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Need for a culturally-sensitive online communication strategy to reach hidden men who have sex with men for

HIV/AIDS prevention and testing in Indonesia T. Anand1, C. Nitpolprasert1, J. Ananworanich1,2,3, N. Phanuphak1,3, T. Parwati Merati4, E. Yunihastuti5, D. Imran5, A.H. Sohn6
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The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2The HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand, 3South East Asia Research Collaboration with Hawaii (SEARCH), Bangkok, Thailand, 4Division of Tropical and Infectious Disease, Faculty of Medicine, Udayana University and Sanglah Hospital, Department of Internal Medicine, Bali, Indonesia, 5Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia, 6TREAT Asia / amfAR - The Foundation for AIDS Research, Bangkok, Thailand Background: Societal and cultural conventions are barriers to advocating for HIV/AIDS awareness and outreach to hidden men who have sex with men (MSM) in Indonesia, and contribute to the growing HIV prevalence (~8.1% in Jakarta and 13-19% in Bali). Although Indonesia is the second largest Facebook user in the world, the internet has not been optimally used for promoting HIV prevention. We explored the need for an online communication strategy to increase HIV/AIDS awareness and testing among Indonesian MSM. Methods: A qualitative research project was conducted from November-December 2011 in Jakarta, Bandung, Yogyakarta, Surabaya and Bali. The study involved structured interviews of 177 MSM selected from shopping malls, fitness centers, clubs and beaches by random sampling methods, and meetings with 60 HIV/AIDS organizations. Factors assessed included barriers to HIV/AIDS awareness and testing, knowledge on MSM safe sex websites, and internet use. Results: Of 177 MSM (mean age 26.4 years), 57% reported sexual intercourse with over 10 lifetime partners. Ten percent had 100% condom use with a regular partner, 79% hid their sexual identity within society and to family, 11% were bisexual, and 54% intend to marry female. Almost all (95%) MSM were active internet users, 74% had 24-hour internet access via Blackberry, 60% used the internet for seeking sex, and 85% were openly gay on social media networks. Eighty-one percent were not aware of any HIV/AIDS website in Bahasa Indonesia, 75% did not know where HIV testing sites were located, and 88% preferred seeking MSM sexual health information through an edutainment website. All HIV/AIDS organizations interviewed noted that outreach to hidden MSM was a major challenge. Conclusions: The study suggests that online communication is a viable channel to access the hidden MSM community in Indonesia, and could help increase HIV/AIDS awareness and testing through compelling strategies that reflect social behavior, while respecting cultural limitations.