Reff HIV Report Indonesia Estimation 2015-2020 Eng

Estimates and Projection of HIV/AIDS
in Indonesia 2015-2020
Directorate General of Disease Control and Prevention

Ministry of Health
2017
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Contents
List of Tables ........................................................................................................................................... 3

List of Figures ......................................................................................................................................... 4
Forward ................................................................................................................................................... 5
CONTRIBUTOR LIST .............................................................................................................................. 6
1 Introduction .................................................................................................................................... 8
2 Objectives ....................................................................................................................................... 8
3 Methodology .................................................................................................................................. 8
3.1 Modeling Approach............................................................................................................... 8
3.2. Software Used ..................................................................................................................... 10
3.2.1. Asian Epidemic Model (AEM) Version 4.12 ................................................................ 11
3.2.2. Spectrum version 5.4 .................................................................................................. 11
3.3. Sources of Data ................................................................................................................... 11
3.3.1. Demographic data ...................................................................................................... 11
3.3.2. Behavioural and Epidemiological Data of Key Affected Populations ....................... 11
3.3.3. KAP Population Size Estimates.................................................................................. 12
3.4. Projection Process - AEM.................................................................................................... 12
3.4.1. Population Worksheet................................................................................................ 13
3.4.2. Heterosexual Worksheet ............................................................................................ 13
3.4.3. PWID Worksheet (Injection Drug Users).................................................................... 19
3.4.4. MSM Worksheet ......................................................................................................... 22
3.4.5. Waria Worksheet ........................................................................................................ 27
3.4.6. Epidemic Worksheet .................................................................................................. 32
3.4.7. HIV Prevalence Worksheet......................................................................................... 33
3.4.8. Adult ART Worksheet................................................................................................. 34
3.5. Projection Process - Spectrum............................................................................................ 34
4 Results........................................................................................................................................... 36
4.1 HIV Prevalence among Population aged ≥ 15 years in Indonesia, 2015-2020 ................... 36
4.2 Number of key affected population members living with HIV (PLHIV), 2015-2020 .......... 36
4.3 Number of new infections among key affected population members, 2015-2020 ........... 37
4.4 Total number of PLHIV, new infections and AIDS-related deaths .................................... 39
4.5 ART among adult PLHIV ..................................................................................................... 39
4.6 HIV among children............................................................................................................. 40
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4.7 ART among children ........................................................................................................... 41
4.8 PMTCT ................................................................................................................................. 42
4.9. Summary of Estimates: 2014 and 2016 Epidemic Updates ............................................... 42
5 Limitations .................................................................................................................................... 43
6 Recommendations for future modeling work ............................................................................. 44
7 References .................................................................................................................................... 44
8 Annexes ........................................................................................................................................ 46
Annex 1: Procedures used to produce national estimates of key parameters for 2015 and trends
over time for input into AEM ............................................................................................................ 46
Annex 2: Inventory of Data Input to AEM Spreadsheets – 2016 Epidemic Update ........................ 48
Annex 3. Parameter Values used in the Final AEM Model after Fitting .......................................... 72
Annex 4. Estimation and Projection of People Living with HIV, New HIV Infections, AIDS Deaths
and ART Needs among Adults and Children by Gender in Indonesia, 2015-2020 .......................... 81
Annex 5. Estimation and Projection of People Living with HIV, New HIV Infections, AIDS Deaths
and ART Needs among Adults age ≥ 15 years old by Gender in Indonesia, 2015-2020 .................. 82
Annex 6. Estimation and Projection of People Living with HIV, New HIV infections, AIDS Deaths
and ART Needs among Children age 0-14 years old by Gender in Indonesia, 2015-2020 .............. 83
Annex 7. Estimation and Projection of People Living with HIV, New HIV infections, AIDS Deaths
and ART Needs among Adults age ≥ 15 years old in Papua and Non-Papua, 2015-2020 ............... 84
Annex 8. New HIV Infections among Adults Age Group ≥ 15 years old by Risk Population in 32
Provinces (Non-Papua), years 1990-2030 ........................................................................................ 84
Annex 9. New HIV Infections among Adults Age Group ≥ 15 years old by Risk Population in Tanah
Papua years 1990-2030 .................................................................................................................... 85
List of Tables
Table 3.1: Updated KAP Population Size Estimates, 2016 ...................................................................... 12

Table 3.2: FSW General 2007-2015 – non-Papua .................................................................................... 14
Table 3.3: FSW General 2007-2015 – Papua ............................................................................................ 14
Table 3.4: FSW Group 1 & Group 2 – non-Papua ..................................................................................... 15
Table 3.5: FSW Group 1 & Group 2 – Papua ............................................................................................ 15
Table 3.6: Clients of FSW – non-Papua ................................................................................................... 17
Table 3.7: Clients of FSW – Papua........................................................................................................... 17
Table 3.8: Population engaging in Casual Sex – non-Papua .................................................................... 18
Table 3.9: Population engaging in Casual Sex – Papua ........................................................................... 18
Table 3.10: Spouses and Regular Partners – non-Papua ......................................................................... 19
Table 3.11: Male PWID Injecting Behaviors – non-Papua ........................................................................ 21
Table 3.12: Male PWID Sexual Behaviors – non-Papua ........................................................................... 22
Table 3.13: Men who have Sex with Men General – non-Papua .............................................................. 23
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Table 3.14: Men who have Sex with Men Group 1 & 2 – non-Papua ........................................................ 24
Table 3.15: Men who have Sex with Men visiting Sex Workers – non-Papua ........................................... 25
Table 3.16: Male Sex Workers – non-Papua ............................................................................................ 26
Table 3.17: Transgenders General – non-Papua ...................................................................................... 27
Table 3.18: Transgenders Sexual Behaviors – non-Papua ....................................................................... 28
Table 3.19: Transgenders - Client Make-up – non-Papua ........................................................................ 29
Table 3.20: Transgenders engaging in Casual Sex - Sexual Behaviors – non-Papua ................................ 30
Table 3.21: Transgenders Sex Workers Partner Make-up for those with CPs – non-Papua...................... 30
Table 3.22: Transgenders with Regular Partners - Sexual Behaviors – non-Papua .................................. 31
Table 3.23: Transgenders Sex Workers Regular Partner Make-up – non-Papua ...................................... 32
Table 3.24: HIV Prevalence among KAPs – non-Papua ........................................................................... 33
Table 3.25: HIV Prevalence among KAPs and General Population – Papua ............................................. 33
Table 3.26: Number of Adults Receiving ART – non-Papua .................................................................... 34
Table 3.27: Number of Adults Receiving ART – Papua ............................................................................ 34
Table 4.1: Estimates and Projection of PLHIV by Key Affected Population in Indonesia, Years 2015-2020
(AEM result) ........................................................................................................................................... 37
Table 4.2: Estimates and Projection of New HIV Infections by Key Affected Population in Indonesia,
Years 2015-2020 (AEM result) ................................................................................................................ 38
Table 4.3: Summary of differences in key results – 2014 vs. 2016 modeling ............................................ 43
List of Figures
Figure 3.1: Flow of HIV Epidemic Modeling in Indonesia 2015-2030 .......................................................... 9

Figure 4.1: Estimates and Projection of HIV Prevalence among Population Aged ≥ 15 years in Indonesia,
Years 2015-2020 (AEM result) ................................................................................................................ 36
Figure 4.2: Comparison of New Infections from 2014 & 2016 HIV Mathematical Modelling, 1990-2030
(AEM result) ........................................................................................................................................... 38
Figure 4.3: Estimates and Projection of PLHIV, AIDS Deaths and New HIV Infections among Population
Aged ≥ 15 years in Indonesia, 2015-2020 (AEM result) ............................................................................ 39
Figure 4.4: Estimates and Projection of PLHIV and ART Needs among Population Aged ≥ 15 Years in
Indonesia, 2015-2020 (AEM result) ......................................................................................................... 40
Figure 4.5: Estimates and Projection of PLHIV, AIDS Deaths and New HIV Infections among Children
Aged 0-14 Years in Indonesia, 2015-2020 (Spectrum result) ................................................................... 40
Figure 4.6: Estimates and Projection of PLHIV and ART Needs among Children Aged 0-14 Years in
Indonesia, 2015-2020 (Spectrum result) ................................................................................................. 41
Figure 4.7: Estimates and Projection of HIV Prevalence among Pregnant Women in Indonesia, 2015-2020
(Spectrum result) ................................................................................................................................... 42
Figure 4.8: Estimates and Projection of PMTCT Service Needs in Indonesia, 2015-2020 (Spectrum result)
.............................................................................................................................................................. 42
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Forward
Jakarta, February 2017

Director General Disease Control and
Prevention
Dr. H. Mohammad Subuh, MPPM

NIP 196201191989021001
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Contributor List
Working Group
Ari Wulan Sari – Ministry of Health
Asep Eka Nur Hidayat – National AIDS Commission
Dwi Rahmadini - National AIDS Commission
Fatien Hamamah – National AIDS Commission
Fetty Wijayanti – WHO Indonesia Office
Lely Wahyuniar – UNAIDS Indonesia Office
Rizky Hasby – Ministry of Health
Viny Sutriani – Ministry of Health
Yori Novrianto – FHI 360
Consultants/Writers
Wiwath Peerapanatapokin
Robert Magnani
Leonita Agustine
Contributors
Siti Nadia Tarmizi – Ministry of Health
Endang Budi Hastuti – Ministry of Health
Triya Novita Dinihari – Ministry of Health
Irawati Panca – Ministry of Health
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Fabio De Mesquita – WHO Indonesia Office
Beatricia Iswari – WHO Indonesia Office
Tiara Nisa – WHO Indonesia Office
Kin Chou – UNAIDS Regional Office
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1 Introduction
The importance of countries’ “knowing their epidemic” as a prerequisite for success in
defeating HIV is widely accepted, and is clearly recognized in Indonesia. Both as a means of
supporting program planning and assessing progress in containing and eventually ending
HIV and AIDS in Indonesia, the Ministry of Health (MOH) periodically updates its official
epidemiologic projections concerning HIV and AIDS. Updates were undertaken in 2008,
2012 and 2014 (report published in February of 2015). The present document was prepared
to update the epidemic situation taking into account new data that have since become
available, most notably the 2015 Integrated Biological-Behavioral Surveillance Survey –
IBBS) among HIV Key Populations (KPs) and the updated population size estimates for KP
for HIV prepared by the MOH in mid-2016.
2 Objectives
The objective of HIV epidemic modeling in Indonesia 2016 exercise is to provide a
comprehensive picture of the current situation of the HIV epidemic and a projection that
can be used by stakeholders for planning an improved and focused HIV and AIDS control
program in Indonesia. In addition, the epidemic model will also serve as a reference for
evaluating the efficacy of various HIV and AIDS control programs that are already running,
and will also strengthen advocacy programs and build a greater commitment among
stakeholders that are directly or indirectly involved. The purpose of the present report is to
(1) provide detailed documentation as to the methods used in undertaking the 2016
epidemiologic update and (2) disseminate the updated results.
3 Methodology
A Technical Working Group (TWG) was established by the MOH Sub-Directorate for HIV
AIDS & STDs in collaboration with the National AIDS Commission (NAC) in September
2016 to carry out the epidemiologic modeling work needed to produce an updated
epidemiologic projection. This TWG was charged of updating the previous HIV/AIDS
modeling undertaken in 2014 by inputting new data and rerunning the epidemiologic
projections. Members of the TWG consisted of staff from the national MOH, NAC, UNAIDS,
WHO, and FHI360.
3.1 Modeling Approach

The modeling approach used in the 2016 update was in most respects the same as was used
in prior HIV epidemiologic updates in Indonesia. The basic steps were:
 Review new data available since the last update with regard to the information they
provide on levels and trends in key parameters;
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 Input the new data into the AIDS Epidemic Model (AEM) and make adjustments to
parameters entered in prior updates as needed in order to make them consistent
with the latest data;
 Run AEM and assess the “fit” of the model results with regard to how well the
projected trends in HIV prevalence correspond to the available data, and make
adjustments as needed to make the model fit adequately;
 Export selected information from AEM to the Spectrum AIDS Impact Model (AIM)
and use the AIDS software to produce estimates related to related to PMTCT; and
 Make final adjustments as needed based to the Spectrum AIM results to make them
consistent with the AEM results.
Figure 3.1: Flow of HIV Epidemic Modeling in Indonesia 2015-2030
Source: UNAIDS 2010
In view of the differences in evolution of HIV in Tanah Papua vs. the rest of the country,
separate updated projections were prepared for Tanah Papua and non-Papua (referred to
as “31 province” model), as was done in prior modeling exercises. The Papua and non-
Papua results were then combined into a single set of results for Indonesia as a whole.
A major challenge in the modeling update was to try to the extent possible to produce
estimates that represent or characterize the HIV situation in the entire country. This task is
made difficult by the fact that the key source of data for tracking the epidemic in Indonesia
is periodic surveys undertaken in a relatively modest number of districts (that is, the
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Integrated Biological-Behavioral Surveys – IBBS). In this regard, several steps were taken to
try to improve the accuracy of the projections in the 2016 update.
First, estimated levels of and trends in key parameters were calculated at the provincial
level and aggregated to the national level using provincial population weights derived from
the recent key population size estimation update for each relevant KP sub-population. This
is expected to produce more accurate estimates than the less formal averaging procedure
used in prior epidemic updates.
Second, smaller cities and districts for which IBBS data were not available were more
explicitly taken into account in the 2016 update. This was accomplished by assigning a
“weight” for such districts based upon the revised key population sizes and using parameter
estimates for the smaller of the cities/districts for which IBBS data were available in lieu of
actual data.
Finally, the 2016 update took advantage of the longer time series of data from key districts
resulting from the 2015 IBBS to more formally reassess trends in key parameters during the
2007-2015 period (note: 2007 was the first large-scale IBBS undertaken in Indonesia).
Trends between these dates were mathematically “smoothed” in order to reduce “noise” in
the data resulting from the fact that KP district sample sizes in the respective rounds of
IBBS were modest.
Further details on the procedures used to produce the final 2015 estimates of key biological
and behavioral parameters, as well as trends over time in these, is described in detail in
Annex 1. Annex 2 documents the sources of data and specific values produced in the 2016
epidemic update exercise.
3.2. Software Used

The bulk of the modeling work was undertaken using the AIDS Epidemic Model (AEM)
software. However, for undertaking projections for PMTCT and ART treatment of children,
the Spectrum AIDS Impact Model (AIM) software package was used. The decision to use
Spectrum was based on the more refined estimation capabilities of Spectrum AIM vs. AEM
for these program areas, which tend to receive a higher level of priority in general
population than concentrated HIV epidemics. As scaling up PMTCT and ART treatment of
children were viewed as strategic priorities in the 2015-2019 SRAN, the added complexities
of using two software packages was felt to be justified. Consistency between AEM and
Spectrum AIM results was ensured by importing incidence figures from the AEM
projections into Spectrum AIM in order to calculate projections pertaining to PMTCT and
children.
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3.2.1. AIDS Epidemic Model (AEM) Version 4.12
AEM has six main worksheets (Population, Heterosexual, IDU, MSM, Waria, Epidemic and
HIV Prevalence) for data input, and few more additional worksheets to accommodate the
results of calculations and adjustments made in the AEM program. The AEM calculations
take into account the disaggregation by gender (male and female).
AEM modeling was used to produce 2015 estimates and projections to the year 2030 of the
following parameters:
- Cumulative and yearly total number of people living with HIV and the number of
HIV/AIDS-related deaths,
- Distribution of PLHIV by age and by year,
- Number of new HIV infections and number of PLHIV for each key population
(FSW, MSM, MSW, PWID, Waria, Clients), among the general population (by
gender), and among children (by gender), and
- The number of new infections by route of transmission.
The definition of the estimating tool AEM about was so called “the low risk population” has
been changed to “non-key population”, since they are very high risk of contracting HIV,
even outside of the traditional KP are sexual partners of SW, sexual partner of PWID, sexual
partner of bisexual males, former SW among sectors.
3.2.2. Spectrum version 5.4

The Spectrum suite of tools includes all of the following “linked” policy models:
Demographic Projections (DemProj), Family Planning (FamPlan), AIDS Impact Model
(AIM), Resources for the Awareness of Population Impacts on Development software
(RAPID), Lives Saved Tool (LiST), GOALS, and Resource Needs Model (RNM). The working
group used the DemProj and AIM software for this exercise.
3.3. Sources of Data

The Working Group used the data sets below in developing the national HIV/AIDS
estimates for 2015 and projections to 2030:
3.3.1. Demographic data

The demographic data used in the 2016 modeling update consisted of population size
and distribution estimates from Central Statistics Board (BPS), updated using data
from the 2015 Inter-Censal Survey (SUPAS), also undertaken by the BPS.
3.3.2. Behavioral and Epidemiological Data of Key Populations

The following data sources were consulted with regard to setting key behavioral and
epidemiologic parameters:
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a. Integrated HIV and Behavioral Surveillance (IBBS) survey among IDUs, FSW,
High Risk Men, Waria and MSM, MoH Indonesia: 2007, 2009, 2011, 2013, and
2015.
b. General Population IBBS in Tanah Papua: 2006 and 2013.
c. AIDS Cases Report, MoH Indonesia 2000-2015.
d. HIV/AIDS program data through 2015.
e. HIV Sentinel Surveillance Report on FSW, IDUs and High Risk Men, MoH
Indonesia 1998-2013. Note, however, that due to concerns about data quality,
the TWG relied almost exclusively on IBBS data from the year 2007 forward.
3.3.3. Key Population Size Estimates

Population size estimates for KPs were updated earlier in 2016 by a Technical Working
Group formed by the MOH. The updated size estimates were used in the 2016 updated HIV
epidemiologic projections. The results are shown in the table below.
Table 3.1: Updated Key Population Size Estimates, 2016
Population Lower Bound Point Upper Bound

