Abstract
Assisted HIV partner notification services provide a safe and effective way for people living with HIV (PLHIV) to inform their partners about the possibility of exposure and to offer them testing, treatment, and support. This study examined whether or not PLHIV in prison might be willing to participate in assisted HIV partner notification services and their reasons for and against disclosing their HIV-positive status to their partners. PLHIV (n = 150) recruited from Jakarta’s two largest all-male prisons completed an interviewer-administered questionnaire collecting demographic and risk behavior data, and attitudes toward HIV disclosure and partner services. Among those who were sexually active and/or injecting drugs before incarceration, two-thirds (66.4%, 91/137) endorsed provider referral as an acceptable way to notify their sex partners, and nearly three quarters (72.4%, 89/123) endorsed provider referral to notify their drug-injecting partners. Only a quarter (25.1%) of participants reported that their main sex partner had ever received an HIV test. Participants with anticipated stigma were less likely to endorse provider referral for sex partners (adjusted odds ratio [aOR] = 0.58, 95% CI: 0.35, 0.96) and drug-injecting partners (aOR = 0.54, 95% CI: 0.29, 1.00). Relationship closeness was associated with higher odds of endorsing provider referral for drug-injecting partners (aOR = 2.08, 95% CI: 1.25, 3.45). Protecting partners from infection and a moral duty to inform were main reasons to disclose, while stigma and privacy concerns were main reasons not to disclose. Most incarcerated PLHIV have at-risk partners in the community who they would be willing to notify if provided with assistance. Assisted partner notification for prison populations offers a promising public health approach to accelerate diagnosis, treatment, and prevention of HIV infection in the community, particularly among women.
Highlights
HIV testing is a major gap in the treatment cascade worldwide and the main obstacle to treatment in many low- to middle-income countries (LMICs) [1], including Indonesia where in 2019 only half (51%) of the estimated 640,000 people living with HIV (PLHIV) were diagnosed [2]
Assisted HIV partner services are demonstrably safe and effective in reaching people with undiagnosed infection and may prove even more potent when offered to PLHIV in prison as part of a comprehensive package of HIV prevention and treatment services
PLHIV in prison understand the importance of notifying their partners and are prepared to accept notification assistance from healthcare providers
Summary
HIV testing is a major gap in the treatment cascade worldwide and the main obstacle to treatment in many low- to middle-income countries (LMICs) [1], including Indonesia where in 2019 only half (51%) of the estimated 640,000 people living with HIV (PLHIV) were diagnosed [2]. On the basis of systematic reviews [11, 15, 16] and recent clinical trials [12, 14], the World Health Organization recommends that healthcare providers encourage and, if asked, actively assist PLHIV to notify their partners and give them options for HIV testing [10]. This policy recommendation, includes no evidence from criminal justice settings, which is an important gap in the scientific literature given the important role of prisons in HIV prevention globally, and the likely challenges to engaging prisoners in partner notification
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