Background: Jakarta''s Provincial Health Office (PHO) articulated 2017 testing targets to reach an annual epidemic control goal of diagnosing 9,292 people living with HIV. Focus was placed on testing key populations (KPs), particularly men who have sex with men (MSM), for whom epidemiological and programmatic data indicated low testing coverage and rising HIV prevalence. Enhanced outreach approaches, amplified mobile and static testing services, and new HIV testing campaigns targeting MSM were among interventions introduced to accelerate HIV testing uptake. However, 2017 was also characterized by a deteriorating environment for MSM human rights, with attempts made to ban online gay social network applications and high-profile raids and arrests of gay and bisexual men taking place under the auspices of enforcing pornography laws.
Description: The USAID- and PEPFAR-supported LINKAGES Indonesia project reviewed 2017 HIV testing data among 88 HIV testing services in Jakarta. Testing uptake among MSM was charted across 12 months. Initiation dates for three important Fast-Track programmatic interventions ? USAID/LINKAGES'' key population mobile testing initiative (DOKLING); PHO''s sub-district testing target guidance; and APCOM''s TestJKT campaign ? were plotted against monthly MSM testing uptake data. Dates of two high-profile sauna raids and mass arrests of MSM were also incorporated into the 12-month analysis.
Lessons learned: While MSM testing uptake has increased by 35 percent over 2017, erratic monthly totals suggest that uptake is affected by both enabling and restrictive measures. An 18 percent increase in testing followed the intensification of mobile testing services between April and May, although testing figures dropped by 12 percent from May to July, corresponding with the raid of Atlantis Spa when 141 persons were detained and mobile testing services were disrupted. Testing rates subsequently rose by 28 percent in July, as the PHO announced sub-district testing targets that increased testing frequency. Thereafter, testing rates declined by 16 percent. An October 6 raid and detention of 58 men did not appear to immediately affect MSM testing uptake, which increased by 19 percent in November as the TestJKT campaign intensified.
Conclusions/Next steps: Close monitoring of enabling environment measures and HIV service uptake among highest-risk KPs is critical in Fast-Track programming environments.

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