FSW 128,114 226,791 364,313
MSM 648,641 754,310 866,840
Waria 13,038 38,928 89,640
PWID 14,016 33,492 88,812
Client FSW 4,415,788 5,254,663 6,167,873
Client Waria 327,596 350,119 375,236
3.4. Projection Process - AEM

The technical working group developed two AEM models, referred to as the “31 Provinces
Module” and the “Tanah Papua Module,” respectively, in order to generate estimates and
projections of key HIV-related parameters in the population aged 15-49 years and HIV
prevalence for the population ages 50 and above from 2015-2030. The two models were
subsequently combined to yield a set of national estimates. The process began by updating
the data input into the AEM worksheets as described below. Assumptions and data from
prior updates were left intact unless indicated below.
It will be noted that in order to “fit” the AEM projections with observed data on HIV
prevalence, it is often necessary to change some of the input parameters. The figures
reported in the remainder of this section of the report were the figures that were initially
input into AEM prior to fitting. The final values used in the “fit” AEM model are provided in
Annex 3.
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3.4.1. Population Worksheet
The Population Worksheet is filled with demographic data such as the population aged 15
years and above and the population aged 15-49 years, by gender (male and female). As was
noted earlier, all demographic data used were sourced from the Central Statistics Bureau
(BPS). These numbers are used in AEM to develop estimates and projections related to
HIV/AIDS in 31 provinces and Tanah Papua.
3.4.2. Heterosexual Worksheet

This Worksheet contains data on sexual risk taking and health seeking behaviors among (1)
Female Sex Workers (FSW), (2) Clients of FSW and the (3) general population of women
aged 15-49 years. The data sources and assumptions used to fill the heterosexual
worksheet were:
Female Sex Workers (FSW)
 Percent of adult females who sell sex

This parameter was estimated from the several KP size estimation exercises that have been
conducted over the years. These exercises yielded estimates of the number of FSW in the
country, which were divided by the estimated number of females of reproductive age. The
value entered into the AEM Worksheet was 0.33%, which consistent with the available
estimates was assumed to be constant over time.
 Percent of FSW who are in “high” and “low” intensity categories

This parameter was estimated from KP mapping data. Mapping exercises to date have
mapped “Direct” and “Indirect” FSW separately. “Direct” FSW (DFSW) refers to women
who sell sex as their primary source of livelihood, while “Indirect” FSW (IFSW) have other
means of livelihood but sell sex to supplement their incomes. DFSW are usually found at
brothels, “lokalisasi” and some massage parlors, while IFSW are found at bars, Karaoke bars
and other entertainment venues. Earlier IBBS data indicated that Direct FSW tended to
have larger numbers of clients and to not use condoms any more frequently than ISFW, and
thus are in general exposed to greater risk of HIV transmission.
Given the recent trend in Indonesia of lokalisasi being closed by local governments and thus
forcing FSW to pursue clients via other means and in different venues, a decision was taken
during the 2016 key population size estimation exercise to do away with the distinction
between Direct and Indirect FSW. Thus, the 2016 size estimates were for all FSW. However,
as the optimal application of AEM distinguishes between FSW with regard to exposure to
risk and the distinction between DFSW and IFSW was retained in the 2015 IBBS, the
epidemic update used DFSW to correspond to “High Intensity FSW,” the designation that
will in now being used by the MOH, and “Low Intensity FSW.” The intent remains the same
– to distinguish between FSW that are at higher and lower levels of risk based upon their
sexual and health seeking behaviors.
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The parameters below were entered into AEM separately for high and low intensity FSW.
Table 3.2: FSW General 2007-2015 – non-Papua
Female Sex Workers -

General 2007 2008 2009 2010 2011 2012 2013 2014 2015
Percent of females aged 15-49
0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33%
who sell sex
Percent of female sex workers
54.4% 54.4% 54.4% 54.4% 50.1% 45.8% 41.5% 37.2% 32.9%
in group 1
Movement from group 1 to
1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
group 2 each year
Table 3.3: FSW General 2007-2015 – Papua
Female Sex Workers -

General 2007 2008 2009 2010 2011 2012 2013 2014 2015
0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%
who sell sex
Percent of female sex workers
37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7%
in group 1
Movement from group 1 to
1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
group 2 each year
The following three parameters were set based upon levels and trends observed in the IBBS
series from 2007 to 2015. The first two parameters were left unchanged from prior
epidemic updates for “High Intensity” FSW, while a modest downward trend observed in
recent IBBS among “Low” Intensity” FSW was input into AEM. A modest upward trend in
the average duration of selling sex was observed for both groups of FSW and was input into
AEM. The values input into AEM for Non-Papua (and Papua) for the years 2007-2015 are
shown in Table 3.4 and 3.5 below.
 Average number of clients per day among FSW

 Working days per week
 Average duration selling sex
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Table 3.4: FSW Group 1 & Group 2 – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Female Sex Workers group 1
(FSW1) / population (in 112.5 113.9 115.3 116.5 108.5 100.2 91.7 82.9 73.9
thousands)
Number of clients per day -
1.6 1.5 1.3 1.5 1.6 1.4 1.1 1.4 1.6
female sex worker group 1
Days worked per week -
6.1 6.1 6.2 5.8 5.4 5.5 5.6 5.5 5.4
female sex workers group 1
Percent condom use with
56.5% 57.9% 59.4% 61.1% 62.8% 65.3% 67.7% 70.0% 72.4%
clients - FSW group 1
Average duration selling sex in
2.4 2.6 2.8 3.0 3.2 3.4 3.6 3.8 4.0
group 1 (years)
STI prevalence among female
36.8% 36.8% 36.8% 36.8% 36.8% 34.6% 32.4% 30.2% 28.0%
sex worker group 1
thousands)
0.8 0.7 0.6 0.6 0.6 0.6 0.7 0.7 0.7
6.2 6.4 6.6 6.2 5.8 5.7 5.5 5.6 5.8
53.1% 53.3% 53.4% 53.6% 53.7% 53.9% 54.0% 54.2% 54.3%
2.0 2.0 2.0 3.0 4.0 4.0 4.0 4.0 4.0
group 2 (years)
18.7% 18.7% 18.7% 18.7% 18.7% 17.5% 16.4% 15.3% 14.2%
sex worker group 2
Table 3.5: FSW Group 1 & Group 2 – Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015
15
thousands)
0.9 0.9 1.0 0.9 0.8 0.7 0.6 0.7 0.8
6.2 6.2 6.1 5.8 5.5 5.7 5.9 5.8 5.6
66.1% 69.5% 72.8% 74.8% 76.8% 81.6% 86.4% 90.5% 94.5%
4.0 4.0 4.0 5.0 6.0 6.0 6.0 7.0 8.0
group 1 (years)
27.9% 27.9% 27.9% 27.9% 27.9% 23.5% 19.0% 15.0% 11.0%
sex worker group 1
thousands)
0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3
6.8 6.6 6.5 6.3 6.1 6.1 6.1 6.2 6.3
63.0% 65.0% 67.0% 68.9% 70.8% 72.9% 75.1% 75.1% 75.1%
2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8
group 2 (years)
18.8% 18.8% 18.8% 18.8% 18.8% 15.8% 12.8% 10.1% 7.4%
sex worker group 2
 Percent condom use with clients

National estimates of the percentage of both higher and lower frequency FSW using
condoms at last sex were calculated as weighted averages based upon data from the five
IBBS surveys undertaken between 2007 and 2015. For cities/districts in which 2009 and/or
2013 IBBS data were available (but not 2015), levels and trends from 2007 to 2015 were
estimated by extrapolating and back-extrapolating from the available IBBS data taking into
account trends in the cities/district for which three rounds of IBBS data (2007, 2011 and
2015) were available. Levels and trends for cities/districts with three rounds of IBBS data
were estimated directly from the IBBS data. HIV prevalence estimates for provinces in
which no IBBS data were available was assumed to approximate the level and trend in
smaller cities/districts for which data were available. A national estimate was then
calculated by weighting the sub-group estimates by key population size and summing
them to yield a national figure. Provincial estimates of numbers of higher and lower
frequency FSW derived from the recent key population size estimation update serving as
weights. This was undertaken separately for the 31 non-Papuan provinces (in the
aggregate) and for the Tanah Papua (two provinces), and then the two sets of estimates
were combined weighted by estimated key population size. The input values are shown in
Table 3.4 and 3.5 above.
 Sexually Transmitted Infection (STI) prevalence among FSW
16
National estimates of the percentage of both higher and lower frequency FSW with
Sexually Transmitted Infections (STIs) were calculated as averages using data from the five
IBBS surveys undertaken between 2007 and 2015. Gonorrhea was chosen as an “index” STI
given its sensitivity to sexual risk taking. Gonorrhea prevalence estimates from larger cities
(i.e., those covered in the 2007, 2011 and 2015 IBBS were averaged with estimates from the
smaller cities covered in the 2009 and 2013 IBBS, and the average values for higher and
lower frequency FSW were input into AEM. Estimates were calculated separately for Papua
and non-Papua. The input values are shown in Table 3.4 and 3.5 above.
Clients of FSW
 Percentage of males aged 15-49 years visiting sex workers in last year
As with FSW, this parameter was estimated from the several key population size
estimation exercises that have been conducted over the years. These exercises yielded
estimates of the number of men who had visited a sex worker in the last year, which was
then divided by the estimated number of males of reproductive age.
 Average duration of being a client

No data are available for this parameter for Indonesia. It was thus set at seven (7) years
based on data from Thailand.
 Percentage of adult males who are circumcised

For non-Papua, the 80% figure used was reported in the 2012 DHS. For Papua, we used the
data from the 2006 and 2013 Papua General Population IBBS to estimate the parameter for
Tanah Papua (16.7%).
Table 3.6: Clients of FSW – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Clients of Female Sex
Workers / population (in 4,768 4,829 4,885 4,935 4,991 5,047 5,101 5,150 5,196
thousands)
Percent of males aged 15-49
who visited FSW in the last 7.6% 7.6% 7.6% 7.6% 7.6% 7.6% 7.6% 7.6% 7.6%
year
Average duration buying sex
7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0
(years)
Percent of adult males who
80% 80% 80% 80% 80% 80% 80% 80% 80%
are circumcised
Table 3.7: Clients of FSW – Papua
17
2007 2008 2009 2010 2011 2012 2013 2014 2015
Workers / population (in 98.5 99.7 100.9 93.8 87.7 81.2 74.3 66.9 59.1
thousands)
year
5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0
(years)
16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7%
are circumcised
Population engaging in casual sex

For the three parameters below, information from several sources was taken into account,
but in the absence of direct data the parameter estimates are based upon strong
assumptions.
 Percent of males and females engaging in casual sex in the last year
 Percent condom use in casual sex
 Average number of sex contacts in last year
The values input into AEM are documented in Table 3.8 and 3.9 below.
Table 3.8: Population engaging in Casual Sex – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Percent of males engaging in
2.8% 2.8% 2.8% 4.8% 6.8% 6.8% 6.8% 6.8% 6.8%
casual sex in the last year
Percent of females engaging
1.0% 1.0% 1.0% 1.5% 2.0% 2.0% 2.0% 2.0% 2.0%
in casual sex in the last year
Percent condom use in casual
18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2%
sex
Average number of sex
12.0 12.0 12.0 12.0 12.0 12.0 12.0 12.0 12.0
contacts in the last year (male)
Table 3.9: Population engaging in Casual Sex – Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Percent of males engaging in
30.0% 30.0% 30.0% 26.3% 22.5% 18.8% 15.0% 15.0% 15.0%
Percent of females engaging
10.0% 10.0% 10.0% 8.8% 7.5% 6.3% 5.0% 5.0% 5.0%
18
Percent condom use in casual
12.6% 12.6% 12.6% 16.2% 19.8% 23.5% 27.1% 27.1% 27.1%
sex
Average number of sex
6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0
Sex with spouses and regular partners

For the two parameters below, no new data were available for the 2016 update, and thus
the non-Papua parameter estimates from the 2014 epidemic update were retained.
 Number of sexual contacts with spouses or regular partners

 Percent condom with spouses or regular partners
For Papua, the working group used data from the 2013 Papua General Population IBBS to
set these parameters. The number of sexual contacts with spouse or regular partner per
week was 1.2, and the percentage of condom use with spouse or regular partner is 3.4%,
using the data of condom use at marital sex from the 2013 IBBS Papua.
 Sexually Transmitted Infection (STI) prevalence in adult population
There are unfortunately no reliable data available on STI prevalence in the general
population in Indonesia. As input into AEM, the working group used the observed
prevalence of gonorrhea among PWID as proxy for general population STI prevalence
(0.8%) for non-Papua. For Papua, where STI data for PWID are not available, we adjusted
the national estimate of STI prevalence of gonorrhea by the Papua/non-Papua ratio of
syphilis prevalence general population men and women to yield a general population
estimate of gonorrhea prevalence for Papua.
Table 3.10: Spouses and Regular Partners – non-Papua
Sex with spouses or regular

2007 2008 2009 2010 2011 2012 2013 2014 2015
partners (RP)
Number of sexual contacts
1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
with spouse or RP (per week)
1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3%
spouses or regular partners
STI prevalence in adult
0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8%
population
3.4.3. PWID Worksheet (Injection Drug Users)

This worksheet is only completed for estimating and projecting in the 31 provinces model
and was left blank for Tanah Papua. The number of female PWID in Indonesia was thought
to be sufficiently small that they would not have a major impact on the HIV epidemic in
Indonesia, and were thus not taken into account in the epidemic update.
Male PWID injecting behaviors

19
 Percent of adult male population who inject drugs
This parameter was estimated from the 2016 key population size estimation update. This
provided the numerator of the parameter, which was then divided by the estimated
number of males 15-19 age. See Table 3.11 for parameter estimates from 2007-2015.
No new data were available for the following two parameters, and thus they were left
unchanged from the last epidemic update.
 Percent of male IDUs in high-risk networks

 IDU mortality (crude mortality per year in %)
The values input into AEM for these parameters are shown in Table 3.11 below.
 Percent of PWID who often and always sharing material last week
This parameter was updated based upon data from the 2015 IBBS. See Table 3.11 for the
2015 estimate and “smoothed” parameter estimates from 2007 to 2015.
 Percent of all injections shared (among those who share)

The 2015 IBBS did not provide a basis for changing the parameter value from the last
epidemic update, and thus it was left unchanged.
 Number of injections per day

2105 IBBS data suggested a slight increase in this parameter. Values for 2007-2015 are
shown in Table 3.11.
 Average duration of injecting behavior (in years)

 Sharing to non-sharing movement per year
The 2015 IBBS did not provide a basis for changing the two above parameters from the last
epidemic update, and thus they were left unchanged – see Table 3.11 below.
20
Table 3.11: Male PWID Injecting Behaviors – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Male IDU - Injecting
131.2 118.8 106.0 90.0 73.8 74.3 61.0 47.4 33.5
Behaviors / population
Percent of males age 15-49
0.21% 0.19% 0.16% 0.14% 0.11% 0.11% 0.09% 0.07% 0.05%
who inject drugs
Percent of male IDUs in high-
70.0% 70.0% 70.0% 70.0% 70.0% 70.0% 70.0% 70.0% 70.0%
risk networks
IDU mortality (crude mortality
1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
per year in %)
Percent of male IDUs who
46.8% 46.8% 46.8% 44.4% 42.0% 36.0% 30.0% 27.0% 24.0%
share needles
Percent of all injections shared 70.0% 70.0% 70.0% 70.0% 72.0% 72.0% 72.0% 72.0% 72.0%
(among those who share)
Number of injections per day 2.0 1.9 1.9 1.7 1.6 1.6 1.6 2.0 2.3
Average duration of injecting
10.8 11.6 12.4 13.2 14.0 14.0 14.0 14.0 14.0
behavior (in years)
Sharing to non-sharing
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
movement per year
Male PWID sexual behaviors
 Percent of male IDUs visiting female sex workers

The 2015 IBBS data suggested a continuing decline in the percent of male PWID availing of
the services of FSW. This parameter is estimated to have fallen to 15.5% in 2015. See table
3.12 for further information.
Data from the 2015 IBBS indicated the continuation of a gradual upward trend in the
following two indicators. This trend is documented in Table 3.12 below.
 Percent condom use with female sex worker group 1

 Percent condom use with female sex worker group 2
The 2015 IBBS did not provide a basis for changing the values for the following two
parameters, and thus they were left unchanged – see Table 3.12 below.
 Percent condom use with spouse or regular partner

 Number of contacts with regular partners (per week)
21
Table 3.12: Male PWID Sexual Behaviors – non-Papua
Male Injecting Drug Users -

2007 2008 2009 2010 2011 2012 2013 2014 2015
Sexual Behaviors
Percent of male IDUs visiting
40.9% 36.7% 32.5% 28.3% 24.2% 22.0% 19.8% 17.7% 15.5%
female sex workers
67.0% 66.7% 66.5% 66.2% 65.9% 65.9% 65.9% 65.9% 65.9%
68.0% 64.7% 61.5% 58.2% 54.9% 54.9% 54.9% 54.9% 54.9%
14.0% 21.1% 28.2% 35.3% 42.4% 42.4% 42.4% 42.4% 42.4%
spouse or regular partner
Number of contacts with
1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
regular partners (per week)
3.4.4. MSM Worksheet

This Worksheet compiles data related to the size and risk-taking and health-seeking
behaviors on MSM in the 31 non-Papuan provinces. As there are insufficient data on MSM
in Papua, MSM in Papua were not included in the epidemic update. The MSM population
size in Papua was thus set to zero in AEM.
MSM General
 Percent of adult males engaging in same-sex behavior

This parameter was estimated from the 2016 key population size estimation update. This
provided the numerator of the parameter, which was then divided by the estimated
number of males 15-19 age from the official BPS population projections and estimates. The
2016 estimate of 1.1% was applied retrospectively.
 Percent of MSM who are in “reachable” and “unreachable” categories

