PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
N/A
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The HIV epidemic in Indonesia has historically been concentrated among injecting drug users (IDU). The first case of HIV among
IDU was diagnosed in 1995 and since then, HIV has spread rapidly among the IDU community. The expansion of the epidemic
into other risk groups in Indonesia can be attributed, at least in part, to sub-epidemics among IDU.
According to the MOH size estimations made in 2006, there are approximately 219,200 IDU in Indonesia. The majority of these
are located in urban areas on Java, Bali and in North Sumatra.
IDU are estimated to make up approximately 55% of PLWHA (range: 169,410 - 216,740). The 2007 Integrated Bio-Behavioral
Survey (IBBS) of MARPs, conducted with support from the USG-funded Aksi Stop AIDS (ASA) program, reported an overall HIV
prevalence among IDU sampled from 6 sites (in Java and North Sumatra) to be 52.4%, with prevalence shown to be consistently
high across different provinces.
The majority of IDU are young - 31.1% are below 24 years of age and additional 46.9% are between the ages of 25-29 years old
- and male (96.2%). IDU in Indonesia begin injecting at a young age with 29% reporting initiation of injecting before the age of 18
and an additional 29% reporting initiating injecting between 19-21 years of age. Most IDU report having injected drugs for more
than 3 years - 60% of IDU in Jakarta and over 80% in Bandung and Surabaya. According to the IBBS, the most common drugs
used by IDU in Indonesia are heroin, subutex (buprenorphine) and amphetamine. Over 90% of heroin is administered by injection,
with about 50% of subutex reported to be administered by injection. Amphetamine injection is rare with less than 10% of IDU
reporting injection.
According to the IBBS, the only other significant non-injecting drug use was methamphetamine use among MSM in 2 cities. Thirty
-one percent of MSM in Jakarta and 25% in Batam reported using methamphetamine in the last 3 months. In all other MSM
sites, 10% or less of MSM reported methamphetamine use. No other MARP group reported significant use of non-injecting drugs.
Given the high prevalence rates among IDU, sexual transmission of HIV remains a major concern. Most IDU are sexually active.
Thirty percent had a single partner (with about one quarter reported being married) and 47% reported multiple partners in the past
year. IDU also serve as a bridge group to FSW; 32% of IDU reported purchasing sex while consistently using condoms with sex
workers only 32% of the time. Consistent condom use was also low with regular partners (13%) and casual partners (24%). Fifty
percent of IDU have regular partners and IDU report that most of their regular partners (73%) know that he/she is an IDU.
IDU who participated in the 2007 IBBS demonstrated an incomplete knowledge of HIV. While 94% know that HIV can be
transmitted through sharing needles, only 11% demonstrated comprehensive knowledge of HIV transmission. Most IDU know
where to go to get HIV testing (84%), but only 48% have been tested and only 44% know their results. Of those who received their
results, around 60% shared the results with their regular partner, but reportedly less than 20% of these partners went for testing.
Over the past several years, a primary focus of the GOI national prevention efforts has been on preventing injection-related HIV
transmission among IDU through comprehensive harm reduction efforts and sexual transmission between IDU and their partners.
While the KPA and the MOH are fully supportive of comprehensive harm reduction efforts, full implementation of an effective
response to prevent new HIV infections among IDU has been hindered by a variety of issues, including: (1) lack of consensus
among key GOI bodies and conservative groups; (2) regulatory barriers; and (3) police cooperation at the local level, although
these issues are being now being addressed. There has been a degree of success with harm reduction efforts as more than half
of the IDU report having used HIV-related services according to the IBBS. Outreach coverage of IDU was high in 4 cities but was
only 50% in Jakarta and Surabaya, Indonesia's two largest cities.
Currently, AUSAid, GFATM, and the IPF provide the funding to support comprehensive IDU prevention efforts, including support
for prison programs. Prior to 2006, USG funds were used to support the ASA program to conduct HIV prevention outreach efforts
among IDU. At that time, the USG-supported ASA program leveraged a significant increase in funding from DfID and the
Indonesian Partnership Fund (IPF) specifically for scaled-up and comprehensive IDU prevention efforts. Given that USG
legislation DOES support prevention programs for IDU that include the use of bleach to disinfect needles and syringes and
medication-assisted therapies, including methadone maintenance (MMT), but DOES NOT provide support for needle and syringe
exchange programs (NSP), and because sufficient resources for coordinated IDU prevention were available through other donors
it was felt that USG programming would better contribute to public health best practices, and stemming of the HIV/AIDS tide in
Indonesia by concentrating USG funding on support for HIV prevention programs on the other MARPs - FSW, MSM,
transgenders and high-risk men.
Forty-four NGOs and 65 puskesmas (district health centers) are currently working in the area of harm reduction with IDU. As of
June 2008, there were 24 methadone clinics serving 3,000 IDU. The KPA target is to have 58 clinics opened by the end of 2008.
The KPA plans to provide MMT services for 50,000 IDU by 2010.
Prior to FY08, the USG supported efforts in prisons since a significant number of those incarcerated are in prison on drug or drug-
related offenses. Activities included conducting staff training, linking NGOs with prisons to conduct prevention activities on site,
and strengthening referral systems for prevention, care and treatment with the objective of developing comprehensive prison
programs for national scale-up. In FY08, the USG transitioned out of its work with prisons as AUSAid in collaboration with other
international donors, the KPA, the Department of Corrections, the National Narcotics Bureau, and the MOH, made the decision to
build on previous USG efforts and support the development of a national strategy and roll-out plan for prison programs, including
the provision of bleach, condoms, MMT and ART.
While no USG funds are being used for specific IDU HIV prevention programming, USG funding remains instrumental in enabling
IDU to access CT, care and support services through the Continuum of Prevention and Care (COPC) model. HIV+ IDU receive
USG supported services in COPC sites. In FY 08, pilot COPC sites for MARPs were developed at 3 sites in Java.
The COPC model involves linking NGOs and CBOs that provide outreach and harm reduction services to IDU (as well as NGOs
working with other MARPs) to the district health centers which provide CT, STI services, and PMTCT. The district health centers
also provide case management, HIV/TB services, OI and ART services for HIV+ IDU. As part of the model, the IDU NGOs also
work in the prisons to insure that incarcerated IDU are linked to services upon discharge, and work with a variety of community
providers to insure provision of home-based care for IDU who have AIDS. Community-based IDU service providers also are
linked to MMT services which are currently provided at clinics and district hospitals in efforts to provide referrals and follow-up of
MMT clients, as well as to residential drug treatment and outpatient and family counseling services.
The structuring of ASA program technical assistance and support to the IDU NGOs and CBOs participating in the COPC model
results in these NGOs also conducting activities relating to sexual transmission among IDU and their partners.
In FY09, USG funds will continue to be used to support IDU and their partners accessing the COPC system as well as helping to
address sexual transmission risks among IDU and their partners. For other non-injecting drug users among MARPs, the focus will
be on establishing sexual prevention activities for MSM which address methamphetamine use.
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Table 3.3.06:
