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Journal of Infrastructure, Policy and Development (2023) Volume 7 Issue 2.
DOI: 10.24294/jipd.v7i2.2287
I Made Sumada1,*, Azhari Aziz Samudra2
1 Faculty of Postgraduate, Department of Magister Administration Science, Universitas Ngurah Rai, Bali 80238,
Indonesia
2 Faculty of Politic and Social Sciences, Department of Doctoral Administration Science, Universitas Muhammadiyah
Jakarta, Jakarta City 15419, Indonesia
This paper presents an overview of the policies and efforts of the
Provincial Government of Bali, Indonesia, to tackle the development
of HIV/AIDS. This study considers the socio-cultural context and
analyzes the factors that are most likely to inuence its spread, the
response of the community, and the local government’s efforts to
form Provincial AIDS commission whose movement is supported
by the village government and the community to suppress the spread
of HIV/AIDS. The authors observe the micro factors that most
determine this program, such as attitudes, behaviors, and desires of
policy-making actors, stakeholders, implementing organizations,
adequacy of human resources, financial funds, information,
education, communication, advocacy, regional languages, the role
of students, and field workers, and local culture in preventing the
spread of HIV/AIDS. Therefore, this research does not focus on
just one dimension in efforts to deal with this outbreak. Following
the application of the public policy theory, all potential contributing
elements must be addressed simultaneously. This requires a truly
interdisciplinary and multisectoral approach that requires to be
comprehended by policymakers in other provinces where the
prevalence of HIV/AIDS is quite high. This effort also requires
commitment and strong political will from levels of government.
local government policies; HIV/AIDS prevention; advocacy;
communication; regional languages; the role of students; field
workers; local culture
ARTICLE INFO
Received: 23 June 2023
Accepted: 28 August 2023
Available online: 20 September 2023
*CORRESPONDING AUTHOR
I Made Sumada, Faculty of
Postgraduate, Department of Magister
Administration Science, Universitas
Ngurah Rai, Bali 80238, Indonesia;
made.sumada@unr.ac.id
COPYRIGHT
Copyright © 2023 by author(s).
Journal of Infrastructure, Policy and
Development is published by EnPress
Publisher LLC.
This work is licensed under the
Creative Commons Attribution-
NonCommercial 4.0 International
License (CC BY-NC 4.0). https://
creativecommons.org/licenses/by-
nc/4.0
CITATION
Sumada IM, Samudra AA (2023).
Implementation of HIV/AIDS
prevention policies: The study in
Bali Province, Indonesia. Journal
of Infrastructure, Policy and
Development 7(2): 2287.
doi: 10.24294/jipd.v7i2.2287
Sexually transmitted diseases (STDs), Human Immunodeficiency Virus (HIV), and Acquired
Immunodeciency Syndrome (AIDS) continue to pose a threat to the world’s population. According
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
2
to data from the World Health Organization (WHO, 2023), in 2018, 37.9 million people were living
with HIV, and the most suerers were in Africa, with a total of 25.7 million people. Due to HIV/
AIDS, 1.4 million people died in 2000 and it was counted 770,000 people died in 2018. According
to the estimates of the Joint United Nations Program on HIV/AIDS (Ocran et al., 2022), Indonesia
has the largest number of people living with HIV in Southeast Asia, namely around 540,000 people
in 2021 (Khodayari-Zarnaq et al., 2021; UNAIDS, 2019).
In Indonesia, HIV/AIDS has been recognized as a national social health problem, and the
President has established the Central AIDS Commission (CAC) through Decree No. 36 of 1994.
CAC aims to carry out eorts to prevent and control AIDS. In Bali Province, CAC has proposed the
formation of a Bali AIDS Commission (BAC). According to the Health Ministry, the development
of HIV/AIDS cases has continued to increase drastically in the past ve years as Bali Province is
a world tourism area. The accumulation of HIV/AIDS cases during the COVID-19 pandemic is a
cause for concerning and requiring serious strategies and management.
The data of Health Ministry indicates that the spread of HIV/AIDS in Bali is happening very
quickly compared to 33 other provinces in Indonesia. The reasons include the high population
growth rate due to urbanization and the visits of tourists from abroad facilitating the transmission
and spread of HIV/AIDS. The Governor of Bali made a policy by establishing BAC based on
Decree No. 544 of 1994 to overcome this problem. However, BAC did not run eectively because
the organizational structure was unstable and did not perform well.
In January 2022, the Ministry of Health stated that the Province of Bali was in the top 10 with the
most cases of HIV/AIDS. Bali occupied the sixth position with the most cases in Indonesia. Data on
HIV/AIDS cases in Indonesia were Jakarta Province with 90,958 cases, East Java with 78,238 cases,
West Java with 57,426 cases, Central Java with 47,417 cases, Papua with 45,638 cases, Bali with
28,376 cases, North Sumatra with 27,850 cases, Banten 15,167 cases, South Sulawesi 14,810 cases,
and Riau Islands with 12,943 cases. HIV/AIDS case data in the Province of Bali are presented in
.
