Understanding why people who inject drugs in Indonesia are disengaged from HIV testing and treatment: gaps in the HIV treatment cascade

Background: Being ranked second among countries with the highest estimated number of people living with HIV in South East Asia, 28.8% of PWIDs in the country are HIV-infected. Despite the UNAIDS 90-90-90 target, gaps exist across the HIV treatment cascade, including testing of those likely to be HIV positive, linking those tested HIV positive to care, and sustaining the antiretroviral (ARV) drugs uptake. Objective: This study aims to evaluate why such gaps exist, by exploring the barriers and challenges present at each stage of the cascade. Methods: A qualitative study was conducted in Bali, in 2016. Interviews were performed among PWIDs who experienced challenges at any stage of the cascade. The interview covered various questions including on HIV, HIV testing, and treatment adherence. Data was analyzed thematically. Results: Participants said they sought testing only when they were concerned about their health; were afraid of testing positive to HIV due to the stigma around HIV; and that starting ARV treatment early was not necessary because they still felt healthy. Participants also expressed the need for support from health providers, peers, and family to stay on ARV, particularly in the face of treatment fatigue; and issues around the quality of care to maintain retention. Conclusions: Challenges hamper each stage of the HIV treatment cascade. Implications and recommendations are discussed.