Sexual risk taking, sexually transmitted infections and HIV prevalence among four "high-risk" occupational groups of Indonesian men

Objectives: This article reports new surveillance data on the prevalence of sexual risk taking, HIV and other sexually transmitted infections (STI) among four occupational groups of Indonesian men thought to be at elevated risk of infection. Methods: Behavioural survey data were collected from 3008 men in 11 cities, among whom 2158 men were tested for HIV and syphilis and 1950 for gonorrhoea and chlamydia. Risk factors for STI were assessed using multivariable logistic regression. Results: Thirty-six per cent of men had sex with a female sex worker (FSW) in the previous year and 20% with non-marital female partners. Consistent condom use was low with both sex workers (17%) and other non-marital partners (13%). HIV prevalence was 2% in Papua and less than 1% elsewhere, but was for the first time detectable in a non-core transmitter male population outside of Papua. STI rates were high for a non-core transmitter group, especially syphilis. Truck drivers were the most at risk. Multivariable analyses revealed exposure to FSW and inconsistent condom use, along with geographical location (Papua vs non-Papua) and unobserved factors associated with certain occupational groups, to be key risk factors for STI infection. Conclusions: The results confirm that men in the four occupational groups are reasonable proxies for "high-risk men" for surveillance purposes in Indonesia. Although HIV prevalence was low, the extent of sexual risk taking and the moderately high levels of STI among these men, along with rising HIV rates among FSW, indicate the potential for HIV/AIDS transmission in Indonesia to accelerate.