Comparison of HIV-AIDS cases in Bali and nationally in 2022.
Source: Bali AIDS Commission, 2022 (Detikhealth, 2022).
Sumada and Samudra
3
The picture above is the latest data released by the Bali AIDS Commission. However, health
experts explained that the actual number of people living with HIV/AIDS in Bali is an iceberg
phenomenon, and this data may only be 10% of the actual data. Because people living with HIV/
AIDS never report their illness, feel ashamed, and do not want others to know about it. Therefore,
the Government and BAC need to re-collect data on people living with HIV/AIDS and invite them
to come to the community health centers and hospitals.
In addition, to tackle the spread of HIV/AIDS, the Governor of Bali signed the Sanur
Commitment Movement by all Governors, Regents, and Mayors. Among the contents of the Sanur
Commitment is strengthening and empowering the role and function of BAC.
In its implementation, the eorts made by the Government and BAC Bali received support from
the Central Government. The Province of Bali is considered capable of suppressing the transmission
of HIV/AIDS. Bali won the award from the Ministry of Health in 2022. The Best Award Certicate
1 was received by Mr. I. Wayan Widia, Head of the Provincial Disease Prevention and Control
Service Bali Health Oce, in Jakarta, on 31 January 2023 (Balitopnews, 2023).
Some of the literature that raises the causes of increasing cases of HIV/AIDS and STDs report
their association with low socioeconomic status. This is due to reports released by developing and
underdeveloped countries (Haakenstad et al., 2019). However, data on the empirical relationship of
SES with HIV/AIDS are mixed with other factors beyond control (Fang et al., 2008).
There are many reasons for the increasing cases of HIV/AIDS. Yang et al. (2005) investigated
migrants working in eight occupational clusters in Beijing and Nanjing, China, to examine
workplace association with HIV-related behaviors and perceptions. For sexually experienced
women, those working in entertainment establishments or personal service (e.g., nightclubs, dancing
halls, barbershops, beauty salons, and massage parlors) engaged in risky sexual practices twice as
frequently as those working in non-entertainment establishments (e.g., restaurants, stalls, domestic
service, and factories). In a study, Cao et al. (2022) suggested that AIDS patients should pay
attention to the maintenance of oral health, and early initiation of highly active antiretroviral therapy
(HAART) may be important for the development of oral lesions. He explained that in patients
infected with HIV/AIDS, age, gender, marital status, income level, smoking behavior, and oral
health aected periodontal clinical indicators; age and marital status correlate with dental clinical
indicators; most have oral manifestations, especially candidiasis albicans, salivary gland disease,
AIDS-associated periodontitis, and mouth ulcers.
In connection with government policies to tackle the spread of HIV/AIDS, a study in Iran
conducted by Khodayari‐Zarnaq et al. (2021) revealed the multidimensional nature of HIV/AIDS,
namely that there are many stakeholders involved in HIV/AIDS control, active and potential in this
eld. However, there is no unied system to involve all stakeholders in HIV/AIDS policy-making.
Therefore, an upstream entity is needed to coordinate and mobilize all stakeholders in managing
and controlling HIV/AIDS—worker studies regarding coordination that does not work between
institutions.
The Zambia study adopted a strategic communication policy and an HIV/AIDS implementation
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
4
policy. Governments rely on formal and informal channels to communicate testing and drug policy
changes to all healthcare providers. Elaborating a National HIV/AIDS Action Strategy has resulted
in little awareness of this policy by frontline providers. Stakeholder agreement using a top-down
concept, limited training of health workers, and nancing harms implementing changes to the test
and treat policy for all (Zakumumpa et al., 2023). In contrast to Rwanda, the HIV self-test policy
improvement (HIVST) program is considered successful because it is supported by stakeholders
(Dzinamarira et al., 2020).
In Ghana, the government has a school-based Counseling on Sex Education (CSE) program
which effectively prevents HIV among young people aged 10–24 years. Unfortunately, Ghana’s
national sexual and reproductive health education policy does not have an overarching policy. This
policy was identied as a factor that could inuence the orientation of school-based health educators
creating disharmony in sex education interventions and introducing sex education messages that
have the potential to create narrow curricula and limit overall HIV/AIDS knowledge (Ocran et al.,
2022). Eventually, this program was discontinued because it was deemed ineectively. Based on the
experiences of various countries in implementing policies to prevent the spread of HIV/AIDS, we
can learn to take practical steps going forward by developing strategic plans that are supported by
the government and society.