“Reachable” MSM, sometimes referred to as “visible” MSM, are those who frequent public
locations to search for and meet sex partners, and can thus be reached via face-to-face
outreach and can be “captured” in mapping exercises. The venues they frequent are
locations that tend to be captured in mapping exercises. “Unreachable” MSM are those
that tend not be found at such public locations and tend to search for sex partners via
internet or through personal networks. An estimated 27.7% of MSM fall into the
“Reachable” category based upon 2015 IBBS data on the percentage of MSM that has been
contacted by an outreach worker. Parameters for MSM were entered into AEM separately
for the reachable and unreachable categories.
 Shift from the “reachable” to the “unreachable” category (percent)

No new data were available for this parameter, and it was thus left unchanged from the last
epidemic update (10%).
22
Table 3.13: Men who have Sex with Men General – non-Papua
Men who have Sex with Men

2007 2008 2009 2010 2011 2012 2013 2014 2015
– General
engaging in same-sex 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1%
behavior
Percent of MSM in risk group 1 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7%
Shift from MSM group 1 to
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
group 2
MSM Risk Taking Behaviors
 Percent engaging in anal sex in the last year - MSM

 Number of anal sex contacts last week (among those having anal sex) - MSM
 Average duration of same-sex behavior (years) – MSM
The values entered into AEM for the three parameters below were based upon data from
the 2015 IBBS. Reachable and non-reachable MSM were assumed to have the same values
for the first and third of these parameters. With regard to anal sex contacts in the week
prior to the 2015 IBBS, non-reachable MSM were assumed to anal sex contact rates that
were only one-fifth of those of reachable MSM. See Table 3.14 below for the AEM input
values.
 Percent of MSM with female partners

2015 IBBS data indicate, for reasons that are not clear, a continuing decline in the percent
of MSM having sex with female as well as male partners. The survey data indicated that this
percent fell to 28.5% in 2015. The trend from 2009 to 2015 was smoothed based upon the
IBBS data for those years. No new information was available for non-reachable MSM, so
the parameter input for this sub-population was left unchanged from the prior epidemic
update at 33%.
 Percent condom use in anal sex with MSM

2015 IBBS data indicate a continuing increase in the percent of MSM using condoms when
having anal sex. The 2015 IBBS indicated that this percent had increased to 74.4% in 2015.
The trend from 2007 to 2015 was smoothed based upon the IBBS data for those years. No
new information was available for non-reachable MSM, and accordingly this parameter was
left unchanged from the prior epidemic update at 60%.
 STI prevalence among MSM
23
STI prevalence (gonorrhea) among reachable MSM in 2015 was estimated from the 2015
IBBS as the weighted average of observed prevalence rates among reachable MSM in
larger and smaller cities/districts, with size estimates from the 2016 size estimation update
being used as weights. This procedure produced an estimate for 2015 of 18%.
Cities/districts for which no estimates were available were assigned the average prevalence
in the four smallest cities for which data were available. No new information was available
for non-reachable MSM. Consistent with above assumption concerning sexual contacts
among non-reachable vs. reachable MSM, the parameter was set at 3.7% (one-fifth or 20%
of the rate for reachable MSM of 18%).
Table 3.14: Men who have Sex with Men Group 1 & 2 – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

191.7 194.1 196.4 198.4 200.7 202.9 205.1 207.1 208.9
group 1 (MSM1) / population
Percent engaging in anal sex in
73.4% 73.2% 73.0% 72.9% 72.7% 72.7% 72.7% 72.7% 72.7%
the last year - MSM1
Number of anal sex contacts
last week (among those having 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
anal sex) - MSM1
Average duration of same-sex
22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0
behavior (years) - MSM1
Percent of MSM1 with female
50.0% 50.0% 50.0% 45.1% 40.2% 39.1% 38.0% 33.2% 28.5%
partners
Percent condom use in anal sex
46.3% 49.6% 52.9% 56.6% 60.3% 64.5% 68.6% 71.5% 74.4%
with MSM1
18.3% 18.3% 18.3% 18.3% 18.3% 18.3% 18.3% 18.3% 18.3%
STI prevalence among MSM1
24
500.5 507.0 512.8 518.1 524.0 529.9 535.5 540.7 545.4
Percent engaging in anal sex in
72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7%
the last year - MSM2
last week (among those having 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2
anal sex) - MSM2
Average duration of same-sex
22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0
Percent of MSM2 with female
33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2%
partners
Percent condom use in anal sex
60.0% 60.0% 60.0% 60.0% 60.0% 60.0% 60.0% 60.0% 60.0%
with MSM2
STI prevalence among MSM2 3.7% 3.7% 3.7% 3.7% 3.7% 3.7% 3.7% 3.7% 3.7%
MSM visiting sex workers

The 2015 IBBS provided no evidence of a need to change the following five (5) parameters
from those used in the last epidemic update, and accordingly they were left unchanged.
See Table 3.15 for AEM input values.
 Percent of reachable MSM visiting male sex workers

 Percent of unreachable MSM visiting male sex workers
 Ratio of frequency of visiting MSW (unreachable MSM /reachable MSM)
 Percent of reachable MSM visiting female sex workers
 Percent of unreachable MSM visiting female sex workers
Table 3.15: Men who have Sex with Men visiting Sex Workers – non-Papua
MSM visiting (male and

2007 2008 2009 2010 2011 2012 2013 2014 2015
female) sex workers
Percent of MSM1 visiting male
19.8% 19.5% 19.2% 18.8% 18.5% 18.5% 18.5% 18.5% 18.5%
sex workers
6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2%
sex workers
Ratio of frequency of visiting
0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
MSW (group 2 / group 1)
Percent of MSM1 visiting
10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2%
female sex workers
10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2%
female sex workers
Percent condom use in anal
53.0% 53.5% 54.0% 57.8% 61.7% 61.7% 61.7% 61.7% 61.7%
sex with male sex workers
Female sex worker group 1 60.3% 61.7% 63.1% 64.5% 65.9% 65.9% 65.9% 65.9% 65.9%
(FSW1)
25
female sex worker group 2 61.2% 59.6% 58.1% 56.5% 54.9% 54.9% 54.9% 54.9% 54.9%
(FSW2)
Based upon 2015 IBBS data indicating increased condom use more or less across the board
in comparison with earlier rounds of IBBS, the values for the three parameters were set to
reflect this trend (although the trend is only slightly upward):
 Percent condom use in anal sex with male sex workers

 Percent condom use with Female sex worker group 1 (FSW1)
 Percent condom use with female sex worker group 2 (FSW2)
Male Sex Workers

The 2015 IBBS provided no evidence of a need to change the following seven (7)
parameters from those used in the last epidemic update, and accordingly they were left
unchanged. See Table 3.16 for AEM input values.
 Percent of males aged 15-49 who sell sex

 Average duration selling sex (in years)
 Shift from MSM1 to MSW
 Shift from MSM2 to MSW
 Percent of MSW reporting anal sex with clients in the last year
 Number of anal sex contacts last week (for MSW with anal sex)
 Percent MSW visiting female sex workers in the last year
Table 3.16: Male Sex Workers – non-Papua
Male Sex Workers 2007 2008 2009 2010 2011 2012 2013 2014 2015
0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03%
who sell sex
Average duration selling sex
8.7 8.7 8.7 8.7 8.7 8.7 8.7 8.7 8.7
(in years)
Shift from MSM1 to MSW 25.0% 25.0% 25.0% 25.0% 25.0% 25.0% 25.0% 25.0% 25.0%
Percent of MSW reporting
anal sex with clients in the last 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0%
year
last week (for MSW with anal 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52
sex)
STI prevalence among male
13.4% 15.2% 17.1% 20.5% 24.0% 24.4% 24.8% 25.6% 26.5%
sex workers
Percent MSW visiting female
23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2%
sex workers in the last year
26
Percent MSW with female
regular partners in the last 72.5% 68.9% 65.2% 56.9% 48.6% 44.4% 40.2% 40.7% 41.2%
year
 STI prevalence among male sex workers

STI prevalence (gonorrhea) among MSW in 2015 was estimated from the 2015 IBBS to be
26.5%, continuing a slightly upward trend over time.
 Percent MSW with female regular partners in the last year

2015 IBBS data indicate, for reasons that are not clear, a continuing long-term decline in
the percent of MSW having sex with regular female partners in the previous year. The
survey data indicated that this percent fell to 41.25% in 2015, up slightly from 40.2% in the
2013 IBBS.
3.4.5. Waria Worksheet
Transgender population- general
 Percent of males aged 15-49 who are transgender

This parameter was calculated using the population size estimate from the 2016 update as
the numerator and the official BPS estimate of the number of males 15-40 years of age as
the denominator. This yielded an estimate of 0.06% for 2015.
 Percent of Transgenders who sell sex

 Percent of Transgenders who engage in casual sex but not sex work
The two parameters above were estimated from the several IBBS that have been
undertaken in Indonesia. The estimated values, which appear to be more or less constant
over time, were 75.9% of Transgenders selling sex and 10.0% engaging in casual sex but not
sex work.
 Percent of Transgenders who have regular partners only

The value for this parameter was calculated as a residual from the previous two items (the
three parameters add to 100%).
Table 3.17: Transgenders General – non-Papua
Transgender population -
2007 2008 2009 2010 2011 2012 2013 2014 2015
General
27
0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06%
who are transgender
Percent of Transgenders who
75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9%
sell sex
engage in casual sex but not 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
sex work
14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1%
have regular partners only
Transgender Sex Workers – Sexual Behaviors

 Percent of transgender sex workers engaging in anal sex with clients

 Number of anal sex contacts last week with clients (for those having anal sex)
 Percent of anal sex contacts with clients which are receptive
 Average duration selling sex (in years)
 Percent condom use in anal sex with clients
 Anal STIs (%) among transgenders who sell sex

STI prevalence (gonorrhea) among Transgenders in 2015 was estimated from the 2015 IBBS
as the average of observed prevalence rates in the cities/districts for which data were
available. This procedure produced an estimate for 2015 of 13.9%, continuing a decline that
appears to have begun after 2011. The estimated Transgender prevalence rates from 2011
to 2015 were smoothed in order to more reliably capture this apparent trend.
Table 3.18: Transgenders Sexual Behaviors – non-Papua
Transgender Sex Workers -

2007 2008 2009 2010 2011 2012 2013 2014 2015
Sexual Behaviors
Percent of transgender sex
workers engaging in anal sex 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
with clients
last week with clients (for 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0
those having anal sex)
Percent of anal sex contacts
with clients which are 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%
receptive
20.8 20.8 20.8 20.8 20.8 20.8 20.8 20.8 20.8
(in years)
75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0%
sex with clients
28
Anal STIs (%) among
26.8% 26.8% 26.8% 26.8% 26.8% 23.4% 20.1% 17.0% 13.9%
transgenders who sell sex
Transgender Sex Workers - Client Make-up

The 2015 IBBS data when compared with data from prior rounds of IBBS indicated modest
trends for the following three parameters, and adjustments were made accordingly – see
Table 3.19.
 Percent of TG clients who are low-risk heterosexual males

 Percent of TG clients who are also clients of female sex workers
 Percent of TG clients who are MSM
 Percent of TG clients who are male IDU

This parameter was calculated as a residual based upon the values of the three prior
parameters (the four parameters must add to 100%).
Table 3.19: Transgenders - Client Make-up – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
Client Make-up
Percent of TG clients who are
80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0%
low-risk heterosexual males
also clients of female sex 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
workers
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
MSM
5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
male IDU
Transgenders engaging in Casual Sex - Sexual Behaviors
 Number of Transgenders having sex with Casual Partners but not selling sex
This parameter was estimated by multiplying the percent of Transgenders reporting having
sex with casual partners but not selling sex in the 2015 IBBS times the estimated size of the
Transgender population in Indonesia from the 2016 key population size update.
The 2015 IBBS provided no evidence of a need to change the following six (6) parameters
 Percent of TGs with casual sex partners who engage in anal sex
 Number of anal sex contacts last week (for TGs having anal sex with CPs)
29
 Percent of anal sex contacts which are receptive
 Percent condom use in anal sex for those with casual partners
 Anal STIs (%) among transgenders who have casual partners
 Percent of annual shift from TGs engaging in casual sex to TGs with RP only
Table 3.20: Transgenders engaging in Casual Sex - Sexual Behaviors – non-Papua
Transgenders engaging in
Casual Sex - Sexual 2007 2008 2009 2010 2011 2012 2013 2014 2015
Behaviors
Percent of TGs with casual
sex partners who engage in 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
anal sex
last week (for TGs having 0.34 0.34 0.34 0.34 0.34 0.34 0.34 0.34 0.34
anal sex with CPs)
Percent of anal sex contacts 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%
which are receptive
sex for those with casual 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3%
partners
Anal STIs (%) among
transgenders who have 10.42% 10.08% 9.75% 9.41% 9.07% 9.07% 9.07% 9.07% 9.07%
casual partners
Percent of annual shift from
TGs engaging in casual sex to 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0%
TGs with RP only
Transgender Sex Workers - Partner Make-up for those with CPs

The 2015 IBBS provided no evidence of a need to change the following four (4) parameters
 Percent of anal sex partners who are low-risk heterosexual males

 Percent of anal sex partners who are also clients of female sex workers
 Percent of anal sex partners who are MSM
 Percent of anal sex partners who are male IDU (calculated from previous 3 rows)
Table 3.21: Transgenders Sex Workers Partner Make-up for those with CPs – non-Papua
30
Partner Make-up for those 2007 2008 2009 2010 2011 2012 2013 2014 2015
with CPs
Percent of anal sex partners
who are low-risk heterosexual 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0%
males
who are also clients of female 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
sex workers
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
who are MSM
5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
who are male IDU
Transgenders with Regular Partners - Sexual Behaviors
 Number of Transgenders with regular partners only

This parameter was estimated by multiplying the percent of Transgenders reporting having
a regular partner but not selling sex or having casual partners in the 2015 IBBS times the
estimated size of the Transgender population in Indonesia from the 2016 key population
size update.
 Percent of TGs with regular partners who engage in anal sex

 Number of anal sex contacts with RPs last week (for TGs having anal sex with
RPs)
 Percent of anal sex contacts with RPs which are receptive
 Percent condom use in anal sex with regular partners
 Anal STIs (%) among transgenders who have regular partners only
Table 3.22: Transgenders with Regular Partners - Sexual Behaviors – non-Papua
Transgenders with Regular

Partners (RP) - Sexual 2007 2008 2009 2010 2011 2012 2013 2014 2015
Behaviors
Percent of TGs with regular
partners who engage in anal 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
sex
31
with RPs last week (for TGs 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2
having anal sex with RPs)
90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%
with RPs which are receptive
18.8% 18.8% 18.8% 18.8% 18.8% 18.8% 18.8% 18.8% 18.8%
sex with regular partners
Anal STIs (%) among
regular partners only
Transgender Sex Workers - Regular Partner Make-up (sums to 100%)

The 2015 IBBS provided no evidence of a need to change the following four (4) parameters
 Percent of anal sex partners who are low-risk heterosexual males

 Percent of anal sex partners who are also clients of female sex workers
 Percent of anal sex partners who are MSM
 Percent of anal sex partners who are male IDU (calculated from previous 3 rows)
Table 3.23: Transgenders Sex Workers Regular Partner Make-up – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
Regular Partner Make-up
males
sex workers
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
who are MSM
5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%
who are male IDU
3.4.6. Epidemic Worksheet

This worksheet contains data related to STI and HIV/AIDS. These data are generally very
limited. Therefore, the data such as STI distribution by age group and the probability of
mother-to-child transmission are taken from another Southeast Asia country (Thailand).
Data on fertility by age group were obtained from the 2012 Indonesia Demographic Health
Survey (IDHS), whereas data on the probability of HIV transmission from high-risk
populations and the start year of the epidemic are the results of the modeling adjustment
with existing HIV surveillance data.
32
3.4.7. HIV Prevalence Worksheet
This Worksheet contains HIV prevalence data from high risk populations in 31 provinces (in
the aggregate) and Tanah Papua, respectively. The data originate from HIV sentinel
surveillance carried out by District Health Offices, VCT service sites, and IBBS data from
2007, 2009, 2011, 2013 and 2015. General population HIV prevalence data were also
available for Tanah Papua for 2006 and 2013.
Prevalence estimates for 2015 were required for all KPs, as well as for the general
population. Estimates for KPs for 2015 for some cities/districts could be taken directly from
the 2015 IBBS. For other cities/districts, only data from the 2009 and/or 2013 IBBS were
available. However, for most of the districts in the country no direct survey-based
estimates of prevalence were available.
The general approach adopted for deriving national estimates of HIV prevalence and trends
for each KP was to produce separate estimates for the three sub-groups of cities/districts
enumerated above and then calculate a national estimate by weighting the sub-group
estimates by key population size and summing them to yield a national figure. Key
population size estimates from the 2016 update exercise were used in the calculations. This
was done separately for the 31 non-Papua provinces (in the aggregate) and for the Tanah
Papua (two provinces), and then combining the two sets of estimates weighted by
estimated key population size.
For cities/districts in which 2009 and/or 2013 IBBS data were available (but not 2015), levels
and trends from 2007 to 2015 were estimated by extrapolating and back-extrapolating
from the available IBBS data taking into account trends in the cities/district for which three
rounds of IBBS data (2007, 2011 and 2015) were available. HIV prevalence estimates for
provinces in which no IBBS data were available was assumed to approximate the level and
trend in smaller cities/districts for which at least some data were available.
Table 3.24: HIV Prevalence among KPs – non-Papua
2007 2009 2011 2013 2015

