The Experiences of Pregnant Women in Having HIV Test at the

Community Health Center in East Jakarta, Indonesia

Rita Ismail

School of Nursing, Health Politechnic Jakarta III, Jl. Arteri JORR, Pondok Melati, Bekasi, Jawa Barat, Indonesia

Keywords: Community Health Center, HIV Test, Indonesia, Pregnant Women.

Abstract: Background: In 2013, East Jakarta was the area in Jakarta province with the highest HIV cases. However, it

is not followed by the awareness for having an HIV testing, especially pregnant women. Objective: to

describe the experience of pregnant women in having an HIV test at a community health center (CHC).

Methods: Descriptive narrative was used in this study. In-depth interviews about the women’ experiences in

having HIV test were conducted with 10 pregnant women at the CHC. Interviews were conducted on 2017

and recorded using a digital voice recorder. Data were analyzed using content analysis method and validated

with health care provider (HCP) and observation. Results: Three themes emerged: obedient to the health

care providers’ recommendations, HIV testing as part of a pregnant woman's health test, lack of knowledge

about HIV testing. All women agreed to have an HIV test, however they still had limited knowledge about

HIV test and the right to have an HIV test. Conclusion: Pregnant women have an HIV test based on HCP’s

recommendation. Providing more information about test HIV and private room at the CHC and having more

health education in the community is needed to increase pregnant women’s understanding about HIV test.

1 INTRODUCTION

Indonesia is one of the countries in Asia with the

highest HIV new cases (National AIDS Commission

Republic of Indonesia [NAC], 2010). In 2005, the

number of HIV cases in Indonesia was 859 and

increased to 30,935 by 2015 (Ministry of Health

Republic of Indonesia [MoH], 2016). In 2015,

Jakarta was the province with the highest HIV rate

in the Indonesia, 4,695 cases, followed by East Java

(4,155 cases) and West Java (3,741 cases) (MoH,

2016). Compared to other districts in Jakarta, East

Jakarta had the highest number of new HIV cases

(MoH, 2013). The number of new HIV cases in

2013 in East Jakarta was 240, while in other districs

were less than 200, 199 cases in South Jakarta, 196

cases in Central Jakarta, 156 cases in West Jakarta,

and 78 cases in North Jakarta (Badan Penelitian dan

Pengembangan Kesehatan, 2013).

The number of women living with HIV in

Indonesia also increases sharply, from 3,565 in 2008

to 12,279 in 2013 (MoH, 2014). Although the

number of new HIV cases in women increases every

year, awareness of women, especially mothers, to

have HIV testing is still very low (MoH, 2014). The

Ministry of Health reported, only 0.4 percent

(21,103) of 5,060,637 pregnant women performed

HIV testing in 2011. Of those who had HIV test, 2.5

percent (534) were HIV positive (NAC, 2012).

A study in Jakarta showed that women were

tested for HIV not during their ANC visits but

because of the advice of doctors when their

husband’s HIV test was positive (Hardon et al, 2009,

Ismail et al, 2018). A study in Bali showed that lack

of knowledge about HIV in pregnant women,

receiving information about the prevention methods

of HIV transmission from mother to fetus with early

detection of HIV was only delivered by health

workers when offering HIV testing, resulting many

pregnant women refuse to have HIV testing

(Anggraini, 2014). This condition results delay of

pregnant women knowing their HIV status, not

geting adequate treatment, and increasing the risk of

HIV transmission to the fetus. The number of AIDS

cases through mother-to-child HIV transmission was

244 in 2010 and became 294 in 2015 (MoH, 2016).

Indonesian government has implemented any

programs to increase the coverage of HIV testing in

pregnant women. In 2013 the MoH launched a

program to prevent HIV transmission from mother

to child (PMTCT). Pregnant women who visit health

facilities for ante natal care (ANC) will be offered an

Ismail, R.

The Experiences of Pregnant Women in having HIV Test at the Community Health Center in East Jakarta, Indonesia.

DOI: 10.5220/0008203100830087

In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 83-87

ISBN: 978-989-758-406-0

HIV test. Health care providers (HCPs) are required

to offer HIV testing to pregnant women, especially

in the HIV epidemic area. HIV testing is carried

together with other routine laboratory examinations

(MoH, 2012). After applying this program, the

number of women diagnosed with HIV increased

from 12,279 in 2013 to 12,573 by 2015 (MoH,

2016). Based on these conditions, the purpose of this

study was to describe the experiences of pregnant

women in having an HIV test at a community health

center (CHC) in East Jakarta.