This study uses qualitative methods supported by a phenomenological approach. Phenomenology
can be dened as an approach to research that seeks to describe the essence of a phenomenon by
exploring it from the perspective of those who have experienced it (Khan, 2018; Nigar, 2020). This
method is supported through in-depth interviews by compiling a list of interviews (DeJonckheere
and Vaughn, 2019). Ishtiaq (2019) formulates various eligibility criteria for interview lists by
considering the research objectives. To compile a list of interviews, the author explored literacy in
various online media regarding the eectiveness of implementing HIV/AIDS policies and programs
and government, NGO, and community partnerships to reduce the spread of HIV/AIDS. After
compiling the list of interviews, the writer tested the list of interviews.
Furthermore, the researchers determined the informants who were directly involved and
understood the topic of this research. Researchers can access these informants and identify
participants during or after data collection. The selection of key informants was carried out using
a purposive sampling technique (Etikan, 2016). The results of the interview list instrument are
presented in the research results. shows the number of informants interviewed.
Adequacy of human resources related to competence, skills and personal abilities is important to
overcome the spread of HIV/AIDS. Human resources are an essential requirement for performance
in the rush skit and community health center. Community health center is the spearhead of health
services and is at the grassroots level. In order to determine the adequacy of human resources,
interviews were conducted as follows.
Sumada and Samudra
5
In order to overcome these obstacles, Mr. Anshori (BAC) initially prepared a strategic plan, as
explained:
We have developed a Strategy and Action Plan at the city, district, and village levels. The goal
is that there is a standard procedure for carrying out AIDS prevention eorts in Bali. A strategic
plan needs to be made with indicators and SOPs for handling HIV/AIDS specically. Then, this
plan was disseminated to BAC human relation and health extension workers.
Regarding the readiness of human resources, Mr. Anshori explained:
We have sucient human resources in the oce and eld to socialize and implement HIV/AIDS
prevention policies. At the village level, BAC Bali needs eld extension workers and counselors.
Therefore, additional village extension officers are needed for the extension program and
outreach to the community to be adequately implemented. We involve students from various
tertiary institutions as eld workers who do not require to be paid; they actively provide case
reports daily through the whats-up group. In the future, we hope that there will be an easy HIV/
AIDS case application for data collection on PLHIV.
Ms. Praesti of the Management Program for AIDS and Drug Concern Student Groups at the
provincial level added:
BAC has a lot of human resources, as well as capability and quality, but only a few officers
understand standard operating procedures. In order to improve their performance, BAC will
strengthen the capabilities of field extension workers. Currently, BAC has recruited one field
No. Name
1Mr. Yahya Anshori BAC Provinsi Bali
2Mr. Wayan Diana Head of BAC Media Program Management
3 Mr. Gede Agus Suryadinata Bali Provincial Health Oce: Prevention and Control of Infectious Dis-
eases
4Ms. Tri Indarti Head of Denpasar City Health Oce
5Mr. A. A. N. Gede Dharmayuda Head of the Disease Control and Eradication Program Division of the
Denpasar City Health Service
6 Mr. Made Adi Mantra Director of the Bali Health Foundation (NGO)
7 Ms. Ni Luh Made Suwari Paramacitta Spirit Foundation (NGO)
8 Ms. Putu Padma Praesti Chairman of the Management Program for AIDS and Drug Concern Stu-
dent Groups
9 Mr. I. Gusti Putu Agung JT Head of the Bali Province AIDS Care Village Cadre Management Pro-
gram (NGO)
10 Ms. I. Wayan Yuni Ambara The District Health Oce, Division of Communicable Disease Preven-
tion and Control
11 Ms. Yurike Ferdinandus Community Members with HIV/AIDS (people with HIV/AIDS disease
(PLWHA))
12 Ms. Yuni Nengah Community Members with HIV/AIDS Community Members with HIV/
AIDS (people with HIV/AIDS disease (PLWHA))
Key informants.
Source: Authors, 2022.
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
6
assistant from students and one HIV/AIDS counselor in each village. They actively report cases
every day via the WhatsApp group.
In an interview with Ms. Ambara, the District Health Oce, Division of Communicable Disease
Prevention and Control, she explained:
We have HIV/AIDS prevention experts, voluntary counseling and testing (VCT) service experts,
and sexually transmitted infections primary care workers. Experts make it easier for us to refer
to people living with HIV/AIDS.
She suggested:
We propose that the addition of several laboratories with complete facilities at the district level is
urgently needed so that the process of handling HIV/AIDS cases can run well and quickly.
Interviews were also conducted with community members infected with HIV/AIDS in the
district. Ms. Yurike explained:
HIV/AIDS service workers on standby at every health center and district hospital. We also see
that there are health workers for VCT and Postmortem computed tomography (PMCT) services.