Direct FSW 5.94% 5.97% 6.03% 6.11% 6.13%
Indirect FSW 2.19% 2.22% 2.26%
People who Inject Drugs 36.06% 33.93% 32.36% 31.47% 28.79%
Men who Have Sex with Men 3.22% 4.75% 6.36% 13.23% 20.25%
Male Sex Workers 7.55% 6.38% 15.44% 12.96% 30.71%
Waria 11.46% 11.44% 11.14% 10.89% 10.65%
Table 3.25: HIV Prevalence among KPs and General Population – Papua
2006 2007 2009 2011 2013 2015

Direct FSW 17.70% 17.91% 17.57% 16.72% 15.92%
33
Indirect FSW 7.00%
General Population Males 2.90% 2.30%
General Population Females 1.80% 2.20%
3.4.8. Adult ART Worksheet

This worksheet collects data on numbers of adults receiving ART, in total and by KP. The
source of data input into AEM was KemKes program data. The input values from 2005-2015
are shown in Table 3.26 and 3.27 below.
Table 3.26: Number of Adults Receiving ART – non-Papua
Number of
adults receiving 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
ART
Male 388 3,385 5,059 6,834 10,154 12,421 14,956 18,266 21,721 27,513 34,536
Female 153 1,391 2,174 3,077 4,785 6,112 7,663 9,779 11,628 16,288 20,446
TOTAL 542 4,776 7,234 9,912 14,939 18,533 22,619 28,044 33,349 43,801 54,982
Table 3.27: Number of Adults Receiving ART – Papua
Number of adults
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
receiving ART
Male 20 50 100 161 267 417 693 978 1,279 2,005 2,484
Female 20 50 100 161 267 417 714 1,113 1,539 2,441 3,025
TOTAL 40 100 200 322 534 834 1,407 2,091 2,818 4,446 5,509
3.5. Projection Process - Spectrum

AEM results obtained as described above were then used as input for the Spectrum
software suite to project some of the consequences of AEM HIV incidence and prevalence
estimates. As was indicated earlier, two (2) Spectrum policy models were used:
Demographic Projection (DemProj) and the AIDS Impact Model (AIM).
Demographic projections in Spectrum relied on Indonesia Population Projection data from

Statistics Indonesia Board for 2000-2025. The sources of the demographic data input into
the Spectrum DemProj module were as follows:
 Population size and composition: The same demographic data that were used in
AEM were input into AIM.
 Life expectancy was estimated from model life tables incorporated into the
Spectrum DemProj module.
 Values for the Age Specific Fertility Rate (ASFR), Total Fertility Rate (TFR) and Sex
Ratio of Births (SRB) were all based on the 2012 Indonesia Demographic Health
34
Survey (IDHS) and the Central Statistics Bureau (BPS) Indonesia Population
Projection 2000-2025.
 International migration: Values for these parameters were set based upon data from
the BPS Indonesia Population Projection Book 2000-2025.
The data related to HIV and AIDS epidemiology used in the Spectrum AIM module were
derived as follows:
 HIV prevalence among adult population (15-49 years old) uses the output of two
AEM modules (Papua and Non-Papua) that have been compiled.
 Starting years of epidemic uses the output from Non-Papua AEM module. This
module was chosen because it contained more comprehensive data on high-risk
population than either Papua and also adjustments of the HIV prevalence from
surveillance results among several key populations.
 Progression of HIV into AIDS requiring ART and deaths of PLHIV as a result of not
receiving ART treatment was set, following recommendations from UNAIDS, based
upon the median time from the initial infection until AIDS related death without
ART. For adults, it is assumed to be 10 years (9.6 years for men and 10.4 years for
women) and for children it is assumed there is a more rapid progression toward
death.
 Age distribution of HIV and AIDS by year uses figures provided by the AEM-
Spectrum module for a country with a concentrated HIV epidemic in certain
populations.
 The Sex Ratio of people with HIV and AIDS was calculated from the distribution of
AIDS cases reported to KemKes.
 The Ratio of Total Fertility Rate of HIV-infected and non HIV-infected women uses
figures provided by the Spectrum AIM module.
 The number of people living with HIV (PLHIV) receiving antiretroviral therapy was
obtained from Ministry of Health Sub-Directorate of AIDS & STD monitoring data
from 2005-2015.
After all, required data were entered into the Spectrum AIM software, AIM calculated key
HIV epidemic impact indicators’ estimates and made projections. The estimates were of
particular interest for the 2016 HIV epidemic update:
 HIV prevalence for the population ages 15-49

 Number of PLHIV, including children
 Number of new infections, including children
 PMTCT coverage
 ART coverage, including children
35
The Spectrum AIM calculations were then compared with those from AEM, and
adjustments made to the Spectrum AIM estimates to cause them to be consistent with
parameter estimates from AEM.
It was agreed that some estimates and projections from Spectrum AIM module would not
be included in this report, such as the impact of the HIV epidemic on the tuberculosis
epidemic and the number of children orphaned by AIDS. The rationale for this was that (1)
the calculation of these indicators in the Spectrum software were based on epidemiological
studies in Africa and (2) some of the required data is not available in Indonesia.
4 Results
4.1 HIV Prevalence among Population aged ≥ 15 years in Indonesia, 2015-2020
Based upon the data and assumptions described above, the AEM projection estimates
indicate that the HIV prevalence among the population ages 15 years and above was 0.33%
in 2015 and will fall slightly to 0.32% in 2020 (Figure 4.1).
Figure 4.1: Estimates and Projection of HIV Prevalence among Population Aged ≥ 15 years in Indonesia, Years 2015-2020
(AEM result)
1.00
0.80
HIV Prevalence (%)
0.60
0.40 0.33 0.33 0.33 0.33 0.32 0.32
0.20
0.00
2015 2016 2017 2018 2019 2020
Year
4.2 Number of key population members living with HIV (PLHIV), 2015-2020
Table 4.1 displays 2015 AEM estimates and projections to the year 2020 of the number of
people living with HIV (PLHIV) among key populations (KPs). Projections to 2020 indicate
that the total number of MSM living with HIV will increase from 87,275 in 2015 to 111,902.
Other groups projected to witness an increase in the number of PLHIV are male sex workers
(from 6,200 to 7,664) and non-KP women (from 206,586 to 222,076). The number of PLHIV
among the other KPs is projected to remain level or decline slightly by 2020. The overall
36
number of key populations living with HIV will increase from 613,435 in 2015 to 631,635 in
2018, and is projected to peak at 632,480 in 2019 before beginning to declining.
Table 4.1: Estimates and Projection of PLHIV by Key Population in Indonesia, Years 2015-2020 (AEM result)
Number of PLHIV
Key Population
2015 2016 2017 2018 2019 2020
Direct Female Sex Workers (FSW
4,646 4,537 4,410 4,271 4,130 3,993
Group 1)
Indirect Female Sex Workers (FSW
3,677 3,699 3,677 3,623 3,550 3,466
Group 2)
Clients of FSW 107,926 102,789 97,876 93,338 89,120 85,215
Men who have sex with men 87,275 92,325 97,316 102,220 107,072 111,902
(MSM)
* Male Sex Workers (MSW) 6,200 6,540 6,846 7,129 7,400 7,664
People who inject drugs (PWID) 9,147 8,492 8,321 8,166 8,034 7,923
Transgenders (Waria) 3,975 3,919 3,853 3,780 3,706 3,633
Non-KP men 184,003 187,173 188,489 188,517 187,491 185,652
Non-KP women 206,586 213,128 217,703 220,591 221,976 222,076
Total 613,435 622,602 628,492 631,635 632,480 631,524
* Part of the MSM worksheet, however the estimates and projection were separated with consideration of PPS have a
higher risk than other MSM
4.3 Number of new infections among key population members, 2015-2020

The 2015 AEM estimate of the number of new HIV infections is 49,199, with the majority of
these coming from non-KP women (17,117 new infections) followed by clients of FSW (both
direct and indirect) with 12,647 new HIV infections, and MSM with 10,194 new infections.
The other KP groups will have new cases of HIV infections had between 260 and 4000 new
cases.
New HIV infections among MSM are projected to increase from 10,194 in 2015 to 12,040 in
2020. The other two groups that are projected to have an increase in the number of new
infections from 2015 to 2020 are MSW (from 2,002 to 2,308) and PWID from (616 to 701).
The incidence of new infections is projected to remain stable or decrease for other groups.
Overall, the AEM projection is that the overall number of new infections will decrease from
49,199 in 2015 and 44,604 in 2020 - a 9% decrease in 5 years.
37
Table 4.2: Estimates and Projection of New HIV Infections by Key Population in Indonesia, Years 2015-2020 (AEM result)
Number of New HIV Infections

Key Population
2015 2016 2017 2018 2019 2020
Direct Female Sex Workers (FSW
1,223 1,101 1,057 1,017 983 951
Group 1)
Indirect Female Sex Workers (FSW
943 915 878 843 813 785
Group 2)
Clients of FSW 12,647 11,588 11,338 11,041 10,723 10,400
Men who have sex with men 10,194 10,447 10,876 11,284 11,669 12,040
(MSM)
* Male Sex Workers (MSW) 2,002 2,088 2,143 2,197 2,253 2,308
People who inject drugs (PWID) 616 582 660 675 691 701
Transgenders (Waria) 260 237 236 233 233 233
Non-KP men 4,198 3,913 3,887 3,850 3,803 3,746
Non-KP women 17,117 16,033 15,283 14,590 13,980 13,440
Total 49,199 46,905 46,357 45,729 45,147 44,604
* Part of the MSM worksheet, however the estimates and projection were separated with consideration of PPS have a
higher risk than other MSM
Figure 4.2 compares the level and distribution of new HIV infections by KP in the 2014 and
2016 epidemiologic updates. As may be observed, the 2016 update presents quite a
different profile than the 2014 update, especially with regard to projections going forward.
The 2014 update suggested that the HIV epidemic had for the most part stabilized with
regard to numbers of new HIV infections for all groups except MSM. However, at then
current levels of intervention coverage and effectiveness, it was projected that the number
of new infections would continue to grow through 2030, with MSM accounting for the bulk
of the increasing number of annual new infections. The 2016 update on the other hand
indicates that the epidemic has already peaked for all groups except MSM, among whom
the projected number of new infections is projected to continue to grow, albeit at a slower
rate that had been projected in 2014. The primary factors underlying the revised epidemic
trajectory consist of (1) lower estimated KP population sizes for MSM and Clients of FSW,
(2) increased condom use across most KPs, (3) lower STI prevalence among most KPs, and
(4) increased ART coverage.
Figure 4.2: Comparison of New Infections from 2014 & 2016 HIV Mathematical Modelling, 1990-2030 (AEM result)
2014 Modelling 2016 Modelling
38
Non-KP males Non-KP females Non-KP males Non-KP females
2016, national (ENG)

2014, national (ENG)
4.4 Total number of PLHIV, new infections and AIDS-related deaths

Figure 4.3 displays in a single figure the AEM projections of numbers of PLHIV, new
infections and AIDS-related deaths from 2015 to 2020. The total number of PLHIV 15+
years of age is projected to peak at 632,480 in 2019, but then to fall to 631,524 by 2020. The
annual number of new HIV infections is projected to decline steadily from 49,199 in 2015 to
44,604 in 2020. In contrast, pending further increases in ART coverage and adherence the
number of AIDS-related deaths in the adult population is projected to increase from 36,936
in 2015 to 45,560 in 2020.
Figure 4.3: Estimates and Projection of PLHIV, AIDS Deaths and New HIV Infections among Population Aged ≥ 15 years in
Indonesia, 2015-2020 (AEM result)
750000 90000
613435 622602 628492 631635 632480 631524
600000 75000
New HIV Infection

60000
450000 49199 AIDS Death &
46905 45729 44302 45560
PLHIV
46357
40468 42586 45147 44604 45000
36936 37737
300000
30000
150000 15000
0 0
2015 2016 2017 2018 2019 2020
Year
AIDS Death New HIV Infection PLHIV
4.5 ART among adult PLHIV

The number of persons aged ≥ 15 years in need of ART was estimated to be 321,235 in 2015,
rising to 372,240 in 2020 (estimates from AEM) (Figure 4.4). ART needs among adult PLHIV
were estimated using the Strategic Use of ARV (SUFA) criteria. The number of PLHIV
receiving ART is projected to increase from 60,301 (18.8% of persons eligible for treatment)
39
in 2015 to 68,719 (18.5% of eligible persons) in 2020. Both projections will be useful in
guiding future program planning for ART supply in 2016-2020.
Figure 4.4: Estimates and Projection of PLHIV and ART Needs among Population Aged ≥ 15 Years in Indonesia, 2015-2020
(AEM result)
750000 30
613435 622602 628492 631635 632480 631524
600000
18.77 18.30 18.63 18.55 18.50 18.46
20
% receiving ART
450000
PLHIV
348622 358516 366261 372240

321235 336263
300000
10
150000
60301 61544 64951 66514 67757 68719
0 0
2015 2016 2017 2018 2019 2020
Year
PLHIV need ART PLHIV receiving ART PLHIV % receiving ART
Note: * Denominator for HIV coverage: PLHIV who are eligible for ART, based on SUFA criteria.
4.6 HIV among children

The projected number of children living with HIV and AIDS shows an increasing trend from
16,712 in 2015 to 20,825 in 2020. At the same time, the number of new infections among
children is projected to trend slightly downward, reflecting both slightly declining general
population HIV prevalence and the impact of PMTCT program efforts. AIDS-related deaths
among children are projected to reach a peak of 2,526 deaths in 2019 and then start to
decline.
Figure 4.5: Estimates and Projection of PLHIV, AIDS Deaths and New HIV Infections among Children Aged 0-14 Years in
Indonesia, 2015-2020 (Spectrum result)
40
25000 10000
20373 20825
19718
18871
20000 17841 8000
16712
New HIV Infection

AIDS Death &
15000 6000
PLHIV
4261 4236 4212 4147 4050

10000 3925 4000
2377 2421 2453 2504 2526 2523
5000 2000
0 0
2015 2016 2017 2018 2019 2020
Year
AIDS Death New HIV Infection PLHIV
4.7 ART among children

ART need among children living with HIV was estimated at 12,869 in 2015 and projected to
be 13,374 in 2020 (estimates from Spectrum using the SUFA criteria) (Figure 4.6). Both the
number of children PLHIV receiving ART and ART coverage among children are projected
to stabilize between 2015 and 2020.
Figure 4.6: Estimates and Projection of PLHIV and ART Needs among Children Aged 0-14 Years in Indonesia, 2015-2020
(Spectrum result)
25000 60
20373 20825
19718
20000 18871
17841
16712 45
% receiving ART
15000 13653 13723 13615 13374

13359
PLHIV
12869
30
10000 21.0 20.3 19.8 20.2
19.7 19.9
15
5000
2708 2708 2708 2708 2708 2708
0 0
2015 2016 2017 2018 2019 2020
Year
PLHIV need ART PLHIV receiving ART PLHIV % receiving ART
41
4.8 PMTCT
Spectrum AIM produced as estimate of HIV prevalence among pregnant women in 2015
and projections to 2020. Prevalence was estimated to be 0.32% in 2015 and is projected to
reach a peak at 0.33% in 2016 and 2017 before beginning to declining (Figure 4.7).
Figure 4.7: Estimates and Projection of HIV Prevalence among Pregnant Women in Indonesia, 2015-2020 (Spectrum result)
1.00
0.80
HIV Prevalence (%)
0.60
0.40 0.32 0.33 0.33 0.32 0.32 0.31
0.20
0.00
2015 2016 2017 2018 2019 2020
Year
As shown in Figure 4.8, the number of HIV positive pregnant women is projected to
decrease from 15,614 in 2015 to 14,298 in 2020. The number of mothers receiving
Prevention of Mother to Child Transmission service needs is projected to reach a peak of
1,727 in 2016, but decrease to 1,539 in 2020. An estimated 10.33% mothers received PMTCT
in 2015. This figure is projected to increase slightly to 10.76% in 2020.
Figure 4.8: Estimates and Projection of PMTCT Service Needs in Indonesia, 2015-2020 (Spectrum result)
30000 15
HIV Positive Pregnant Women
25000 11.04 10.82 10.70 10.68 10.76 12

10.33
20000
% receiving PMTCT
15614 15468 15176 9

15638 14778 14298
15000
6
10000
5000 3
1613 1727 1674 1624 1579 1539
0 0
2015 2016 2017 Year 2018 2019 2020
HIV positive pregnant women Mothers receiving PMTCT % receiving PMTCT
4.9. Summary of Estimates: 2014 and 2016 Epidemic Updates

The changes in estimates of key parameters resulting from the 2016 modeling update (vs.
the 2014 modeling work) are summarized in Table 4.3 below.
42
Table 4.3: Summary of differences in key results – 2014 vs. 2016 modeling
2014 2016
Parameter
Modeling Modeling
Number of new HIV infections – 2016 73,875 51,141
Number of new HIV infections – 2017 75,829 50,569
Number of PLHIV – 2016 722,050 640,443
Number of PLHIV – 2017 751,875 647,363
Total HIV-related deaths – 2016 36,029 40,158
Total HIV-related deaths – 2017 38,913 42,921
Number of persons eligible for ART – 2016* 351,112 349,622
Number of persons eligible for ART – 2017 373,503 362,275
Number of persons on ART – 2016 46,592 64,252
Number of persons on ART – 2017 50,663 67,659
 Strategic Use of ARV for Program Policy implemented beginning in 2013.
5 Limitations
The limitations of the 2016 modeling work are largely those faced in most, if not all,
epidemic modeling exercises. The main issues concern data limitations in relation to data
required by AEM and Spectrum AIM. Notable among these are the following:
 Lack of a functioning sentinel surveillance mechanism, resulting in reliance on

periodic large-scale surveys (i.e., IBBS) to provide crucial information. This results in
data being available for a limited number of cities and districts, making the
production of estimates at the national level a challenge. The fact that not all KPs
were covered in each city/district in the IBBS conducted to data further complicates
accurate estimation.
 Limited time series data from IBBS, making discerning trends over time a challenge
even for those cities and districts for which data are available. Only in the 12 cities
and districts that were covered in the 2007, 2011 and 2015 IBBS were data at three
points in time available. Data at two points in time were available for an additional
13 cities and districts.
 Extremely limited general population data.
 Country-specific data on key parameters of the AEM were, as in many countries, not
available for Indonesia – for example, HIV incidence rates by KP or population sub-
group. As a result, it was necessary to use “default” values built into AEM that are
based upon the compilation of existing from other Asian countries. The extent to
which epidemic patterns in Indonesia correspond to those in the Asia region as
43
whole is uncertain, but considerable research went into this issue during the
development of AEM.
6 Recommendations for future modeling work