2 METHODS

This is a qualitative study with descriptive narrative

method. The population of this study were pregnant

women who visited the CHC in East Jakarta for

ANC and got HIV test. The inclusion criteria

included having an HIV test at the CHC during their

current pregnancy; being able to speak Indonesian

well; willing to be fully involved in the research; and

signed the consent form as participants. The

exclusion criteria are participant not able to

complete the interview.

Data were collected from September to

November 2017. In-depth interviews were

conducted participants using interview guidelines.

Interview questions included how they have an HIV

test, their reason to have an HIV test, the result of

their HIV test. Interviews were recorded using

digital voice recorders. Interviews were conducted

for 30-60 minutes in one of the rooms at the CHC.

Before the interview, the researcher explained the

purpose of the study, provided an opportunity for

participants to ask questions related to the study.

Once the participant agreed to get involved in the

study, participants were asked to sign the informed

consent sheet. During the interviews, the researcher

made field notes as supporting data. The researcher

also validated the data related to the answers of the

participants at the end of the interviews to avoid

misinterpretation and validated to the HCPs and

observation.

Interviews were transcribed verbatim and

analyzed using content analysis method with the

process: 1. Open coding: reading the interview texts

carefully and repeatedly, writing notes, labels, and

headings the data); 2. Category creation: creating

groups based on headings. Each category consisted

of similar data. Each category was divided into

subcategories; 3. Abstractions: Data were put

together into general categories and used words that

consisted of the content obtained. Ethical clearance

of this study were obtained from Ethical Committee

Health Polytechnic Jakarta III.

3 RESULTS

3.1 Characteristic of Participants

Of 15 prospective participants who were asked to

get involved in the study, only 10 who agreed. Three

prospective participants refused to participate

because of time constraints or they had to redeem

drugs at the pharmacy. Two participants who were

contacted by telephone did not respond. One HCP

who worked at the ANC unit was interviewed to

validate the data. The researcher also did

observation on the process of HIV test on pregnant

women at the CHC.

The age of participants ranged from ages 20 - 36

years in which more than half of participants are

over 30 years old. Half of the participants completed

high school, while others were junior high school.

Only one participant had a bachelor degree. Almost

all participants were housewives. One participant

worked as a private employee while other two

participants worked as traders.

Half of the participants had their first pregnancy,

while others were their third, fourth and fifth

pregnancy. All participants' HIV test results were

negative. The average age of the participant's

husband was 31 years with a range of 19-40 years.

Half of the participating husbands completed high

school, while the rest finished junior high school and

undergraduate degrees. Almost all participating

husbands had a job, except for one person (because

of illness). Most of participants’ husband worked at

private companies, while others worked as

entrepreneurs or couriers.

3.2 Themes

There are three themes found in this study, namely:

3.2.1 Obedient to the Health Care

Providers’ Recommendations

All participants stated that they had HIV test

because of the request from HCPs, midwives at the

CHC and midwives who referred them to the CHC

for having blood test. Some participants stated that

HCPs informed them that pregnant women were

required to take an HIV test. Only one participant

came to the CHC to have a blood test. Another

participants had an HIV test because of a referral

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

from the midwife. Other participants visited the

CHC to check the condition of their pregnancy.

"The main thing is that when we have ANC we

are immediately asked to… to have blood draw

and a urine test." (H1, 28 years old)

"Actually, I had ANC at a midwifery clinic. The

midwifery recommended me have HIV test and it

can be done in the CHC. That’s why I come to

this CHC." (H1, 24 years)

The reasons of the participants agreed to be

tested for HIV was because it was recommended by

HCPs and useful to know the condition of their

pregnancy.

"Yes, we just follow [the HCP’s

recommendation] so that it will be easy for us

when we have ANC... If you know it, we refuse to

have it [HIV test], we will get confused by

ourselves if there is something happens on

us...We will have trouble by ourselves.” (H2, 28

years).

