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The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

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Abstract

Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03–1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00–1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.

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Acknowledgments

The research was supported through a Fulbright Senior Scholar Award in Global Health from the J. William Fulbright Commission, U.S. State Department. This publication resulted in part from funding provided by the Chicago Developmental Center for AIDS Research, an NIH-funded program (P30 AI 082151) supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NCCAM, and from NIH awards for career development (NIDA K24 DA017072) and training (T32 GM07205, F30 DA039716, D43 TW001419) and (R25 TW009338) funded by NIAID and Fogarty International Center. We thank study participants for generously sharing their time and experiences. We thank, Swasti Wulan, Budhi Mulyadi and Herlia Yuliantini for research assistance. We gratefully acknowledge operational support from the Directorate General of Corrections, Republic of Indonesia, especially Akbar Hadi Prabowo, and Hetty Widiastuti. We also thank Nurlan Silitonga, Cindy Hidayati, Alia Hartanti, David Shenman, Suzanne Blogg (HIV Cooperation Programme for Indonesia); Kathleen Norr and Colleen Corte (University of Illinois at Chicago); Elly Nurachmah, Dewi Irawaty, and Junaiti Sahar (Universitas Indonesia).

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Authors and Affiliations

  1. Department of Health Systems Science, University of Illinois at Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA

    Gabriel J. Culbert

  2. Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia

    Gabriel J. Culbert, Agung Waluyo & Mariska Iriyanti

  3. Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Gabriel J. Culbert, Alexander R. Bazazi, Maxim Polonsky & Frederick L. Altice

  4. Directorate General of Corrections, Indonesian Ministry of Law and Human Rights, Jakarta, Indonesia

    Astia Murni &  Finnahari

  5. Bina Nusantara University, Jakarta, Indonesia

    Azalia P. Muchransyah

  6. Department of Health Policy & Administration, University of Illinois at Chicago School of Public Health, Chicago, IL, USA

    Judith Levy

  7. Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

    Gabriel J. Culbert, Alexander R. Bazazi & Frederick L. Altice

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  1. Gabriel J. Culbert
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Correspondence to Gabriel J. Culbert.

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Culbert, G.J., Bazazi, A.R., Waluyo, A. et al. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons. AIDS Behav 20, 1026–1038 (2016). https://doi.org/10.1007/s10461-015-1198-4

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