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There has been a limited focus on HIV among men who purchase sex (MWPS) in many
countries. Systematic information is lacking on the HIV prevalence in this population, and on
interventions conducted to reduce HIV risk. Looking specifically to Indonesia, MWPS are
understood to be at higher risk of HIV infection compared with men in the general population
but there has been a relative lack of attention put towards identifying characteristics such as
the rate of condom use and HIV testing in this population and developing appropriate
interventions. Accordingly, the studies included in the Book contribute to filling the
knowledge gap for this population in regard to estimation of rate of condom use and HIV
testing and evaluation of control strategies among MWPS in Indonesia.
A range of research designs and analytical approaches was applied. The first study is a metaanalysis
of the burden of HIV among MWPS in low- and middle-income countries (LMICs). We
found that HIV prevalence was elevated compared to the population as a whole, and that
there was a strong association (RR 1.95) between purchasing sex and HIV prevalence. The
second study is a systematic review of HIV interventions conducted among MWPS, or groups
often used as proxies for MWPS, in LMICs to reduce their risk of HIV infection. We observed
that only a few studies had evaluated the impact of interventions on HIV testing rates. The
third study is a survey in Bali, Indonesia, which identifies rates and predictors of condom use
and HIV testing among MWPS in this setting. The study found a high condom use (88.5%), but
low HIV testing rates (8.1%) among this group. The fourth study explores in more detail why
such a low HIV testing phenomenon among MWPS occurs in this setting and the preferences
for testing strategies. Men's preference for HIV self-testing over HIV testing at the clinic was
expressed. The fifth study is a study piloting the HIV self-testing strategies to identify whether
this method could improve HIV testing rates among this group. A pilot single-arm nonrandomised
trial study was conducted among men presenting at the brothels area and found
high acceptability of this testing strategy to improve HIV testing rates among MWPS; HIV
testing acceptance was 6-7 times higher than the HIV testing history of less than 8.1% found
in the third study.