"We were just told [to have HIV test]. It’s said

that it [HIV] is a mandatory test. Every pregnant

woman must get tested [for HIV]. It was for

unpredicted diseases. Thus we must get tested.

"(H7, 35 years).

"The reason is so my baby and for our health ..."

(H1, 28 years)

All participants stated that it was their first time

testing for HIV test. None of the participants had

HIV test in their previous pregnancy. There was one

participant who planned to take an HIV test before

becoming pregnant but she did not do it until got

pregnant.

HCPs stated that they had to offer and persuade

the pregnant women for having an HIV test on their

first visit at the CHC. It is one of the government

program to increase HIV test among pregnant

women.

3.2.2 HIV Test as Part of a Pregnant

Women's Health Test

All participants stated that there were several tests

they had other than HIV testing during their first

ANC at the CHC. These tests included blood drawn

and urine tests for Hepatitis B, hemoglobin,

platelets, glucose, leukocytes, blood types and

rhesus, urinalysis (albumin and glucose). All these

tests were free of charge because they were covered

by the Indonesian national health care insurance.

Before having the tests, participants were given a

brief explanation by HCPs at the MCH regarding the

name and purpose of the test tests. They were also

interviewed about high risk behaviors. Once they

had received information about the test, they were

referred to the STI clinic and laboratory for blood

draw and urine collection

"I was asked to…I was interviewed and asked to

have blood draw and urine test for HIV.” (H1,

28 years old)

Participants had blood draw and urine test in the

laboratory. The results of the tests were received at

the same day or the next day if the participants did

not have to wait for the results. The test results were

read and explained by HCPs or they were contacted

by HCPs by phone to inform their test results.

"At first, they did blood draw and urine test…and

the process could take a whole day. The next

morning, if I am not mistaken, we can get the test

results." (H7, 35 years)

"Morning, at that time it was 10 o'clock? 9

o'clock? I had the test. At 3 o'clock the results

were finished. I met the midwife, she explained to

me that the thrombocyte and haemoglobin level

were normal. Everything is normal. And she

explained the HIV test result. The syphilis test

was negative. For Hepatitis B, it needed a week

to get the result. I was informed by phone about

the HB test result. "(H5, 30 years)

The HCPs stated that pregnant women had to

have several tests on their first visit including HIV,

hepatitis B, and syphilis. The women were also

checked for complete blood count and urine test.

3.2.3 Lack of Knowledge about HIV Testing

in Pregnant Women

The main reason of participants did not have HIV

test before becoming pregnant or initiated for having

HIV test once they were pregnant was because they

were not aware of HIV test for pregnant women.

Some participants stated that they knew the

importance of HIV testing for pregnant women

when they had ANC at the CHC.

"I don't know about it [HIV test for pregnant

women]" (H1, 24 years)

"People don't have time to do it [HIV test], we

know about it when we are here [CHC] right

here." (H3, 21 years old)]

Some participants were able to explain about

HIV transmission, including sexual intercourse and

needles; groups who needed to have HIV test were

those who practiced high-risk behaviours such as

prostitutes or injection needle users. Several

participants stated that HIV can be transmitted

through coughing.

"Usually it is transmitted through a syringe ... it

is contagious ... Syringe, having sex other than

The Experiences of Pregnant Women in having HIV Test at the Community Health Center in East Jakarta, Indonesia

their partners [were the HIV transmission

mode]." (H4, 35 years)

"Yes, it [HIV] is contagious ... it can be

transmitted through coughing" (H1, 21 years)

Some participants stated that before having HIV

test, HCPs only gave a brief explanation to the

participants. The test is to determine the condition of

maternal and infant health and identify treatment if

the laboratory results were not normal. When

explaining laboratory test results, the HCPs only

stated that the results of the test were normal without

any follow-up information.

"Yesterday, I was only told that it was for HIV

test, as well HB test, that's what the HCP

explained.” (H1, 24 years)

"It was explained. I was just told that all the test

results were normal.” (H1. 21 years old)

Before the women have an HIV test, the HCPs

explained the tests that the women would have. It

included the name of the test, the purpose of the test,

the place to have the test. It took about 10-15 for

each patient to complete the assessment form and

explanation for the HCPs. In the room, there were

some table were each HCPs explain about the test

and the examination rooms were only separated by a

screen. Thus, other patients in the room were able to

listen the explanation and discussion between

patients and HCPs. The women would get the test

result on the next day and the HCP would explain

more detail if the test result not good.

