In the efforts to encourage sex workers to take advantage of voluntary HIV counseling and testing (VCT) services, follow-up measures remain a problem.
"We have passed through the difficult phase of convincing them to take the test, but it turns out that VCT service providers are still not ready to be proactive and meet the demand," Azhari Irdah, the field work coordinator of the Kapeta foundation for HIV prevention, said recently.
It seems that VCT provision is moving at a slower pace than public education efforts. Bureaucracy and a lack of human resources and mobility have been cited as the "somewhat cliched-but-real causes", Kapeta field officers say.
VCT by definition is the process of providing counseling to an individual to enable them to make an informed choice about being tested for HIV.
It is deemed an entry point for prevention and care and is acknowledged internationally as an effective as well as cost-efficient strategy for facilitating behavior change, Family Health International reports.
"For sex workers, whose minds can change in a split second, quickly providing them with easy access to VCT is important," the field coordinator, better known as Ari, said. "And easy access means making the services mobile enough to come to them," he said.
Currently, VCT services are available in a limited number of clinics and referral hospitals, which are mostly far from the prostitutes' workplaces. "It is not only about proximity. It is more about making them feel comfortable," Ari said.
A monitoring team from the Health Ministry has recognized that the provision of VCT services has not kept pace with needs, rarely being easily accessible, or friendly to vulnerable groups, the Spiritia Foundation said.
In its evaluation of the 25 hospitals nationwide, the ministry said that VCT services were largely passive in nature, with staff waiting for people to come to them. Limited human resources is a rampant problem in those centers as counselors still have to perform other daily tasks as medical workers.
Currently, Jakarta is providing additional VCT services in community health centers such as in Gambir, Central Jakarta, and Tebet, South Jakarta. "We provide free VCT for those at a potentially high risk of HIV infection. But, we cannot go door-to-door as we have limited resources," said Tebet community health center officer Fadlina.
HIV prevention groups like the Kapeta Foundation have looked away from support for VCT services from the health agency or ministry due to complicated bureaucratic procedures. Kapeta has recently been working closely with organizations like the Indonesian Family Planning Group (PKBI), Ari said.
"We are open to cooperating with anyone who is not reluctant to work quickly," he said. "If we take too long, our sex worker friends could change their minds about VCT or, speaking in terms of a worst-case scenario, die before getting any help." – Anissa S. Febrina