We also always find extension workers who actively disseminate HIV/AIDS prevention to
people’s homes. We consider all of this necessary for society because most of the people do not
understand how infected people with HIV/AIDS transmit the diseases to others.
In order to tackle the spread of HIV/AIDS, an adequate budget is needed. The budget is an
essential thing in the HIV/AIDS prevention program. An interview with Mr. Anshori (BAC)
obtained the following information.
In particular, the treatment of HIV/AIDS patients is different from diseases in general. The
government has provided health funding assistance to purchase ambulances, vehicle maintenance
costs, purchase medicines, produce IEC brochures, and socialize the prevention of HIV/AIDS
to the public. The budget is IDR 1,395,861,500 (equivalent to US$ 95,000) per month. These
funds are channeled to districts and cities. At the village level, additional funds are needed for
local NGOs that work with BAC. We have submitted a budget to the Provincial Government and
Central BAC so that HIV/AIDS cases can be handled earlier and more quickly.
Head of the Provincial Level AIDS and Drug Concern Student Management Program, Ms.
Praesti, added:
Currently, we are improving the abilities, skills and expertise of field officers. In the future,
additional funds will be needed to strengthen the implementation of the Socialization, and
Information Education Communication (IEC) program.
In an interview with Mr. Dharmayuda, Head of the Disease Control and Eradication Program
Division of the Denpasar City Health Service, he explained:
At the district and village levels (central health), additional funds are needed to procure
medicines and medical devices—for example, reagents and ARVs, so that the health services for
Sumada and Samudra
7
PLHIV can be appropriately handled.
Interviews were also conducted with community members infected with HIV/AIDS in the
district. Ms. Yuni explained:
The government has prepared drugs for the prevention of HIV/AIDS. For example, ARV drugs
can be obtained at provincial, city, and district hospitals. However, the COVID-19 pandemic
has hampered and obtaining medicine has become more complex. Most of the health funds is
probably diverted to tackling the COVID-19 pandemic. By the end of COVID-19, the availability
of ARV drugs has recovered and is easy to obtain.
The success factor of a policy/program lies in the role of the implementing organization, as
indicated by the structure, bureaucracy, norms, and patterns of relationships that occur (Ahmad et
al., 2017). In the Province of Bali, patterns of community relations can be seen in norms, values,
habits, and customs, which are symbols of the community always obeying the culture that has
existed for generations (Basyir 2019; Gedela et al., 2020). Strong local culture has apparently
helped the Balinese in accelerating the prevention of the spread of HIV/AIDS (Runiari et al., 2018).
In an interview with Mr. Anshori (BAC), he explained:
The activities carried out so far have been organized. For example, HIV/AIDS outreach
programs. Pregnant women coordinated with field counseling. This program is considered
successful because of the cooperation of the field workers team with the pregnant women
program. In addition, the handling and administration of drugs to suerers of HIV/AIDS cases
also exceeded the target. We collaborate with cross-sectors and communities, and it is going well.
The Governor has instructed that eorts to tackle HIV/AIDS must be carried out comprehensively
and BAC has a role in initiating and advocating for stakeholders and the community.
In an interview with Ms. Praesti, Head of the AIDS Management Program and Drug Concern
Student Group at the provincial level, she said:
BAC has played the best role in which BAC always controls the performance of hospitals
and health centers through coordination with the Health Office. BAC also controls staff and
eld extension workers every day. In addition, it encourages sta and eld extension workers
regulary, for example, by mingling with eld extension workers at the desk hence, the community
feels comfortable and excited.
The results of an interview with Mr. Mantra, Director of the Bali Health Foundation who is an
Activist for Harm Reduction, an NGO in Bali, is as follows:
HIV/AIDS prevention programs have been carried out jointly. The Bali Health Foundation is
a partner of BAC. We play a role as assistants and community educators about HIV/AIDS, and
pregnant women. We are always involved in cross-sectoral meetings and BAC programs and
evaluate programs in the eld.
In an interview with Mrs. Ambara from the Communicable Disease Prevention and Control
Division, she explained:
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
8
We have a role in supporting logistics, ARV drugs, and service delivery to improve the quality of
life for PLWHAs. We are members of BAC meetings and programs/activities, such as resource
persons in seminars, webinars, and outreach at the village oce.
Disposition is defined as policy actors’ attitude, behavior, and desire to implement the policy
(Knoepfel et al., 2011). Disposition has an essential role in implementing HIV/AIDS policy and
inuences the success of the HIV/AIDS program (Handayani et al., 2021; McRobie et al., 2017).