4 DISCUSSION

The results of this study indicate that all participants

were tested for HIV during their pregnancy because

of recommendations of HCPs. HIV test is one of the

laboratory examination procedures for pregnant

women when they first time to check their

pregnancy at the CHC. The HIV test is carried out

with other blood and urine tests including

hemoglobin, platelets, Hepatitis B, blood type, blood

resus, albumin and glucose. Lack of knowledge

about HIV testing in pregnant women results them

to have their first HIV test at the CHC. To encourage

pregnant women to take an HIV test, HIV test for

pregnant women has been launched by the Ministry

of Health since 2005. This is mainly done in areas

with high HIV cases. HCPs are required to offer

HIV tests to pregnant women when they some for

ANC at the health facilities (MoH, 2011). Including

HIV test with other tests on pregnant women has

positive and negative impacts. Offering and

including HIV test in a series of laboratory tests on

pregnant women can increase the number of

pregnant women taking HIV test. However, this

condition can lead the HIV testing counseling

process to be less effective because of limited time

and information as HCP have to explain different

kind of tests. In addition, when HCPs offer HIV test

for pregnant women it can give an impression that

HIV test is an obligation for the pregnant women not

an option.

Information about HIV test emphasizes the

importance of identifying the mother's HIV status to

prevent transmission to the fetus. This causes

pregnant women agree to have HIV test because it is

a standard procedure that must be done.

Furthermore, HIV test is offered by health

professionals who will carry out ANC during their

pregnancy visit. The rejection from the pregnant

women to have HIV test can lead problems in the

future. Therefore, the pregnant women prefer to

have HIV test. During the ANC, the atmosphere of

the room was crowded and the room was not

soundproof. These can cause pregnant women to be

embarrassed to ask further about HIV test. The

results of this study were similar in Canada.

Pregnant women who have HIV test when having a

pregnancy check-up at a health facility had

difficulties in understanding the information

provided HCPs about HIV testing and ignorance of

the right of the women to refuse to have HIV test

(Bulman et al., 2013).

Our study showed that all participants had never

taken an HIV test before. This is due to a lack of

information about HIV testing in pregnant women.

Some participants thought that those who need to

take an HIV test are individuals who practice high-

risk behaviors, including prostitutes and injection

needle users. Even though participants have received

information about HIV testing and transmission

before have HIV test, some participants have not

been able to explain correctly about HIV test. A

study in Guinea-Bissau, Africa, showed similar

results. The level of knowledge of pregnant women

regarding HIV test remained low despite getting

counseled before having HIV test. This can be

caused by ineffectiveness of the counseling process

as well as privacy, limited time and the authority of

health workers (Vieira et al., 2017).

Similar conditions also happened in Tbilisi

(Georgia) and Ghana. Lack of knowledge about the

importance of HIV testing, limited voluntary

counseling and testing (VCT), low aspects of

confidentiality, poor communication between

patients and HCPs, HCPs not informing pregnant

women about HIV testing were the reasons for

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

pregnant women not having an HIV test. The

women also believed that that they would not get

HIV because they never practice high risk behaviors

(Butsashvili et al, 2014; Kwapong et al, 2014).

All participants in this study had negative HIV

test results. As a result, they did not to seek more

information about HIV. In addition, when the HIV

test results were negative, participants were not

given additional information about the importance of

future HIV testing. More information about HIV

testing in pregnant women and HIV transmission

provided by HCPs needs to be improved when

counseling for HIV test. In addition, it is important

to provide a private room that can guarantee the

privacy of pregnant women during counseling. This

will allow them to ask further questions about HIV

test without feeling uncomfortable and afraid that

other people will listen to their questions.

5 CONCLUSIONS

Pregnant women have HIV test at the CHC on their

first visit for ANC but they do not have any option

other than having HIV test based on the HCPs

recommendation. Providing more information about

test HIV and private room are needed to allow

pregnant women received adequate information about

test HIV and being able to ask more about the test

without feeling embarrassed and understand their

right to decide for having an HIV test. Furthermore,

health education in the community about HIV test

among pregnant women should be conducted as

pregnant women have had a better understanding

about HIV test before they have it at the CHC.

