident for the study participants.

COVID-19 PANDEMIC, SECURITY ISSUES AND SAFE SHIPMENTS

Participants reported higher crime rates in their place of residence because incidents of theft were more common. Some participants can’t afford rent and electricity so they have to live with friends or relatives.

COVID-19 AND MENTAL HEALTH

Despite financial worries, some participants experienced the loss of loved ones: children, husbands, and parents. Boredom, stress, confusion, anxiety, and discomfort from leaving the house for fear of contracting Covid-10 are some of the reported experiences.
In addition, one participant felt restless and restless and wanted to return to his hometown. However, due to his undisclosed HIV status, he felt uncomfortable returning home.

PERCEPTIONS OF GOVERNMENT ACCOUNTABILITY DURING PANDEMIC

The issue of community trust in the government is mainly related to the food aid distribution system. During the pandemic, untargeted distribution was one of the most common problems experienced by participants. As a result, families have to share food aid with other families in
the environment (eg, one package for two families). Participants also raised the issue of assistance programs and services related to Covid-19 which are prone to corruption.

RECOMMENDATION

Participants in this study hope that the government will improve health care and assistance programs for those who are vulnerable to being affected by Covid-19. The distribution of assistance that is equitable and well targeted, as well as providing access to jobs are the things most recommended by participants as things that need to be improved.

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