In an interview with Mr. Anshori (BAC), the role of actors is explained as follows:
The provincial government always controls programs implemented by BAC. We must always
pay attention to key populations and the general population and advocate, initiate, monitor,
and evaluate every program that involves stakeholders. All stakeholders, such as health oces
in provinces, cities, districts and hospitals, health centers, NGOs, student’s movements, village
governments, and health educators, participate in eorts to prevent HIV/AIDS. All stakeholders
have the same desire, attitude, and goals to play a role, and BAC unites their desires and needs
to tackle HIV/AIDS problems.
In an interview with Ms. Indarti, Head of Denpasar City Health Oce, she explained that:
The city government intends that HIV/AIDS in Denpasar and the province of Bali can be
reduced. We have socialized it to traditional villages in all cities and districts in Bali. Prevention
in the general population in the province of Bali has been carried out intensively because the
Healthy Village program of the Ministry of Health supports it. Hence, all BACs in districts and
cities have been formed and developed this program. We also coordinate with the Department of
Culture and the Traditional Village Assembly which budgeted aid funds for this program.
Furthermore, the interview was conducted with Ms. Suwari from Paramacitta Spirit Foundation,
Bali. She explained as follows:
We are HIV/AIDS prevention activists, hoping that our family and society will be free from
HIV/AIDS. Consequently, during meetings with clients, we always provide health education
counseling. There are many obstacles in the eld for dealing with high-risk members of society.
The example is injecting drug users (IDU), sex workers, and customers of sexual relations. BAC
and Bali Health Foundation have coordinated and contributed regarding early detection and
referred them to the center of health. Although we have advised, some of the sex workers and
customers no matter what we say. We remain humble, and even though it is dicult, we must not
give up trying to change people’s attitudes.
The Head of the Disease Control and Eradication Program Division of Denpasar City said:
Our service focuses on quantity and quality of life, and all PLWHA must routinely take ARV
therapy. Treatment is generally recommended by doctors using antiretroviral therapy (ARV).
This therapy consists of a combination of antiviral drugs for HIV infection, and treatment with
ARV drugs is recommended for everyone with HIV/AIDS. We are currently developing a Policy
to serve PLWHA or the Balinese people. The Health Oce has a stock of ARVs distributed by the
Ministry of Health for the next six months.
Sumada and Samudra
9
The implementation of HIV/AIDS control policies and programs is determined by communication
factors (Suparmi et al., 2020). Communication must be delivered accurately and consistently.
Communication failures hinder policy implementers from achieving success in the HIV/AIDS
prevention programs (Djellouli and Quevedo-Gómez, 2015; Mehra et al., 2014).
In an interview with Mr. Anshori (BAC), he explained:
There are two strategies carried out by BAC, namely verbal and non-verbal communication.
Verbal communication is done by visiting the people who live together HIV/AIDS, the general
public, and meeting places in village oces, traditional villages and communities. BAC is here
to provide information with are able to be comprehended, especially the impact of HIV/AIDS.
While non-verbal communication activities are carried out through correspondence, brochures,
leaets, booklets and banners in local languages that are easier for the public to understand.
He continued his description:
For example, BAC invites and involves all stakeholders in commemorating the Archipelago AIDS
Reflection Night and World AIDS Day. We have carried out outreach and communication on
HIV/AIDS prevention through lm screenings. For example, the lm Nyiramang Layon has been
socialized on social media and other mass media in collaboration with the Cadre of AIDS Care
Journalists.
Mr. Mantra, the Reduction Director of the Bali Health Foundation, added the description:
Information, education, and communication activities are conducted for regional officials,
students, and the community. The goal is for them to know the dangers of HIV/AIDS. In order to
support the acceleration of information, we held socialization by distributing yers at red lights,
essential events, and the Province of Bali birthdays.
Mr. Dharmayuda from the Health Service, Communicable Disease Prevention and Control
Division said:
The keys to successful HIV prevention and control management are ongoing activities,
communication, and patient outreach. At each HIV/AIDS discussion meeting, information is
inserted that strengthens efforts to understand HIV/AIDS. BAC’s active communication with
eld workers and public health centers is necessary to monitor the progress of each case; for
example, reporting routinely the results of the implementation of field officers who contain
service diculties.
Furthermore, he added:
Considering the background of various levels of community awareness and participation, it is
necessary to carry out regular communication and approaches so that the community is open
to providing information about the importance of this matter. The success rate of HIV/AIDS
prevention is highly dependent on information and communication intentions.
In an interview with Mr. Diana, Head of the BAC Media Program Management district, he said:
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
10
In our experience in the eld, miscommunication sometimes occurs in carrying out obligations
and duties. The solution is that in public communication, we must use language easily understood
by the public accompanied by examples they understand every day.
