Accepted Paper:

Navigating local systems to stay alive: a study of engagement with HIV care in an era of decentralised healthcare in Indonesia  
Elan Lazuardi (UNSW Sydney)

Paper short abstract:

HIV intervention programs are often designed with specific "target groups" in mind. Based on a study of everyday clinical practices in urban HIV testing and treatment services, this paper will unearth institutional processes which govern the localization of HIV intervention strategies in Indonesia.

Paper long abstract:

In a socio-economically and culturally diverse country such as Indonesia, HIV intervention programs are often designed to give priority to specific groups in the community - often referred to as "target groups" or "key populations". However, with priorities set by government or international donor agencies in a top-down approach, local actors providing or accessing clinics are often left with little room to improvise.

Based on a study of everyday clinical practices in a number of urban HIV testing and treatment services, this paper will unearth institutional processes which govern the localization of early testing and treatment for HIV infection strategies in Indonesia, and explore the extent to which these processes are evident in accounts of providing and accessing HIV services.

Engagement with HIV care in health care settings is often characterised by a complex set of power relations between clients and healthcare workers, with those who have personal or peer-based connections doing much better at knowing how to navigate local systems effectively. With programs intended to target communities defined as "hard to reach" due in particular to their sexual identity (eg. 'men who have sex with men) or sexual practice (eg. 'sex workers'), there is little room for clients and healthcare workers to examine the way that their own values influence their interactions. As a result, clients' needs are often neglected with respect to the aspects of their lives which are associated with stigma, creating considerable barriers to good care.

Panel P30
Social death by neglect in health and health systems