 To ensure that the models’ outputs are close to reality, there is urgent need to
generate information needed for modeling through collection of quality program
data.
 The accuracy of both KP population size estimates and epidemic modelling would
be greatly improved by having mapping data from more cities and districts.
7 References
1. Central Statistics Bureau Indonesia and Ministry of Health Indonesia. 2004. Report
on Results of Behavioral Surveillance Survey 2002-2003 in Indonesia. Jakarta: s.n.,
2004.
2. Ministry of Health Indonesia. 2005. Report on Results of Study of Prevalence of
Reproductive Tract Infections among FSW, Indonesia 2005. Jakarta: MoH, 2005.
3. Ministry of Health Indonesia. 2005. HIV Infection Risk Behavior Situation in
Indonesia, Results of Behavioral Surveillance Survey 2004-2005. Jakarta: s.n.,
2005.
44
4. Ministry of Health Indonesia. 2006. Guidelines for HIV Sentinel Surveillance,
Second Generation HIV Surveillance. Jakarta: MoH, 2006.
5. Ministry of Health Indonesia. 2007. Risk Behavior and HIV Prevalence in Tanah
Papua. 2006. Directorate General of CDC & EH, 2007.
6. Ministry of Health Indonesia. 2007. Report on Real Integrated Biological and
Behavioral Survey 2007. Jakarta: MoH, 2007.
7. Ministry of Health Indonesia RI. 2008. Integrated Biological and Behavioral Survey.
Directorate General of CDC & EH, 2008.
8. Ministry of Health Indonesia. 2008. Mathematic Model of HIV Epidemic in
Indonesia 2008-2014. Directorate General of CDC & EH, 2008.
9. Ministry of Health Indonesia. 2009. Estimates the Most at Risk Population of HIV
2009. Directorate General of CDC & EH, 2010.
10. Ministry of Health Indonesia. 2009. Report on Results of Survey of Prevalence of
Reproductive Tract Infections among FSW in Kupang, Samarinda, Pontianak,
Yogyakarta, Timika, Makassar and Tangerang 2006-2007. Jakarta: MoH, 2009.
11. Ministry of Health Indonesia. 2011. Report on Result of Integrated Biological and
13. World Health Organization. 2011. Guidelines for Second Generation HIV
Surveillance: an update: Know your epidemic. Geneva: WHO, 2011.
14. Ministry of Health Indonesia. 2013. 2012 Size Estimation of Key Affected
Populations (KPs). Jakarta: MoH, 2013.
16. Ministry of Health Indonesia. 2014. Integrated Biological & Behavioral Surveillance
(IBBS) in General Population in Tanah Papua, 2013 (PowerPoint slides).
17. Ministry of Health Indonesia. 2016. Result of Integrated Biological and Behavioral
Survey 2015 (PowerPoint slides)
18. Ministry of Health Indonesia. 2016. Draft report of 2016 Size Estimation of Key
Affected Populations (KPs).
45
8 Annexes
Annex 1: Procedures used to produce national estimates of key parameters for

2015 and trends over time for input into AEM
The 2015 IBBS, like prior rounds of IBBS, was designed as a surveillance mechanism to track
trends in key indicators in selected cities/districts over time. This design is sub-optimal for
producing true national estimates as it features data for only a modest number of
cities/districts that were not randomly chosen. Nevertheless, national estimates were
desired for the 2016 epidemic update, and accordingly an estimation approach was devised
to enable this while at the same time maintaining the surveillance mechanism begun with
the 2007 IBBS.
The general approach adopted for deriving national estimates of key AEM parameters for
each KP was to produce separate estimates for (1) the cities/districts for which data were
available – these are primarily the larger cities/districts that have been the primary focus of
HIV control efforts to date, and (2) cities/districts for which IBBS data were not available –
these are primarily smaller cities/districts that have not been deemed as being among the
highest risk districts, and most have not been targeted for GFATM funding support (note,
however, that some – albeit a minority – of cities/districts in this group are indeed
recipients of GFATM funds). Mean parameter estimates for the smaller of the
cities/districts for which IBBS data were available were used in lieu of actual data for
cities/districts for which no IBBS data were available. A national estimate was then
calculated by weighting the sub-group estimates by KP population size estimates from the
2016 size estimation update and summing them to yield a national figure. This was done
separately for the 31 non-Papuan provinces (in the aggregate) and for the Tanah Papua
(two provinces), and then combining the two sets of estimates weighted by estimated KP
population size. This is expected to produce more accurate national estimates than the less
formal averaging procedure used in prior epidemic updates.
46
The procedure is illustrated below in the case of the indicator “Proportion of Transgenders
Using a Condom at Last Commercial Sex.” IBBS data were available for a total of nine (9)
cities/districts in 2015 (years for which IBBS data were available are highlighted in yellow).
Five (5) of these were from the largest cities/districts that were the earliest focus of HIV
control efforts in Indonesia and for which three (3) rounds of IBBS data are available – 2007,
2011 and 2015. IBBS data were also available for four (4) smaller cities/districts (2009 and
2013) that were among the second “wave” for priority attention beginning with GFATM
Round 9.
The 2015 estimates from the 2015 IBBS data are shown in the “2015” column of the table.
The 2015 estimate for cities/districts for which IBBS data were not available (labelled “The
Rest” in the table) was calculated by taking the mean of the four smaller cities/districts. The
national estimate for 2015 was derived by taking the parameter estimates shown for 2015,
weighting them by the estimated population size of Transgenders shown in the right-most
column of the table, and summing them to yield the national estimate.
Table A1.1: Illustrative Calculation of National Estimate of the Proportion of Transgenders Using Condom at Last Commercial
Sex
Condom Use (Last Sex) Size
District Estimates
2007 2009 2011 2013 2015
(Province)
Jakarta 85.00 86.95 88.89 78.32 67.74 1,103
cities/districts
Kota Bandung 82.00 79.65 77.30 82.59 87.88 4,073

Largest
Kota Semarang 68.00 55.16 42.31 34.86 27.40 3,806

Kota Malang 69.00 67.45 65.90 68.37 70.84 3,898
Kota Surabaya 86.00 86.09 86.18 87.64 89.09 370
Kota Palembang 30.86 30.86 46.43 62.00 73.71 1,612
Smaller cities/
districts
Kota Pontianak 62.61 77.19 83.10 89.00 89.00 1,303

Kota Makassar 47.37 58.40 75.70 93.00 93.00 1,852
Kota Samarinda 30.01 35.47 43.74 52.00 54.50 704
The rest 42.71 50.48 62.24 74.00 77.55 20,207
Weighted average 53.70 57.25 63.57 71.27 73.43 38,928
The 2016 epidemic update took advantage of the longer time series of data from key
districts resulting from the 2015 IBBS to more formally reassess trends in key parameters
during the 2007-2015 period (note: 2007 was the first large-scale IBBS undertaken in
Indonesia). Trends between these dates were mathematically “smoothed” in order to
reduce “noise” in the data resulting from the fact that KP district sample sizes in the
respective rounds of IBBS were modest. For cities/districts in which 2009 and/or 2013 IBBS
data were available (but not 2015), levels and trends from 2007 to 2015 were estimated by
47
extrapolating and back-extrapolating from the available IBBS data taking into account
trends in the cities/district for which three rounds of IBBS data (2007, 2011 and 2015) were
available. HIV prevalence estimates for provinces in which no IBBS data were available was
assumed to approximate the level and trend in smaller cities/districts for which at least
some data were available.
Annex 2: Inventory of Data Input to AEM Spreadsheets – 2016 Epidemic Update
Heterosexual Behaviors and STI

Behavioral inputs to AEM for the heterosexual population
No Category
I. Female Sex Workers / population (thousands)
- Baseline 2014:
Input AEM: 2007 = 208.7, 2009 = 215.2, 2011 = 221.6, 2013 = 227.8, and 2015 = 234.1
- Baseline 2016:
Data obtained: Non-Papua = percent of females aged 15-49 who sell sex  0.33%;
population females aged 15-49 in 2030  73.730.400; Papua = percent of females aged
15-49 who sell sex0.19%; population female aged 15-49 in 20301.346.000
Calculation: Population FSW for Non-Papua = 0.33%*73.730.400/1000=243.4; for
Papua = 0.19%*1.346.000/1000=2.5
Input AEM: Non Papua put the number in 2030 = 243.4; and the rest  1975 – 2025
copy paste transpose from sheet population AEM; and 2030, 2035, 2040, 2045 & 2050
just copy paste one by one; 2007 = 206.8, 2009 = 211.9, 2011 = 216.6, 2013 = 220.9,
2015 = 224.7, and 2030 = 243.4; Papua put the number in 2030 = 2.5; and the
rest1975 – 2025 copy paste transpose from sheet population AEM; and 2030, 2035,
2040, 2045 & 2050 juts copy paste one by one; 2007 = 1.8, 2009 = 1.9, 2011 = 1.9, 2013 =
2.0, 2015 = 2.1, and 2030 = 2.5;
Data source: Census 2010; Data Demography Spectrum (Indonesia Spectrum AEM
Sep16.PJNZ).
Female Sex Workers – General

1 Percent of females aged 15-49 who sell sex
- Baseline 2014:
Data obtained: FSWs (direct & indirect)  214.054; female population age Non-Papua
15-49  62.225.596
Calculation: 214.054/62.225.596 = 0.34%, 0.35% (2011)
48
Input AEM: 0.33% (all year)
Data source: Size estimation of MARP, MoH 2009.
- Baseline 2016:
Data obtained: total population FSW Non-Papua 2015  224.691; population females
aged 15-49 2015  68.064.500; total population FSW Papua 20152.100; population
females aged 15-49 20151.130.900;
Calculation: percent of females aged 15-49 who sell sex in Non-Papua =
224.691/68,064,500 = 0.33%; Papua = 2.100/1.130.900 = 0.19%;
Input AEM: Non-Papua = 0.33% (all year); Papua = 0.19% (all years).
Data source: Size estimation of MARP, MoH 2015; Data Population AEM.
2 Percent of female sex workers in group 1 (higher frequency)
- Baseline 2014:
Data obtained: Direct FSW  106,011; FSWs (direct & indirect)  214,054
Calculation: 106,011/214,054 = 49.53%
Input AEM: 49.53% (2009); 54% (2011)

Data source: Size estimation of MARP, MoH 2009.
- Baseline 2016:
Data obtained: total population FSW Non-Papua 2015  224.691; total DFSW size
from (total size estimates per province*DFSW weight per province) Non-Papua
73.894; total population FSW Papua 20152.100; total DFSW size from (total size
estimates per province*DFSW weight per province) Papua793;
Calculation: 74.686/226.791 = 32.9%; 793/2.100 = 37.7%;
Input AEM: Non-Papua = 32.9% (all years); Papua = 37.7%

Data source: Size estimation of MARP, MoH 2015; Data Mapping, NAC 2015.
3 Movement from group 1 to group 2 each year
- Baseline 2014:
No data available. Use default data from Thailand Baseline Projection
Input AEM = 1% (All years)
- Baseline 2016:
Assumed: keep the balance of FSW size
Input AEM = 1% (All years)
II Female Sex Workers group 1 (FSW1) / population (in thousands)
- Baseline 2016:
Data obtained: total population FSW 2015  224.7; percent FSW in group 1 2015 
32.9%
Calculation: 2015  224.7*32.9% = 73.9
49
1 Number of clients per day - FSW group 1
- Baseline 2014:
Data obtained: BSS 2002  1.7; BSS 2004  1.9; IBBS 2009  2.1 (clients per week: 8;
# workday per week: 3.8. # clients per day: 8/3.8 = 2.1, Average = (1.7+1.9+2.1)/3 = 1.9);
IBBS 2011 Papua 1.7 (clients per week:9 #workday per week: (23/30*7) = 5.4 #client
per day: 9/5.4 =1.7, Average = (1.7+1.9+2.1+1.7)/4 =1.9); IBBS 2011 Non-Papua  1.7
(clients per week:9 #workday per week: (23/30*7) = 5.4 #client per day: 9/5.4 =1.7,
Average = (1.7+1.9+2.1+1.7)/4 =1.9).
Input AEM = 1.9 (All years)

Data source: BBS 2002, 2004, IBBS 2009, 2011
- Baseline 2016:
Data obtained: number of clients per week (Mean) / days worked per week.
Calculation: 2007 9.72/6.1 = 1.5; 2009 8.099/6.1 = 1.3; 20118.79/5.4 = 1.6;
20136.21/5.6 = 1.1; 20158.9/5.4 = 1.6.
Input AEM = 1.5 (all year’s) average from 2007 to 2015

Data source: IBBS 2007, 2009, 2011, 2013, 2015.
2 Days worked per week - FSW group 1
- Baseline 2014:
Data obtained: BSS 2004 = working days per month 22; months per year 8.6;
weeks per year 52; days per week 8.6x22/52 = 3.6. IBBS 2009 = working days per
month 25; months per year 8; weeks per year 52; days per week 8x25/52 =
3.8. Average = (3.6+3.8)/2 = 3.7.
IBBS 2011= workday per month 23.33; day per month30; work day per week
23.33/30*7 = 5.4. Average 3.6+3.8+5.4)/3 = 4.3. IBBS 2011 Non-Papua= workday per
month 23.27; day per month 30; work day per week 23.27/30*7 = 5.4. Average
(3.6+3.8+5.4)/3 = 4.3. IBBS 2011 Papua = workday per month 23.8; day per month
30; work day per week23.8/30*7 = 5.5. Average (3.6+3.8+5.5)/3 = 4.3.
Input AEM: 4.3 (all years)

Data source: BSS 2004, IBBS 2009, IBBS 2011
- Baseline 2016:
Data obtained: 2007 = Non-Papua  6.1 (mean), 6.25 (median); Papua 6.24 (mean),
6.5 (median); 2009 per month = Non-Papua  24.61 (mean), 26 (median); Papua 
24.44 (mean), 26 (median); 2011 = Non-Papua  5.4; Papua  5.5; 2013 = Non Papua
 5.64 (mean), 5.75 (median); Papua  5.93 (mean), 6.25 (median); 2015 = Non Papua
 5.42; Papua  5.63.
50
Input AEM: 5.7 (all year’s) average from 2007 to 2015
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
3 Percent condom use with clients - FSW group 1
- Baseline 2014:
Data obtained: increasing condom use as an impact of promotion condom in work
place (national consensus in August 2008);
Input AEM: 1986 = 5%; 1990 = 5%; 1993 = 13%; 1996 = 36%; 2000 = 41%; 2003 = 58%;
2007 = 67%; 2009 = 60%; 2011 = 73.6%; 2011 = 67.3%.
Data source: DHS Indonesia 1985 (% of condom use for family planning); Household
survey (national consensus in August 2008); BSS 1996; BSS 2000 in 3 cities; BSS 2002
& 2004 (last sex) in 13 cities; IBBS 2007 (last sex); IBBS 2009 (last sex); IBBS 2011 (last
sex) - Non-Papua; IBBS 2011 (last sex) - Papua.
- Baseline 2016:
Data obtained: weighted last sex condom use DFSW Non-Papua = 2007  56.4984;
2015 72.3801;
Calculated: 2007  56.4984*0.95 = 53.7%; 2015  72.3801*0.8 = 57.9% #2007 to 2015
interpolate and 2005  45.0%
Input AEM: 2005 = 45.0%; 2007 = 53.7%; 2009 = 54.7%; 2011 = 55.8%; 2013 = 56.8%;
2015 = 57.9%
Data source: Size estimation of MARP, MoH 2015; IBBS 2007, 2009, 2011, 2013, 2015;
4 Average duration selling sex in group 1 (years)
- Baseline 2014:
Data obtained: BSS 2004 = % of FSW worked <12 months27.75%; Duration
1/27.75% = 3.6; IBBS 2009 = % of FSW worked <12 months35%; Duration1/35% =
2.9; Average duration  3.6+2.9/2 = 3.25; IBBS 2011 = % of FSW worked <12
months33.63%; Duration 1/33.63% = 2.97; Average
duration3.6+2.9+2.97/3=3.16; IBBS 2011 Non-Papua  1/34.29% = 2.92; IBBS 2011
Papua 1/27.82% = 3.59.