The spread of HIV/AIDS cases in Bali is concentrated in three districts involving: Denpasar
Municipality, Badung, and Buleleng Regencies. The highest cases were found through injecting
drugs in Denpasar. The average age of people living with HIV/AIDS in Denpasar ranges from 20 to
29 years with a total of 10,162 cases (37.9%); aged 30–39 years with a total of 9594 (33.6%) of the
total cases (DetikBali, 2022).
This data shows that the young age group, especially between 20 and 39 years are vulnerable to
the spread of HIV/AIDS in Bali. The steps taken by the Provincial Government and BAC to map
the area are the rst steps towards successfully reducing HIV/AIDS cases in the Province of Bali.
Mapping this area makes it very easy for BAC to reach and handle the spread of people living
with HIV/AIDS. Mapping area is one of the strategies included in the BAC strategic plan (Collins,
2019). These key populations are very important and able to reach all the necessary information by
addressing a wide range of options (Stonbraker et al., 2018).
In accordance with the theoretical model of public policy implementation, in order for the
implementation of public policy to be successful, at least ve key factors must be found, namely the
adequacy of human resources, the adequacy of nal funds, the role of implementing organizations,
actor dispositions, and communication (Finsterwalder et al., 2022). Other factors that support the
ve factors can be added, namely the involvement of eld extension cadres, student’s involvement,
the use of WhatsApp communication tools, an easy referral system, the availability of medicines,
and especially the role of NGOs (Berenguera et al., 2011).
According to Melkote et al. (2014), the factors of information, education, and communication
(IEC) are interesting and crucial in increasing the success of the spread of HIV/AIDS. Research on
IEC has been carried out by the Department for International Development UK, the Global Fund,
the Ministry of Health, and the National AIDS Commission of Burkina Faso, Ghana, and Senegal.
They concluded that IEC in native languages required to be considered in planning HIV/AIDS
related health communications (Batchelor et al., 2019). In addition, the role of the IEC helps this
program’s success (Mahapatra, 2014).
Drawing lessons from studies in China which indicated the causes of behavior towards HIV/
AIDS (Lai et al., 2020) and the failure of HIV/AIDS prevention policies (Francis, 2012), or studies
in Iran reveal that there is no unied system to involve all stakeholders in the HIV/AIDS policy-
making process (Khodayari-Zarnaq et al., 2021), and studies that generate little awareness of
the policy by frontline providers (Simooya et al., 2023), or the government that failed to carry
out comprehensive sex education outreach to young people (Keogh et al., 2018), the Provincial
Government of Bali does not intend to repeat the same mistake. The Province of Bali is able to learn
from many countries in Rwanda which were able to implement a policy to improve the HIV self-test
program, and it was implemented successfully because it depended heavily on the involvement of
relevant stakeholders (Dzinamarira et al., 2020).
Sumada and Samudra
11
Based on the experiences of many countries in implementing policies to combat the spread
of HIV/AIDS, the Province of Bali can learn to create practical steps in the future by developing
strategic plans and being supported by the government and the community.
The research conducted in the Province of Bali, Indonesia, communication from eld extension
workers who came to villagers’ homes and students at red lights and open elds, in markets, and
leaets, booklets, and banners in Balinese were considered more eective than the main language.
Likewise, stakeholders who go down to the village hall and to the health center to advocate for the
community (Koesbardiati et al., 2017), and a friendly approach to people with HIV/AIDS disease is
also required (Mohammadi et al., 2021).
The adequacy of human resources is a major factor in the success of an HIV/AIDS program (Owan
et al., 2022). Adequacy of human resources related to competence, skills, and personal abilities to
tackle the spread of HIV/AIDS. Human resources are an essential requirement for performance in
hospitals and health centers. Community health center is the spearhead of health services and is at
the grassroots level (Kurniawan et al., 2017). Therefore, Bali government realizes that the success
of the HIV/AIDS prevention program is not only due to strong institutions and abundant funds but
coordination and involvement of all aspects of society from the top to the grassroots. Studies on
coordination in the implementation of HIV/AIDS programs have been carried out by Khosla et al.
(2016).
The success of HIV/AIDS prevention in the Province of Bali, Indonesia is caused by many
factors. These include reforming the institutional system by establishing the Provincial AIDS
Commission; inter-stakeholder coordination and cross-sector collaboration; regional mapping
activities; involvement of NGOs; mobilization of students and field officers to accelerate
understanding of the dangers of HIV/AIDS; adequacy and capacity of human resources and
field workers; adequate funds, advocacy, and good communication and easily understood by the
community; an easy referral system; monitoring the performance of field staff; and the use of
WhatsApp to speed up the handling of PLHIV.
The most important activity in developing countries for government programs to be successful
is to disseminate useful causes through communication, information, and education to grassroots
communities. IEC activities are very useful because Bali is a world tourism area, and many
grassroots people are illiterate or do not understand the impact of HIV/AIDS. Dissemination of IEC
activities for HIV/AIDS through eld counseling, university activities, and continuous support from
public actors in the villages is an important aspect of the success of this program.
