Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study

Abstract

Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.