Data source: BSS 2004; IBBS 2009, 2011
- Baseline 2016:
Data obtained: selling sex up to interview time in group 1 (years) (Median)*2 = 2007
Non-Papua1*2 = 2; Papua2*2 = 4; 2009 Non-Papua1*2 = 2; Papua2*2 = 4;
2011 Non-Papua  3*2 = 6; Papua 3*2 = 6; 2013 Non Papua2*2 = 4; Papua3*2
= 6; 2015 Non Papua2*2 = 4; Papua4*2 = 8.
Calculation: 2007 = 3.3 (baseline 2014) interpolate up to 2015 = 4 (2*2).
51
Input AEM: 2007 = 3.3; 2009 = 3.5; 2011 = 3.7; 2013 = 3.8; 2015 = 4.0
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
5 STI prevalence among FSW group 1
- Baseline 2014:
Data obtained:
Calculated from adjusted% FSW infected by NG and or CT in area survey of Java
Island; RTI Study 2003 & 2005 in 7 cities excluded Papua (% of direct FSW infected by
NG and or CT); RTI study in 12 cities, excluded Papua (% direct FSW with infected NG).
Input AEM: 2003 = 39%; 2007 = 32%; 2009 = 37%; 2011 = 51.13%; 2011 = 57.11%
Data source: Survey among FSW; National consensus in August 2008; IBBS 2009, 2011
Papua & Non-Papua.
- Baseline 2016:
Data obtained: gonorrhea big; gonorrhea small
Calculation: average between gonorrhea big and gonorrhea small
Input AEM: 2000 = 60%; 2007 = 36.8%; 2009 = 36.8%; 2011 = 36.8%; 2013 = 32.4%;
2015 = 28.0%
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
III Female Sex Workers group 2 (FSW2) / population (in thousands)
- Baseline 2016:
Data obtained: total population FSW 2015  224.7; percent FSW in group 2 2015 
67.1%
Calculation: 2015 224.7*67.1% = 150.8
1 Number of clients per day - FSW group 2
- Baseline 2014:
Data obtained: clients per week
Calculated: average number of client per day from 4 surveys in 2002, 2004, 2007 and
2009 among indirect FSW;
Note: working days/month 22; working months/year 9; working days/week 
(9x22)/52 week = 3.8 days/week.
- BSS 2002/2003 (3.5 clients per week /3.8 days per week) = 0.92 clients/day)
- BSS 2004/2005 (4.2 clients per week /3.8 days per week) = 1.11 clients/day)
- IBBS 2007 (3.29 clients per week /3.8 days per week) = 1.84 clients/day)
- IBBS 2009 (4 clients per week/4.5 days per week) = 0.88; Average =
(0.92+1.11+1.84+0.88)/4 = 1.19
- IBBS 2011: #3 clients per week #23 workdays per month, #workday per week
(23/30*7) = 5.37 #clients per day (3/5.37) =0.84; Average =
(0,92+1.11+1.84+0.88+0.84)/5 = 1.12
- IBBS 2011 (WPSTL Non-Papua): #3.3 clients per week #23.21 workdays per month,
#workday per week (23.21/30*7) = 5.42, #clients per day (3.3/5.42) =0.61
52
- IBBS 2011 (WPSTL Papua): #2.06 clients per week #24.33 workdays per month,
#workday per week (24.33/30*7) =5.67, #clients per day (3.3/5.67) = 0.58; Average =
(0,92+1.11+0.88+0.61)/4 = 0.88
- Baseline 2016:
Data obtained: number of clients per week (Mean) / days worked per week.
Calculation: 2007 4.72/6.2 = 0.8; 2009 4.166/6.5 = 0.6; 20113.3/5.8 = 0.6;
20133.81/5.5 = 0.7; 20153.95/5.7= 0.7
Input AEM: 2007 = 0.8; 2009 = 0.6; 2011 = 0.6; 2013 = 0.7; 2015 = 0.7
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
2 Days worked per week – FSW group 2
- Baseline 2014:
Data obtained: BSS 2004 = working days per month22; months per year8.6;
weeks per year 52;
Calculated: day worked per week = 8.6x26/52 = 3.6;
IBBS 2009 = working days per month26; months per year9; weeks per year52;
Calculated: day worked per week = 9x26/52 = 4.5; Average = (3.6+4.5)/2 = 4.05.
IBBS 2011: clients per week 3; working days per month23; day worked per week
(23/30*7) = 5.37; Average = (3.6+4.5+5.37)/3=4.49
IBBS 2011 Non-Papua = Average (3.6+4.5+5.42)/3 = 4.51; IBBS 2011 Papua = Average
(3.6+4.5+5.67)/3 =4.59;
IBBS 2007 = working days25; off work weeks7; weeks/total work weeks49; total
week52;
Calculation: 25/30*7*49/52; IBBS 2011 = same calculation.
Input AEM: 4.49 (All years); updated: 2007 = 5; 2011 = 2.7

Data source: BSS 2004, IBBS 2007, IBBS 2009, IBBS 2011
- Baseline 2016:
Data obtained: 2007 Non Papua (Mean) = 6.24; Papua (Mean) = 6.55; 2009 used day
worked per month in Non Papua (Mean) = 26.22; calculated: 26.22/number per week
4 = 6.555; Papua (Mean) = 25.83; calculated: 25.83/number per week4 = 6.457;
2011 used day worked per month in Non Papua (Mean) = 23.21; calculated:
23.21/number per week 4 = 5.8025; Papua (Mean) = 24.33; calculated: 24.33/number
per week4 = 6.0825; 2013 Non Papua (Mean) = 5.5; Papua (Mean) = 6.05; 2015 used
day worked per month in Non Papua (Mean) = 23.19; calculated: 23.19/number per
week4 = 5.7975; Papua (Mean) = 25.09; calculated: 25.09/number per week4 =
6.2725.
53
Input AEM: 2007 = 6.24; 2009 = 6.6; 2011 = 5.8; 2013 = 5.5; 2015 = 5.8
Data source: IBBS 2007; IBBS 2009; IBBS 2011; IBBS 2013; IBBS 2015
3 Percent condom use with clients - FSW group 2
- Baseline 2014:
Data obtained: DHS Indonesia 1985% of condom use for family planning; Increasing
condom use as an impact of promotion condom in work placenational consensus in
August 2008; household surveynational consensus in August 2008.
Input AEM: 1986 = 5%; 1990 = 5%; 1993 = 13%; 1996 = 36%; 2000 = 38%; 2003 = 55%;
2007 = 68%; 2009 = 63%; 2011 = 60.7%; 2011 = 62.3%; 2011 = 57.74%; 2011 = 37.37%;
2011 = 31.92%.
Data source: BSS 1996, BSS 2000 in 3 cities, BSS 2002 & 2004 (last sex) in 13 cities;
IBBS 2007 (last sex), IBBS 2009 (last sex), IBBS 2011 (last sex), IBBS 2011 (last sex Non-
Papua), IBBS 2011 (last sex Papua), IBBS 2011 (week consistent Non-Papua), IBBS 2011
(week consistent Papua).
- Baseline 2016:
Data obtained: percent condom use with client FSW153.7%*0.8 = 42.96%; Note: all
years % condom use FSW1* with 0.8
Input AEM: 2007 = 42.96%; 2011 = 44.6%; 2015 = 46.3%

Data source: IBBS 2007; IBBS 2009; IBBS 2011; IBBS 2013; IBBS 2015
4 Average duration selling sex in group 2 (years)
- Baseline 2014:
Data obtained: BSS 2004 = % of FSW worked <12 months)  34.9%; calculation:
1/34.9% = 2.9
IBBS 2009 = % of FSW worked <12 months) 44%; calculation: 1/44% = 2.27; Average
= (2.9+2.27)/2 = 2.59
IBBS 2011 = % of FSW worked <12 months)37.86%; calculation: 1/37.86%=2.64
Input AEM: 2.64 (All years)
- Baseline 2016:
Data obtained: selling sex up to interview time in group 2 (years) (Median)*2 = 2007
Non-Papua1*2 = 2; Papua1*2 = 2; 2009 Non-Papua1*2 = 2; Papua0*2; 2011
Non Papua  2*2 = 4; Papua 2*2 = 4; 2013 Non Papua2*2 = 4; Papua1*2 = 2;
2015 Non Papua2*2 = 4; Papua2*2 = 4.
Calculation: 2007 = 2.666 (baseline 2014) interpolate up to 2015 = 4 (2*2).
54
Input AEM: 2007 = 2.6666; interpolate up to 2015 = 4.0
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
5 STI prevalence among FSW group 2
- Baseline 2014:
Data obtained: RTI Study 2003 in 7 cities any Gonorrhea and or Chlamydia; RTI study
2005; IBBS 2007 (NG); IBBS 2009 (NG); IBBS 2011 (CTNG), non-Papua; IBBS 2011
(CTNG), non-Papua; Average: IBBS 2013. Average of STI 19+18+20+17=18%
Input AEM: 2003 = 35%; 2005 = 31%; 2007 = 13.91%; 2009 = 22%; 2011 = 49.52%; 2011
= 39.6%; updated 2013 = 18%, but interpolate from 2010-2013 (30%-18%).
Data source:
- Baseline 2016:
Data obtained: using number gonorrhea big in 2011 18.65%; number of STI
prevalence among FSW group 1 2013 32.4%; number of STI prevalence among FSW
group 1 2011 36.8%; number of STI prevalence among FSW group 1 2015 28.0%;
Calculation: in 2007 used 2011 = 18.65%; 2009 used 2011 = 18.65%; 2011 used number
of gonorrhea big size IBBS 2011 = 18.65%; 2013 = 32.4%*18.65%/36.8% = 16.4%; 2015
= 28.0%*18.65%/36.8% = 14.15%;
Input AEM: 2007 = 18.65%; 2009 = 18.65%; 2011 = 18.65%; 2013 = 16.4%; 2015 =
14.15%
Data source: IBBS 2007, 2009, 2011, 2013, 2015.
Clients of FSWs
IV Clients of FSW / population (in thousands)
The results of the 2016 KP Size Estimation exercise were used as input for this
parameter. The national calculation was 5,254,663 clients (95% CI = 4,415,788 –
6,167,873)
Input to AEM: 2015 non-Papua: 5,195,579; 2015 Papua: 59,084

1 Percent of males aged 15-49 who visited FSW in the last year
- Baseline 2014:
Data obtained: clients = 3.241.244; male population age Non-Papua 15-49 = 59.379.236
Calculation: 3.241.244/59.379.236 = 5% Non-Papua
Input AEM: 5% (All years); 2011 = 11.7

Data source: size estimation of MARP, MoH 2009.
55
- Baseline 2016:
Data obtained: client FSW Non-Papua6.264.328; population males aged 15-49
(2015) 68.727.200
Calculation: 6.264.328/68.727.200 = 9.1%
Input AEM: 9.1% (all years)

Data source: size estimation of HIV key populations, MoH 2016
2 Average duration buying sex (years)
- Baseline 2014:
Data obtained: no data available, use default data from Thailand baseline projection to
reduce the epidemic, to make the different pattern on IFSW and FSW.
Input AEM: 10.0 (All years); updated = 7%
- Baseline 2016:
Input AEM: used baseline 2014 = 7.0 (all years)
3 Percent of adult males who are circumcised
- Baseline 2014:
Data obtained: data assumed 80% of adult males are Moslem (DHS 2007), assumed all
adult males Moslem circumcised
Input AEM: 80% (All years)
- Baseline 2016:
Input AEM: used baseline 2014 = 80% (all years)
Population engaging in Casual Sex
V.I Males engaging in casual sex / population (thousands)
- Baseline 2016:
Data obtained: percent of males engaging in casual sex in the last year6.8%;
population males aged 15-49 2030 75.411.300.
Calculated: population males engaging in casual sex in 2030 = 6.8%*75.411.300/1000 =
5.158
Input AEM: put the number in 2030 = 5.158; and the rest  1975 – 2025 copy paste
transpose from sheet population AEM; and 2030, 2035, 2040, 2045, & 2050 just copy
paste one by one. 2007 = 1.779, 2009 = 1.822, 2011 = 4.516, 2013 = 4.615, 2015 = 4.701
and 2030 = 5.158
Sep16.PJNZ).
V.II Females engaging in casual sex / population (thousands)
- Baseline 2016:
Data obtained: percent of females engaging in casual sex in the last year2.0%;
population females aged 15-49 2030 73.730.400.
56
Calculated: population females engaging in casual sex in 2030 = 2.0%*73.730.400/1000
= 1.475
Input AEM: put the number in 2030 = 1.475; and the rest  1975 – 2025 copy paste
transpose from sheet population AEM; and 2030, 2035, 2040, 2045, & 2050 just copy
paste one by one. 2007 = 626, 2009 = 642, 2011 = 1.312, 2013 = 1.338, 2015 = 1.361 and
2030 = 1.475
Sep16.PJNZ).
1 Percent of males engaging in casual sex in the last year
- Baseline 2014:
Data obtained:
Calculation: proportion of HRM visiting sex worker adjusted by proportion of HRM in
the population male 15-495%; % HRM having casual sex  5% x 0.565 = 2.83%
Input AEM: 2009 = 2.83%
Data source: IBBS 2009
- Baseline 2016:
Data obtained: no changes used baseline 2014
Input AEM: 1975 – 2009 = 2.8%; 2010 = 4.8%; 2011 – 2050 = 6.8%
2 Percent of females engaging in casual sex in the last year
- Baseline 2014:
Data obtained: data given from national consensus meeting on August 2008
Input AEM: 2007 = 0.3%
- Baseline 2016:
Input AEM: 1975 – 2009 = 1%; 2010 = 1.5%; 2011 – 2050 = 2.0%
3 Percent condom use in casual sex
- Baseline 2014:
Data obtained: 2002 = BSS in 13 cities1%; 2004 = BSS in 13 cities17%; 2007 = IBBS
10 cities; no scale up program on condom in Indonesia and limited condom
available18.2%;
Note: Data obtained is % condom use at last casual sex among high risk man
Input AEM: 2002 = 1%; 2004 = 17%; 2007 = 18.2%
- Baseline 2016:
Input AEM: 1975 – 2002 = 1%; 2003 = 9%; 2004 = 17%; 2005 = 17.4%; 2006 = 17.8%;
2007 – 2050 = 18.2%
4 Average number of sex contacts in the last year (male)
57
- Baseline 2014:
Data obtained: BSS 2004 in 13 cities (data given from MoH). Average number of sexual
contact among male worker = 2
Input AEM: 2004 = 2
- Baseline 2016:
Spouses and Regular Partners
VI Sex with spouses or regular partners (RP)
1 Number of sexual contacts with spouse or RP (per week)
- Baseline 2014:
Data obtained: no data available. Use default data from Thailand baseline projection
Input AEM: 1.0 (All years)
- Baseline 2016:
2 Percent condom use with spouses or regular partners
- Baseline 2014:
Data obtained: DHS 2003
Input AEM: 2003 = 1.3%
- Baseline 2016:
Input AEM: 1.3% (all years)
3 STI prevalence in adult population
- Baseline 2014:
Data obtained: assumed from the STI cases reported among adult, data given from
MoH.
Input AEM: 2003 = 0.2%
- Baseline 2016:
Data obtained: assumed from STI Prevalence PWID Gonorrhea same with general
population
Input AEM: gonorrhea big PWID = 0.8% (all years)
58
Male Same-Sex Behaviors and STI
Behavioral inputs to AEM for men having sex with men
No. Category
Men who have Sex with Men - General
Percent of males aged 15-49 engaging in same-sex behaviour
2014 : No data input
2016 : Fitting  #Size Estimate : 754.310 #Data spectrum for Male age 15-49 in 2015
: 68.727.200  Data obtained : 754.310/68.727.200 = 0,0109
Input AEM : 1.1%
Data Source : Size Estimate MSM 2016

: Data Census 2010
: Spectrum File
Percent of MSM in risk group 1
2015: 27.7% based upon the # of MSM that had been contacted by an outreach
workers in the past year, which was used as a proxy indicator for “reachability”
Shift from MSM group 1 to group 2
Estimate (10%) based upon regional data
Men who have Sex with Men group 1 (MSM1) / population
Percent engaging in anal sex in the last year - MSM1
No data input for this category
Number of anal sex contacts last week (among those having anal sex) - MSM1
Average duration of same-sex behavior (years) - MSM1
Percent of MSM1 with female partners
2016 : Fitting  IBBS #2007 : 50,0% #2009 : 50,0% #2011 : 40,2% #2013 : 38,0%
#2015 : 28,5%
: 1975 – 2006 use data 2007
: 2016 – 2050 use data 2015
Data Source : IBBS 2007, 2011, 2015

: IBBS 2009, 2013
Percent condom use in anal sex with MSM1
2016 : Proportion last sex condom use MSM, 2007: Proportion per province from
59
(IBBS 2007*size estimates MSM/100) #Total proportion: 349.007; #Total size
estimates of MSM: 754,310  Data Obtained : 349.007/754.310*100 = 46.26%
: Proportion last sex condom use MSM, 2009: Proportion per province from
estimates of MSM: 754,310  Data Obtained : 561.392/754.310*100
= 74.42%
Input AEM : 2007: 46.3% ; 2009: 52.85% ; 2011: 60.3% ; 2013: 68.6% ; 2015: 74.42%

: IBBS 2009, 2013
: Size estimation of KP. MoH 2016
2016 : Gonorrhoea IBBS 2007: 19.7; 2009: 17; 2011: 20.8; 2013: 21.1; 2015: 12.7  Data
obtained : Average(19.7;17;20.8;21.1;12.7) = 18.26%
Input AEM : 18.26%

: IBBS 2009, 2013
Men who have Sex with Men group 2 (MSM2) / population

Percent engaging in anal sex in the last year – MSM2
Number of anal sex contacts last week (among those having anal sex) – MSM2
Average duration of same-sex behavior (years) – MSM2
Percent of MSM2 with female partners
Percent condom use in anal sex with MSM2
60
2016 : #STI Prevalence among MSM1/5 (assume by consultant) #18.3/5 = 3.7%
Input AEM : 3.7%
Data Source : STI Prevalence among MSM1

: IBBS 2007. 2011, 2015
: IBBS 2009, 2013
MSM visiting (male and female) sex workers
Percent of MSM1 visiting male sex workers
Percent of MSM2 visiting male sex workers
Ratio of frequency of visiting MSW (group 2 / group 1)
Percent of MSM1 visiting female sex workers
Percent of MSM2 visiting female sex workers
Percent condom use in anal sex with male sex workers
Percent condom use with Female sex worker group 1 (FSW1)
2016 : Use #Percent condom use with clients - FSW group 1
Input AEM : 57.9%
Percent condom use with female sex worker group 2 (FSW2)
Input AEM : 46.3%
Male Sex Workers
Percent of males aged 15-49 who sell sex
2016 : #Size Estimate MSM 2016 : 208.878 #MSM who sells sex in the past year and
have 10 or more partners in the past month (IBBS) : 9.6% #Projection Number for
Male age 15-49 in 2015 : 68,727,200  #20,878*9.6% = 20,043 #20,043/68,727,200
= 0.0003
Input AEM : 0.03%
Data Source : Size Estimate MSM 2016