Data will be made available on request.
This study was approved by the Universitas Ngurah Rai, Denpasar, Bali Research Ethics Review
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
12
Board (017-UNR-RERB-08-2022).
Conceptualization, IMS and AAS; methodology, IMS; software, AAS; validation, IMS and AAS;
formal analysis, AAS; investigation, IMS; resources, IMS; data curation, IMS and AAS; writing—
original draft preparation, IMS and AAS; writing—review and editing, IMS and AAS; visualization,
AAS; supervision, IMS and AAS; project administration, IMS and AAS; funding acquisition, IMS.
All authors have read and agreed to the published version of the manuscript.
This research was funded by Universitas Ngurah Rai, grant number No. 45-PPs-1/9-2022, 23
May 2022.
The authors gratefully acknowledge the University Research and Development Fund, and special
appreciation is given to the Chancellor of the Universitas Ngurah Rai, Denpasar, Bali.
The authors declare no competing interests.
Ahmad M, Budiningsih I, Sukamto H, Suyanto B (2017). Factors affecting the successful implementation of
bureaucratic reform in government institutions. International Journal of Economic Research 14: 203–220.
Balitopnews (2023). Quickly and accurately handling HIV/AIDS Bali Province wins 1st Best Award Certicate
for achievements of HIV/AIDS program and PIMS 2022. Balitopnews, 1 February.
Basyir K (2019). The “acculturative Islam” as a type of home-grown Islamic tradition: Religion and local culture
in Bali. Journal of Indonesian Islam 13(2): 326. doi: 10.15642/JIIS.2019.13.2.326-349
Batchelor K, Yoda L, Ouattara F, Hellewell O (2019). Multilingualism and strategic planning for HIV/
AIDS-related health care and communication. Wellcome Open Research 4: 200. doi: 10.12688/
wellcomeopenres.15584.1
Berenguera A, Pujol-Ribera E, Violan C, et al. (2011). Experiences about HIV-AIDS preventive-control activities.
Discourses from non-governmental organizations professionals and users. Gaceta Sanitaria 25(3): 184–
190. doi: 10.1016/j.gaceta.2010.10.015
Cao P, Zhang Y, Dong G, et al. (2022). Clinical oral condition analysis and the influence of highly active
antiretroviral therapy on human salivary microbial community diversity in HIV-infected/AIDS patients.
Frontiers in Cellular and Infection Microbiology 12: 937039. doi: 10.3389/fcimb.2022.937039
Collins FS (2019). NIH strategic plan for HIV and HIV-related research. Available online: https://www.oar.nih.
gov/sites/default/les/NIH_StrategicPlan_FY2021-2025.pdf (accessed on 4 September 2023).
DeJonckheere M, Vaughn L (2019). Semistructured interviewing in primary care research: A balance of
relationship and rigour. Family Medicine and Community Health 7(2): e000057. doi: 10.1136/fmch-2018-
000057
Sumada and Samudra
13
DetikBali (2022). HIV cases in Badung are the second highest, dominated by 20–29 year olds (Indonesian).
DetikBali, 29 August.
Detikhealth T (2022). Bali is among the top 10 provinces with the most HIV cases in Indonesia (Indonesian).
https://www.detik.com/bali/berita/d-6258508/bali-masuk-10-besar-provinsi-dengan-kasus-hiv-terbanyak-
di-ri/2 (accessed on 4 September 2023).
Djellouli N, Quevedo-Gómez MC (2015). Challenges to successful implementation of HIV and AIDS-
related health policies in Cartagena, Colombia. Social Science & Medicine 133: 36–44. doi: 10.1016/
j.socscimed.2015.03.048
Dzinamarira T, Kamanzi C, Mashamba-Thompson TP (2020). Key stakeholders’ perspectives on implementation
and scale up of HIV self-testing in Rwanda. Diagnostics 10(4): 194. doi: 10.3390/diagnostics10040194
Etikan I (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical
and Applied Statistics 5(1): 1–4. doi: 10.11648/j.ajtas.20160501.11
Fang X, Li X, Yang H, et al. (2008). Can variation in HIV/STD-related risk be explained by individual SES?
