Cultural and religious determinants of HIV transmission: A qualitative study with people living with HIV in Belu and Yogyakarta, Indonesia.

Nelsensius Klau Fauk,Karen Hawke,Lillian Mwanri,Paul Russell Ward,Joseph Telfair

doi:10.1371/journal.pone.0257906

Abstract

As a part of a larger qualitative study to understand HIV-risk factors and impacts on people living with HIV (PLHIV) (52 women and 40 men) in Belu and Yogyakarta, Indonesia, this paper reports the influences of cultural practices and religious beliefs on sexual relationships and behaviours of participants as contributors for HIV transmission. This study was conducted from June to December 2020. Data collection was conducted using one-one-one in-depth interviews. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. The findings showed that cultural practices in Belu related to the use of bride wealth, managing spousal disputes, marriage, and condom use, influenced spousal relationships and sexual behaviours or practices which contributed to HIV transmission. Javanese cultural practices and expectation of an ‘ideal wife’, Islamic religious beliefs about expected husband-wife relationships, forbidden premarital sex, and the participants’ individual interpretation of their religious beliefs about condom use spousal sexual relations, also influenced spousal sexual relations and behaviours, which supported HIV transmission among the participants. The findings indicate the need for HIV education programs that address cultural practices and religious beliefs for community members and population groups to enhance their understanding about HIV, condom use, and how cultural practices and religious beliefs play a role in HIV transmission. The findings also indicate the need for involvement of religious leaders in HIV education programs to bring insights to people and help them interpret their religious beliefs in health promoting ways. Future studies that explore different aspects of culture and religion which may contribute to HIV transmission are recommended.

Highlights

The 2020 UNAIDS report [1] showed a global estimation of 38 million people living with HIV (PLHIV) and 1.7 million newly diagnoses in 2019
This paper describes the influence of cultural practices and religious beliefs on sexual relationships, behaviours and practices of women and men living with HIV in Belu and Yogyakarta, as contributing factors for HIV transmission, which have been understudied, both in Indonesia and globally [27,28,29,30]
Our findings suggest that cultural practices on bride wealth, sanctions towards spousal dispute, purpose of marriage, condom use and cultural expectation of an ‘ideal wife’ are contributors to HIV transmission among both women and men living with HIV in Belu and Yogyakarta

Summary

Introduction

The 2020 UNAIDS report [1] showed a global estimation of 38 million people living with HIV (PLHIV) and 1.7 million newly diagnoses in 2019. The UNAIDS report showed that HIV infection in the context of Indonesia increased by 25.5% during the period from 2010 to 2018, with an estimated 510,000 cases in 2010 to 640,000 in 2018 [2] Behavioural factors such as unprotected sexual intercourse and injecting drug use (IDU) have been reported as the main routes of HIV transmission in the country [3]. Poor economic or financial conditions is another contributor for HIV transmission as it is reported to often lead to people’s involvement in transactional sex or sex with multiple partners in exchange for money and the experience of sexual coercion which often occurs without protection or condom use due to refusal by sex clients or partners [15,16,17]. This is tied in with cultural practices where men or husbands are perceived to be entitled to sex and accepted to have multiple sex partners, while women are expected to remain faithful, fulfil their duty and submit to their husbands [24,25,26]

Methods

Results

Conclusion