: Projection Number of 2015
: IBBS 2007. 2011, 2015
: IBBS 2009, 2013
61
Average duration selling sex (in years)
2016 : #Average duration selling sex (in years) – Median 2011: 6; 2013: 3; 2015: 4 
Average (6,3,4)*2 = 8.7
Input AEM : 8.7

: IBBS 2009, 2013
Shift from MSM1 to MSW
Shift from MSM2 to MSW
Percent of MSW reporting anal sex with clients in the last year
Number of anal sex contacts last week (for MSW with anal sex)
STI prevalence among male sex workers
2016 : STI Prevalence #2007 : 13.4% #2009 : 17.1% #2011 : 24.0% #2013 : 24.8%
#2015 : 26.5%
: 1975 – 2006 use data 2007
: 2016 – 2050 use data 2015
Input AEM : 2007 : 13.4%; 2009 : 17.1%; 2011 : 24.0%; 2013 : 24.8%; 2015 : 26.5%

: IBBS 2009, 2013
Percent MSW visiting female sex workers in the last year
2016 : #Percent MSW visiting female sex workers in the last year #2007 : 16.56
#2009 : 29.79  Average (16.56, 29.79)/100 = 0.23175
Input AEM : 23.17%
Data Source : IBBS 2007

: IBBS 2009
Percent MSW with female regular partners in the last year
2016 : IBBS #2007 : 72.5% #2009 : 65.2% #2011 : 48.6% #2013 : 40.2% #2015 : 41.2%
: 1975 – 2006 use data 2007
: 2016 – 2050 use data 2015
Input AEM : 2007 : 72.5%; 2009 : 65.2%; 2011 : 48.6%; 2013 : 40.2%; 2015 : 41.2%
62
: IBBS 2009, 2013
Injecting Drug Use Behaviors

Behavioral inputs to AEM for Injecting Drug Users and Injecting Sex Workers
Male IDU - Injecting Behaviours / population

Percent of males age 15-49 who inject drugs
2014 : Size estimation of MARP. MoH & NAC 2006
: Size estimation of MARP. MoH 2009  Data obtained: # IDUs: 105,784; #male
population non-Papua age 15-49: 59,379,236  Calculation: 105,784/59,379,236 = 0.18%
0.30% (2006); 0.18% (2009)
2016 : #Size Estimate IDU 2012: 74,326 #Projection Number for Male age 15-49 in 2012 :
66,764,400  #74,326/66,764,400 = 0.00111
: #Size Estimate IDU 2015 : 33,492 #Projection Number for Male age 15-49 in 2015 :
68,727,200  #33,492/68,727,200 = 0.0005
Input AEM : 2012 : 0.11%; 2015 : 0.05%
Data Source : Size Estimate IDU 2012

: Size Estimate IDU 2016
: Data Census 2010
: Spectrum File
Percent of male IDUs in high-risk networks
2014 : 50% (1975-2006)  Referred to the HIV prevalence among IDUs during 2004-2006
: Interpolate 2006-2009 : 74% (2009)
: 36.4% (2011)  IBBS 2011
2016 : No data input for this category
IDU mortality (crude mortality per year in %)
2014 : 1.0% (All years)  No data available. Use default data from Thailand Baseline
Projection
Percent of male IDUs who share needles
2014 : 60% (2002)  BSS 2002-2003; 56% (2007)  IBBS 2007
: Update 39*1.2=45.1% (2007); update 25*1.2=35% (2009)  IBBS 2007 (often and
63
always sharing material last week) multiply by 1.2 (same until 2009) Note the adjustment
because we need last year so we make it 20% higher
: 13.3% (2011)  IBBS 2011 (Last day injection)
2016 : Needle Sharing in the past week  0.20012 (2015), Assumed PWID in Indonesia 1.2;
Needle Sharing in the past year  0.20012*1.2 = 0.2401
: 2007 – 2013 use baseline 2014
Input AEM : 24.0% (2015)

: IBBS 2009, 2013
Percent of all injections shared (among those who share)
2014 : 70% (All years)  No data available. Use default data from Thailand Baseline
Projection
Number of injections per day
2014 : 2 (2007, IBBS 2007); 1.89 (2009, IBBS 2009); 1.6 (2011, IBBS 2011)  Last day
injection
2016 : #Average Bigger Set 2007 : 2; 2011 : 1.6; 2015 : 1.69; 2009 : =average (1.6,2) = 1.8;
2013 : =average (1.69,1.6) = 1.645
: #Average Smaller Set 2009 : 1.89; 2013 : 3; 2007 = 2009 : 1.89; 2011 : =average
(3,1.89) = 2.445; 2015 = 2013 : 3
: #Average National (=average (bigger set, smaller set)
2007 : (=average (2, 1.89) = 1.945
2009 : (=average (1.8, 1.89) = 1.845
2011 : (=average (1.6, 2.445) = 2.0225
2013 : (=average (1.645, 3) = 2.3225
2015 : (=average (1.69, 3) = 2.345
: #Number of injections per day 2007 : 2; 2009 : 1.9; 2011 : 1.6 (use bigger set 2011,
because national number too high); 2013 : 1.6 (use bigger set 2013, because national
number too high); 2015 : 2.3
Input AEM : 2007 : 2; 2009 : 1.9; 2011 : 1.6; 2013 : 1.6; 2015 : 2.3

: IBBS 2009, 2013
Average duration of injecting behaviour (in years)
2014 : 10.0 (All years)  Assumed is double of IBBS 2007 and IBBS 2009
: 7.00 (2011)  IBBS 2009
2016 : use baseline 2014  2007: 10.8; 2009: 12.4; 2011: 14.0; 2013: 14.0; 2015: 14.0
Data Source : AEM 2014

Sharing to non-sharing movement per year
64
2014 : 10% (2004, BSS 2004); 20% (2007)  IBBS 2007. Data from national consensus in
2008
Male Injecting Drug Users - Sexual Behaviors
Percent of male IDUs visiting female sex workers
2014 : 34% (2009)  IBBS 2009
2016 : IBBS 2015: 15.5%; 2011 : 24.2% (use baseline 2014); Interpolate from 2011-2015
Input AEM : 15.5%

: IBBS 2009, 2013
Percent condom use with female sex worker group 1
2014 : 67% (2007)  IBBS 2007. Assumed is equal to client; 60% (2009, IBBS 2009)
Input AEM : 57.9% (2015)

: IBBS 2009, 2013
Percent condom use with female sex worker group 2
2014 : 68% (2007)  IBBS 2007. Assumed is equal to client; 63% (2009, IBBS 2009)
Input AEM : 46.3% (2015)

: IBBS 2009, 2013
Percent condom use with spouse or regular partner
2014 : 14% (2007)  IBBS 2007. Data given from MoH; 33% (2009, IBBS 2009 Last Sex)
Number of contacts with regular partners (per week)
2014 : 1 (All years)  Quoted from Regional’s recommendation.
Female IDU - Injecting Behaviours / population (thousands)

Percent of females age 15-49 who inject drugs
Percent of female IDUs in high-risk networks
Percent of female IDUs who share needles
65
Number of injections per day
Average duration of injection (in years)
Sharing to non-sharing movement per year
Female Injecting Drug Users - Sexual Behaviours
Percent whose regular partners also inject drugs
Percent condom use with spouse or regular partner
Number of contacts with regular partners (per week)
Injecting FSW group 1 (ISW1) / population (thousands)
Percent of female sex workers in group 1 who inject drugs
2014 : 1% (All years)  IBBS 2007.Data given from MoH
Percent of injecting FSW in group 1 in high-risk networks
2014 : 0% (All years)  No data available. Assumed 0% due the number of population very
small
Percent of injecting FSW in group 1 who share injections
small
small
Number of injections per day for injecting FSW in group 1
2014 : 2 (2007)  IBBS 2007 (2). Assumed the injection behavior not different between man
and woman IDUs
: 1.898 (2009)  IBBS 2009 (1.898). Assumed the injection behavior not different
between man and woman IDUs
Average duration of injecting for FSW in group 1
2014 : 5.0 (2007, IBBS 2007); 5.0 (2009, IBBS 2007)
Percent condom use with clients - Injecting FSW in group 1
2014 : 58% (2003, BSS 2002); 67% (2007, IBBS 2007); 60% (2009, IBBS 2009 Represent by
66
the heterosexual behavior among direct sex worker)
Injecting FSW group 2 (ISW2)/ population (thousands)
Percent of female sex workers in group 2 who inject drugs
2014 : 2% (All years)  BSS 2004.national consensus in 2008
Percent of injecting FSW in group 2 in high-risk networks
small
Percent of injecting FSW in group 2 who share injections
small
small
Number of injections per day for injecting FSW in group 2
2014 : 2 (2007)  IBBS 2007 (2). Assumed the injection behavior not different between man
and woman IDUs
: 1.898 (2009)  IBBS 2009 (1.898). Assumed the injection behavior not different
between man and woman IDUs
Average duration of injecting for FSW in group 2
2014 : 5.0 (2007, IBBS 2007); 5.0 (2009, IBBS 2009)
Percent condom use with clients - Injecting FSW in group 2
2014 : 58% (2003, BSS 2002); 67% (2007, IBBS 2007); 60% (2009, IBBS 2009 Represent by
the heterosexual behavior among direct sex worker)
Transgendered Populations
Behavioral inputs to AEM for Transgenders
Transgender population - General

Percent of males aged 15-49 who are transgender
2014 : 0.60%
2016 : #Size Estimate IDU 2015 : 38,928 #Projection Number for Male age 15-49 in 2015 :
68,727,200  #38,928/68,727,200 = 0.0006
Input AEM : 0.06% (2015)
67
Data Source : Size Estimate Transgender 2016
: Data Census 2010
: Spectrum File
Percent of Transgenders who sell sex
2014 : 95% (Consensus)
2016 : IBBS #2007 : 87.0% #2009 : 63.0% #2011 : 80.76% #2013 : 80.0% #2015 : 68.9%
Average (87.0, 63.0, 80.76, 80.0, 68.9)/100 = 75.932/100 = 0.75932
Input AEM : 75.9%

: IBBS 2009, 2013
Percent of Transgenders who engage in casual sex but not sex work
Percent of Transgenders who have regular partners only (calculated from previous 2
rows)
2016 : fitting 1-Percent of Transgenders who sell sex; Percent of Transgenders who
engage in casual sex but not sex work
Input AEM : 14.1% (All years)
Transgender Sex Workers - Sexual Behaviours
Percent of transgender sex workers engaging in anal sex with clients
2014 : 95% (Consensus)
2016 : No data input in this category
Number of anal sex contacts last week with clients (for those having anal sex)
2014 : 3.47 (All years)  Average mean of number of client anal sex per week from IBBS
: 2,6 (2013)4 (2011), 3.89(2009), 3,1 (2007)= 3.47 (all years)
2016 : IBBS #2007 : 2 #2009 : 2 #2011 : 5 #2013 : 4 #2015 : 2  Average (2, 2, 5, 4, 2) = 3
Input AEM : 3 (2015)

: IBBS 2009, 2013
Percent of anal sex contacts with clients which are receptive
2014 : 90% (All years) (Consensus, mostly TG are receptive but about 10% may bought to
be penetrative.)
Average duration selling sex (in years)
2014 : 20 (All years)  IBBS (average year-start year)x 2 = (32-19) x2=20an (adjusted we cut
out the 0-1 years). After fitting
2016 : IBBS - Average duration selling sex (in years) (median) #2007 : 10 #2009 : 9 #2011 :
11 #2013 : 9 #2015 : 13  Average (10, 9, 11, 9, 13)*2 = 10.4*2 = 20.8
68
Input AEM : 20.8

: IBBS 2009, 2013
Percent condom use in anal sex with clients
2014 : 15 (All years)
Anal STIs (%) among transgenders who sell sex
2016 : IBBS #2007 : 26.8% #2009 : 26.8% #2011 : 26.8% #2013 : 20.1% #2015 : 13.9%
: 1990 – 2007 : 50%
: after 2015 : 13.9%
Input AEM : 2007 : 26.8%; 2009 : 26.8%; 2011 : 26.8%; 2013 : 20.1%; 2015 : 13.9%

: IBBS 2009, 2013
Transgender Sex Workers - Client Make-up (sums to 100%)
Percent of TG clients who are low-risk heterosexual males
2014 : 45% (All years) __> IBBS
2016 : Fitting  80.0% (2005); 82.5% (2010)  Assumed by consultant
Input AEM : 80.0% (2005); 82.5% (2010)
Percent of TG clients who are also clients of female sex workers
2014 : 30% (All years)
Input AEM : 5.0% (2005); 10.0% (2010)
Percent of TG clients who are MSM
2014 : 20% (All years)
Input AEM : 10.0% (2005); 2.5% (2010)
Percent of TG clients who are male IDU (calculated from previous 3 rows)
2014 : 20% (All years)
2016 : Fitting  1 – Sum(Percent of TG clients who are low-risk heterosexual males;
Percent of TG clients who are also clients of female sex workers; Percent of TG clients who
are MSM) in same year
Input AEM : 5.0% (2015)
Transgenders engaging in Casual Sex - Sexual Behaviours
Percent of TGs with casual sex partners who engage in anal sex
2014 : 95% (All years)
Number of anal sex contacts last week (for TGs having anal sex with CPs)
2014 : 0.6 (All years)
69
Percent of anal sex contacts which are receptive
2014 : 90% (All years)
Percent condom use in anal sex for those with casual partners
2014 : 37 (2007-2011)  IBBS 2007,2009 2011, 2013; 55% (2013)  Use the average from
2007-2011; 46% (2007); 31% (2009); 34% (2011) Average = 37
Anal STIs (%) among transgenders who have casual partners
2014 : 15% (All years)  IBBS
Percent of annual shift from TGs engaging in casual sex to TGs with RP only
2014 : 5% (Assumption the shift is low)
Transgender Sex Workers - Partner Make-up for those with CPs (sums to 100%)
Percent of anal sex partners who are low-risk heterosexual males
2014 : 45% (All years)  Assumption same with Transgender Sex Workers - Client Make-up
(sums to 100%)
Percent of anal sex partners who are also clients of female sex workers
(sums to 100%)
Percent of anal sex partners who are MSM
(sums to 100%)
Percent of anal sex partners who are male IDU (calculated from previous 3 rows)
2014 : 5%
2016 : Fitting  1 – Sum(Percent of anal sex partners who are low-risk heterosexual males;
Percent of anal sex partners who are also clients of female sex workers; Percent of anal sex
partners who are MSM) in same year
Input AEM : 5.0% (2015)
Transgenders with Regular Partners (RP) - Sexual Behaviours
Percent of TGs with regular partners who engage in anal sex
2014 : 95%
Number of anal sex contacts with RPs last week (for TGs having anal sex with RPs)
2014 : 0.30%
70
Percent of anal sex contacts with RPs which are receptive
2014 : 90%
Percent condom use in anal sex with regular partners
2014 : Assumption 1/3 with Percent condom use in anal sex for those with casual partners
Transgender Sex Workers - Client Make-up (sums to 100%)
Anal STIs (%) among transgenders who have regular partners only
2014 : 7.5 (All years)
Transgender Sex Workers - Regular Partner Make-up (sums to 100%)
Percent of anal sex partners who are low-risk heterosexual males
2014 : 45%  Assumption ½ with casual
Percent of anal sex partners who are also clients of female sex workers
No data input in this category
Percent of anal sex partners who are MSM
No data input in this category
Percent of anal sex partners who are male IDU (calculated from previous 3 rows)
2016 : Fitting  1 – Sum(Percent of anal sex partners who are low-risk heterosexual males;
Percent of anal sex partners who are also clients of female sex workers; Percent of anal sex
partners who are MSM) in same year
Input AEM : 5.0% (2015)
71
Annex 3. Parameter Values used in the Final AEM Model after Fitting
Table A3.1 FSW General 2007-2015 – non-Papua
Female Sex Workers - General 2007 2008 2009 2010 2011 2012 2013 2014 2015
0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33% 0.33%
who sell sex
Percent of female sex workers in
50.1% 47.9% 45.8% 43.6% 41.5% 39.3% 37.2% 35.0% 32.9%
group 1
Movement from group 1 to group
1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
2 each year
Table A3.2: FSW General 2007-2015 – Papua
Female Sex Workers - General 2007 2008 2009 2010 2011 2012 2013 2014 2015
0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19% 0.19%
who sell sex
Percent of female sex workers in
37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7% 37.7%
group 1
Movement from group 1 to group
1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
2 each year
Table A3.3: FSW Group 1 & Group 2 – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015
72
thousands)
1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5
Days worked per week - female
5.7 5.7 5.7 5.7 5.7 5.7 5.7 5.7 5.7
sex workers group 1
Percent condom use with clients -
53.7% 54.2% 54.7% 55.3% 55.8% 56.3% 56.8% 57.4% 57.9%
FSW group 1
3.3 3.4 3.5 3.6 3.7 3.8 3.8 3.9 4.0
group 1 (years)
STI prevalence among female sex
36.8% 36.8% 36.8% 36.8% 36.8% 35.8% 34.8% 33.8% 32.8%
worker group 1
thousands)
0.8 0.7 0.6 0.6 0.6 0.6 0.7 0.7 0.7
Days worked per week - female
6.2 6.4 6.6 6.2 5.8 5.7 5.5 5.6 5.8
sex workers group 2
Percent condom use with clients -
42.9% 43.4% 43.8% 44.2% 44.6% 45.1% 45.5% 45.9% 46.3%
FSW group 2
2.7 2.8 3.0 3.2 3.3 3.5 3.7 3.8 4.0
group 2 (years)
STI prevalence among female sex
12.9% 12.9% 12.9% 12.9% 12.9% 12.5% 12.2% 11.8% 11.5%
worker group 2
Table A3.4: FSW Group 1 & Group 2 – Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015
73
thousands)
0.9 0.9 1.0 0.9 0.8 0.7 0.6 0.7 0.8
6.2 6.2 6.1 5.8 5.5 5.7 5.9 5.8 5.6
49.6% 51.7% 53.7% 55.8% 57.9% 60.0% 62.0% 64.1% 66.2%
4.0 4.0 4.0 5.0 6.0 6.0 6.0 7.0 8.0
group 1 (years)
27.9% 27.9% 27.9% 27.9% 27.9% 25.1% 22.2% 19.4% 16.5%
sex worker group 1
thousands)
0.5 0.6 0.6 0.6 0.5 0.4 0.4 0.4 0.5
6.2 6.2 6.1 5.8 5.5 5.7 5.9 5.8 5.6
50.4% 51.6% 52.8% 54.0% 55.3% 56.5% 57.7% 58.9% 60.1%
2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8
group 2 (years)
18.8% 18.8% 18.8% 18.8% 18.8% 16.9% 15.0% 13.0% 11.1%
sex worker group 2
Table A3.5: Clients of FSW – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Workers / population (in 4,768 4,829 4,885 4,935 4,991 5,047 5,101 5,150 5,196
thousands)
year
7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0
(years)
80% 80% 80% 80% 80% 80% 80% 80% 80%
are circumcised
Table A3.6: Clients of FSW – Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Workers / population (in 98.5 99.7 100.9 93.8 87.7 81.2 74.3 66.9 59.1
thousands)
74
year
5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0
(years)
16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7% 16.7%
are circumcised
Table A3.7: Population engaging in Casual Sex – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Percent of males engaging in 2.8% 2.8% 2.8% 4.8% 6.8% 6.8% 6.8% 6.8% 6.8%
Percent of females engaging 1.0% 1.0% 1.0% 1.5% 2.0% 2.0% 2.0% 2.0% 2.0%
Percent condom use in casual 18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2% 18.2%
sex
Average number of sex 12.0 12.0 12.0 12.0 12.0 12.0 12.0 12.0 12.0
Table A3.8: Population engaging in Casual Sex – Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Percent of males engaging in 30.0% 30.0% 30.0% 26.3% 22.5% 18.8% 15.0% 15.0% 15.0%
Percent of females engaging 10.0% 10.0% 10.0% 8.8% 7.5% 6.3% 5.0% 5.0% 5.0%
Percent condom use in casual 12.6% 12.6% 12.6% 16.2% 19.8% 23.5% 27.1% 27.1% 27.1%
sex
Average number of sex 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0
Table A3.9: Spouses and Regular Partners – non-Papua
Sex with spouses or regular