ACKNOWLEDGEMENTS

The author thanks to participants. This study was

supported by Health Polytechnic Jakarta III (grant

number LB.02.01/I/0828.2/2017).

REFERENCES

Anggraini, I., G., A. 2014. Faktor-faktor yang

mempengaruhi perilaku pemeriksaan VCT pada ibu

hamil di wilayah kerja puskesmas II Melaya kabupaten

Jembrana provinsi Bali. Unpublished skripsi.

Badan Penelitian dan Pengembangan Kesehatan

Kemenkes. 2013. Pokok Pokok Hasil Riset Kesehatan

Dasar Provinsi DKI Jakarta Tahun 2013.

Kementerian Kesehatan RI: Jakarta.

Butsashvili, M., Kajaia, M., Kamkamidze, G., Tchendjou,

P., du Loû, A., Dabis, F…et al. 2014. Factors

associated with HIV testing history among pregnant

women and their partners in Georgia: The

ANRS12127 Prenahtest trial, AIDS Research and

Treatment, vol. 2014, p. 1-6.

Bulman, D., Mathews, M., Parsons, K., O’Byrne. 2013.

HIV testing in pregnancy: Using women’s voices to

inform policy. Women and Birth, vol. 26, e37-40.

Hardon, A. P., Oosterhoff, P., Imelda, J. D., Anh, N. T., &

Hidayana, I. 2009. Preventing mother-to-child

transmission of HIV in Vietnam and Indonesia:

Diverging care dynamics. Social Science and

Medicine, vol. 69, no. 6, p. 838-845.

Ismail et al., 2018. A Content Analysis Study: Concerns of

Indonesian Women Infected with HIV by Husbands

Who Used Intravenous Drugs. Journal of the

Association of Nurses in AIDS Care, vol. 29, no. 6,

pp.914–923.

Ministry of Health. 2011. Pedoman nasional pencegahan

penularan HIV dari ibu ke bayi.

Ministry of Health. 2012. Pedoman nasional pencegahan

penularan HIV dari ibu ke anak (PPIA). Edisi Kedua.

Kemenkes: Jakarta.

Ministry of Health. 2013. Statistik kasus HIV/AIDS di

Indonesia. Dilapor sampai September 2013. Jakarta.

Available from: http://spiritia.or.id/Stats/StatCurr.pdf

Ministry of Health. 2013. Badan Penelitian dan

Pengembangan Kesehatan Kemenkes. 2013. Pokok

Pokok Hasil Riset Kesehatan Dasar Provinsi DKI

Jakarta Tahun 2013. Kementerian Kesehatan RI:

Jakarta.

Ministry of Health. 2014. Laporan Laporan

Perkembangan HIV-AIDS, Triwulan III, Tahun 2014.

Kemenkes: Jakarta.

http://spiritia.or.id/Stats/StatCurr.pdf

Ministry of Health. 2016. Laporan situasi perkembangan

HIV-AIDS dan PIMS di Indonesia Juli_September

2016. Kemenkes: Jakarta.

http://spiritia.or.id/Stats/StatCurr.pdf

Kwapong, G., Boateng, D., Agyei-Baffour, P., & Addy, E.

(2014). Health service barriers to HIV testing and

counseling among pregnant women attending

antenatal clinic; a cross-sectional study, Health

Services Research, vol. 14, no. 267, p. 1-10.

National AIDS Commission Republic of Indonesia. 2010.

Republic of Indonesia country report on the follow up

to the declaration of commitment on HIV/AIDS

(UNGASS) reporting period 2008 – 2009. NAC:

Jakarta.

National AIDS Commission Republic of Indonesia. 2012.

Republic of Indonesia country report on the follow up

to the declaration of commitment on HIV/AIDS

(UNGASS) reporting period 2010 – 2011. NAC:

Jakarta.

Vieira, N., Rasmussen, D., Oliveira, I., Gomes, A., Aaby,

P., Wejse, C., Unger, H., 2017. Awareness, attitudes

and perceptions regarding HIV and PMTCT amongst

pregnant women in Guinea-Bissau– a qualitative

study. BMC Women's Health. Vol. 17, no: 71, p. 1-11.

The Experiences of Pregnant Women in having HIV Test at the Community Health Center in East Jakarta, Indonesia