2007 2008 2009 2010 2011 2012 2013 2014 2015
partners (RP)
Number of sexual contacts
1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
with spouse or RP (per week)
1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3% 1.3%
spouses or regular partners
STI prevalence in adult
0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8%
population
Table A3.10: Male PWID Injecting Behaviors – non-Papua
75
2007 2008 2009 2010 2011 2012 2013 2014 2015
Male IDU - Injecting 131.2 118.8 106.0 90.0 73.8 74.3 61.0 47.4 33.5
Behaviors / population
Percent of males age 15-49 0.21% 0.19% 0.16% 0.14% 0.11% 0.11% 0.09% 0.07% 0.05%
who inject drugs
Percent of male IDUs in high- 55.0% 55.0% 55.0% 55.0% 55.0% 55.0% 55.0% 55.0% 55.0%
risk networks
IDU mortality (crude mortality 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
per year in %)
Percent of male IDUs who 50.6% 48.7% 46.8% 44.4% 42.0% 37.2% 32.4% 27.7% 22.9%
share needles
Percent of all injections shared 70.0% 70.0% 70.0% 70.0% 72.0% 72.0% 72.0% 72.0% 72.0%
(among those who share)
Number of injections per day 2.0 1.9 1.9 1.7 1.6 1.6 1.6 2.0 2.3
Average duration of injecting 10.8 11.6 12.4 13.2 14.0 14.0 14.0 14.0 14.0
behavior (in years)
Sharing to non-sharing 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
movement per year
Table A3.11: Male PWID Sexual Behaviors – non-Papua
Male Injecting Drug Users -

2007 2008 2009 2010 2011 2012 2013 2014 2015
Sexual Behaviors
Percent of male IDUs visiting 40.9% 36.7% 32.5% 28.3% 24.2% 22.0% 19.8% 17.7% 15.5%
female sex workers
Percent condom use with 53.7% 54.2% 54.7% 55.3% 55.8% 56.3% 56.8% 57.4% 57.9%
spouse or regular partner
Number of contacts with 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
regular partners (per week)
Table A3.12: Men who have Sex with Men General – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
– General
engaging in same-sex 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1%
behavior
Percent of MSM in risk group 1 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7% 27.7%
Shift from MSM group 1 to
10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
group 2
Table A3.13: Men who have Sex with Men Group 1 & 2 – non-Papua
2007 2008 2009 2010 2011 2012 2013 2014 2015

Men who have Sex with Men 191.7 194.1 196.4 198.4 200.7 202.9 205.1 207.1 208.9
Percent engaging in anal sex 73.4% 73.2% 73.0% 72.9% 72.7% 72.7% 72.7% 72.7% 72.7%
in the last year - MSM1
76
last week (among those 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
having anal sex) - MSM1
Average duration of same-sex 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0
Percent of MSM1 with female 50.0% 50.0% 50.0% 45.1% 40.2% 39.1% 38.0% 33.2% 28.5%
partners
Percent condom use in anal 44.0% 45.9% 47.9% 49.8% 51.7% 53.7% 55.6% 57.6% 59.5%
sex with MSM1
Men who have Sex with Men 500.5 507.0 512.8 518.1 524.0 529.9 535.5 540.7 545.4
Percent engaging in anal sex 72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7% 72.7%
in the last year - MSM2
last week (among those 0.20 0.20 0.20 0.20 0.20 0.20 0.20 0.20 0.20
having anal sex) - MSM2
Average duration of same-sex 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0 22.0
Percent of MSM2 with female 33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2% 33.2%
partners
sex with MSM2
Table A3.14: Men who have Sex with Men visiting Sex Workers – non-Papua
MSM visiting (male and

2007 2008 2009 2010 2011 2012 2013 2014 2015
female) sex workers
19.8% 19.5% 19.2% 18.8% 18.5% 18.5% 18.5% 18.5% 18.5%
sex workers
6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2% 6.2%
sex workers
Ratio of frequency of visiting
0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
MSW (group 2 / group 1)
10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2%
female sex workers
10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2% 10.2%
female sex workers
53.0% 53.5% 54.0% 57.8% 61.7% 61.7% 61.7% 61.7% 61.7%
sex with male sex workers
Female sex worker group 1 53.7% 54.2% 54.7% 55.3% 55.8% 56.3% 56.8% 57.4% 57.9%
(FSW1)
female sex worker group 2 42.9% 43.4% 43.8% 44.2% 44.6% 45.1% 45.5% 45.9% 46.3%
(FSW2)
Table A3.15: Male Sex Workers – non-Papua
Male Sex Workers 2007 2008 2009 2010 2011 2012 2013 2014 2015
77
Percent of males aged 15-49 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03% 0.03%
who sell sex
Average duration selling sex 8.7 8.7 8.7 8.7 8.7 8.7 8.7 8.7 8.7
(in years)
Percent of MSW reporting
anal sex with clients in the last 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0% 82.0%
year
last week (for MSW with anal 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52 2.52
sex)
STI prevalence among male 13.4% 15.2% 17.1% 20.5% 24.0% 24.4% 24.8% 25.6% 26.5%
sex workers
Percent MSW visiting female 23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2% 23.2%
sex workers in the last year
Percent MSW with female
regular partners in the last 72.5% 68.9% 65.2% 56.9% 48.6% 44.4% 40.2% 40.7% 41.2%
year
Table A3.16: Transgenders General – non-Papua
Transgender population -
2007 2008 2009 2010 2011 2012 2013 2014 2015
General
0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06% 0.06%
who are transgender
75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9% 75.9%
sell sex
engage in casual sex but not 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
sex work
14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1% 14.1%
have regular partners only
Table A3.17: Transgenders Sexual Behaviors – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
Sexual Behaviors
Percent of transgender sex
workers engaging in anal sex 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
with clients
last week with clients (for 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0
those having anal sex)
with clients which are 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%
receptive
20.8 20.8 20.8 20.8 20.8 20.8 20.8 20.8 20.8
(in years)
75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0%
sex with clients
78
Anal STIs (%) among
26.8% 26.8% 26.8% 26.8% 26.8% 23.4% 20.1% 17.0% 13.9%
transgenders who sell sex
Table A3.18: Transgenders - Client Make-up – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
Client Make-up
Percent of TG clients who are 81.0% 81.5% 82.0% 82.5% 82.5% 82.5% 82.5% 82.5% 82.5%
low-risk heterosexual males
also clients of female sex 7.0% 8.0% 9.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0%
workers
MSM
male IDU
Table A3.19: Transgenders engaging in Casual Sex - Sexual Behaviors – non-Papua
Transgenders engaging in
Casual Sex - Sexual 2007 2008 2009 2010 2011 2012 2013 2014 2015
Behaviors
Percent of TGs with casual
sex partners who engage in 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
anal sex
last week (for TGs having anal 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2
sex with CPs)
which are receptive
sex for those with casual 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3% 56.3%
partners
Anal STIs (%) among
casual partners
Percent of annual shift from
TGs engaging in casual sex to 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0%
TGs with RP only
Table A3.20: Transgenders Sex Workers Partner Make-up for those with CPs – non-Papua

Partner Make-up for those 2007 2008 2009 2010 2011 2012 2013 2014 2015
with CPs
males
sex workers
Percent of anal sex partners 7.0% 5.5% 4.0% 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
who are MSM
who are male IDU
79
Table A3.21: Transgenders with Regular Partners - Sexual Behaviors – non-Papua
Transgenders with Regular

Partners (RP) - Sexual 2007 2008 2009 2010 2011 2012 2013 2014 2015
Behaviors
Percent of TGs with regular
partners who engage in anal 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%
sex
with RPs last week (for TGs 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6
having anal sex with RPs)
with RPs which are receptive
sex with regular partners
Anal STIs (%) among
regular partners only
Table A3.22: Transgenders Sex Workers Regular Partner Make-up – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015
Regular Partner Make-up
males
sex workers
who are MSM
who are male IDU
80
Annex 4. Estimation and Projection of People Living with HIV, New HIV
Infections, AIDS Deaths and ART Needs among Adults and Children by Gender in
Indonesia, 2015-2020
2015 2016 2017 2018 2019 2020

PLHIV
Male 407,114 410,407 412,400 413,279 413,286 412,683
Female 223,032 230,036 234,963 238,074 239,567 239,667
Total 630,147 640,443 647,363 651,353 652,853 652,349
New HIV Infections
Male 32,098 31,024 31,295 31,402 31,446 31,437
Female 21,361 20,116 19,274 18,474 17,752 17,091
Total 53,460 51,141 50,569 49,876 49,197 48,529
AIDS Deaths
Male 27,089 27,379 28,928 30,111 30,989 31,550
Female 12,223 12,779 13,992 14,979 15,839 16,532
Total 39,313 40,158 42,921 45,090 46,828 48,083
ART Needs
Male 232,077 240,748 247,952 253,741 258,409 262,266
Female 89,159 95,515 100,669 104,775 107,852 109,974
Children 12,869 13,359 13,653 13,723 13,615 13,374
Total 334,104 349,622 362,275 372,239 379,876 385,614
81
Infections, AIDS Deaths and ART Needs among Adults age ≥ 15 years old by
Gender in Indonesia, 2015-2020
2015 2016 2017 2018 2019 2020

PLHIV
Male 398,526 401,238 402,703 403,150 402,823 401,990
Female 214,909 221,364 225,789 228,485 229,657 229,534
Total 613,435 622,602 628,492 631,635 632,480 631,524
New HIV Infections
Male 29,917 28,856 29,139 29,279 29,372 29,428
Female 19,282 18,049 17,218 16,450 15,775 15,176
Total 49,199 46,905 46,357 45,729 45,147 44,604
AIDS Deaths
Male 25,876 26,143 27,674 28,831 29,698 30,261
Female 11,059 11,594 12,793 13,755 14,604 15,298
Total 36,936 37,737 40,468 42,586 44,302 45,560
ART Needs
Male 232,077 240,748 247,952 253,741 258,409 262,266
Female 89,159 95,515 100,669 104,775 107,852 109,974
Total 321,235 336,263 348,622 358,516 366,261 372,240
82
infections, AIDS Deaths and ART Needs among Children age 0-14 years old by
Gender in Indonesia, 2015-2020
2015 2016 2017 2018 2019 2020

PLHIV
Male 8,588 9,169 9,697 10,129 10,463 10,693
Female 8,123 8,672 9,174 9,589 9,910 10,133
Total 16,712 17,841 18,871 19,718 20,373 20,825
New HIV Infections
Male 2,181 2,168 2,156 2,123 2,074 2,009
Female 2,079 2,067 2,056 2,024 1,977 1,915
Total 4,261 4,236 4,212 4,147 4,050 3,925
AIDS Deaths
Male 1,213 1,236 1,254 1,280 1,291 1,289
Female 1,164 1,185 1,199 1,224 1,235 1,234
Total 2,377 2,421 2,453 2,504 2,526 2,523
ART Needs
Male
Female
Total 12,869 13,359 13,653 13,723 13,615 13,374
83
infections, AIDS Deaths and ART Needs among Adults age ≥ 15 years old in
Papua and Non-Papua, 2015-2020
2015 2016 2017 2018 2019 2020

PLHIV
Papua 60,530 60,131 59,257 57,988 56,427 54,652
Non-Papua 552,905 562,471 569,235 573,647 576,053 576,871
Total 613,435 622,602 628,492 631,635 632,480 631,524
New HIV Infections
Papua 3,478 3,154 2,964 2,794 2,641 2,503
Non-Papua 45,721 43,751 43,393 42,935 42,506 42,101
Total 49,199 46,905 46,357 45,729 45,147 44,604
AIDS Deaths
Papua 3,404 3,553 3,838 4,063 4,202 4,277
Non-Papua 33,532 34,184 36,629 38,523 40,100 41,282
Total 36,936 37,737 40,468 42,586 44,302 45,560
ART Needs
Papua 25,042 26,178 26,852 27,123 27,069 26,754
Non-Papua 296,193 310,085 321,770 331,393 339,192 345,485
Total 321,235 336,263 348,622 358,516 366,261 372,240
Annex 8. New HIV Infections among Adults Age Group ≥ 15 years old by Risk
Population in 32 Provinces (Non-Papua), years 1990-2030
84
2014, non papua (ENG) 2016, non papua (ENG)
Annex 9. New HIV Infections among Adults Age Group ≥ 15 years old by Risk
Population in Tanah Papua years 1990-2030
2014, papua (ENG) 2016, papua (ENG)
85
86

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Estimates and Projection of HIV/AIDS

Directorate General of Disease Control and Prevention

List of Tables ........................................................................................................................................... 3

Table 3.1: Updated KAP Population Size Estimates, 2016 ...................................................................... 12

Figure 3.1: Flow of HIV Epidemic Modeling in Indonesia 2015-2030 .......................................................... 9

Jakarta, February 2017

Dr. H. Mohammad Subuh, MPPM

3.1 Modeling Approach

Figure 3.1: Flow of HIV Epidemic Modeling in Indonesia 2015-2030

Source: UNAIDS 2010

3.2. Software Used

3.2.2. Spectrum version 5.4

3.3. Sources of Data

3.3.1. Demographic data

3.3.2. Behavioral and Epidemiological Data of Key Populations

3.3.3. Key Population Size Estimates

Table 3.1: Updated Key Population Size Estimates, 2016

Population Lower Bound Point Upper Bound

3.4. Projection Process - AEM

3.4.2. Heterosexual Worksheet

Female Sex Workers (FSW)

 Percent of adult females who sell sex

 Percent of FSW who are in “high” and “low” intensity categories

Table 3.2: FSW General 2007-2015 – non-Papua

Female Sex Workers -

Table 3.3: FSW General 2007-2015 – Papua

Female Sex Workers -

 Average number of clients per day among FSW

2007 2008 2009 2010 2011 2012 2013 2014 2015

Table 3.5: FSW Group 1 & Group 2 – Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015

 Percent condom use with clients

 Sexually Transmitted Infection (STI) prevalence among FSW

 Average duration of being a client

 Percentage of adult males who are circumcised

Table 3.6: Clients of FSW – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015

Table 3.7: Clients of FSW – Papua

Population engaging in casual sex

Table 3.8: Population engaging in Casual Sex – non-Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015

Table 3.9: Population engaging in Casual Sex – Papua

2007 2008 2009 2010 2011 2012 2013 2014 2015

Sex with spouses and regular partners

 Number of sexual contacts with spouses or regular partners

Table 3.10: Spouses and Regular Partners – non-Papua

Sex with spouses or regular

3.4.3. PWID Worksheet (Injection Drug Users)

Male PWID injecting behaviors

 Percent of male IDUs in high-risk networks

 Percent of all injections shared (among those who share)

 Number of injections per day

 Average duration of injecting behavior (in years)

2007 2008 2009 2010 2011 2012 2013 2014 2015

Male PWID sexual behaviors

 Percent of male IDUs visiting female sex workers

 Percent condom use with female sex worker group 1

 Percent condom use with spouse or regular partner

Male Injecting Drug Users -

3.4.4. MSM Worksheet

 Percent of adult males engaging in same-sex behavior

 Percent of MSM who are in “reachable” and “unreachable” categories

 Shift from the “reachable” to the “unreachable” category (percent)