Findings from female sex workers in a rural Chinese county. Health Care for Women International 29(3):
316–335. doi: 10.1080/07399330701738382
Finsterwalder J, Kuppelwieser VG, Fisk RP (2022). Dynamics of individual actors’ self, social, and task pre-
dispositions in multi-actor service ecosystems. Journal of Business Research 147: 518–531. doi: 10.1016/
j.jbusres.2022.04.023
Francis DP (2012). Deadly AIDS policy failure by the highest levels of the US government: A personal look back
30 years later for lessons to respond better to future epidemics. Journal of Public Health Policy 33: 290–
300. doi: 10.1057/jphp.2012.14
Gedela K, Wirawan DN, Wignall FS, et al. (2020). Getting Indonesia’s HIV epidemic to zero? One size does not
t all. International Journal of STD & AIDS 32(3): 290–299. doi: 10.1177/0956462420966838
Haakenstad A, Moses MW, Tao T, et al. (2019). Potential for additional government spending on HIV/AIDS in
137 low-income and middle-income countries: An economic modelling study. The Lancet HIV 6(6): E382–
E395. doi: 10.1016/S2352-3018(19)30038-4
Handayani F, Nurhayati AK (2021). Disposition role on adolescent reproduction health policy implementation.
In: Proceedings of the 1st Paris Van Java International Seminar on Health, Economics, Social Science and
Humanities (PVJ-ISHESSH 2020); 15 March 2020; Bandung, Indonesia. doi: 10.2991/assehr.k.210304.109
Ishtiaq M (2019). Book Review: Creswell, J. W. (2014). Research Design: Qualitative, Quantitative and Mixed
Methods Approaches (4th ed.). Thousand Oaks, CA: Sage. English Language Teaching 12(5): 40. doi:
10.5539/elt.v12n5p40
Keogh S, Stillman M, Awusabo-Asare K, et al. (2018). Challenges to implementing national comprehensive
sexuality education curricula in low- and middle-income countries: Case studies of Ghana, Kenya, Peru and
Guatemala. PLoS ONE 13(7): e0200513. doi: 10.1371/journal.pone.0200513
Khan MS (2018). Exploring the role of transformational leadership in human capital effectiveness: Empirical
evidence from the Malaysian healthcare sector. World Journal of Entrepreneurship, Managementand
Sustainable Development 14(2): 191–204. doi: 10.1108/WJEMSD-10-2017-0075
Khodayari-Zarnaq R, Ravaghi H, Mosadeghrad-Rad AM, et al. (2021). HIV/AIDS policy‐making in Iran: A
stakeholder analysis. The International Journal of Health Planning and Management 36(6): 2351–2365.
doi: 10.1002/hpm.3313
Khosla N, Marsteller JA, Hsu YJ, Elliott DL (2016). Analysing collaboration among HIV agencies through
combining network theory and relational coordination. Social Science & Medicine 150: 85–94. doi:
10.1016/j.socscimed.2015.12.006
Knoepfel P, Larrue C, Varone F, Hill M (2011). Public Policy Analysis. Policy Press. pp. 38–61.
Koesbardiati T, Kinasih SE, Mas’udah S (2017). Integrating the roles of stakeholders in preventing the HIV/AIDS
transmission in East Java, Indonesia. Indonesian Journal of Tropical and Infectious Disease 6(5): 124. doi:
10.20473/ijtid.v6i5.4792
Implementation of HIV/AIDS prevention policies: The study in Bali Province, Indonesia
14
Kurniawan A, Tamtomo D, Murti B (2017). Evaluation of community health center management information
system (SIMPUS), primary care (P care), and bridging data system in Sukoharjo District. Journal of Health
Policy and Management 2(2): 157–164. doi: 10.26911/thejhpm.2017.02.02.07
Lai J, Pan P, Lin Y, et al. (2020). A survey on HIV/AIDS-related knowledge, attitudes, risk behaviors, and
characteristics of men who have sex with men among university students in Guangxi, China. BioMed
Research International 2020: 7857231. doi: 10.1155/2020/7857231
Mahapatra T (2014). Role of information, education and communication materials in HIV control: A perspective.
Annals of Tropical Medicine and Public Health 7(1): 3–4. doi: 10.4103/1755-6783.144996
McRobie E, Wringe A, Nakiyingi-Miiro J, et al. (2017). HIV policy implementation in two health and
demographic surveillance sites in Uganda: Findings from a national policy review, health facility surveys
and key informant interviews. Implementation Science 12: 47. doi: 10.1186/s13012-017-0574-z
Mehra B, Bhattar S, Bhalla P, Rawat D (2014). HIV/AIDS awareness among VCT clients: A cross-sectional study
from Delhi, India. BioMed Research International 2014: 269404. doi: 10.1155/2014/269404
Melkote SR, Moore D, Velu S (2014). What makes an effective HIV/AIDS prevention communication
campaign? Insights from theory and practice. Journal of Creative Communications 9(1): 85–92. doi:
10.1177/0973258613517441
Mohammadi Y, Mirzaei M, Shirmohammadi-Khorram N, Farhadian M (2021). Identifying risk factors for late
HIV diagnosis and survival analysis of people living with HIV/AIDS in Iran (1987–2016). BMC Infectious
Diseases 21(1): 390. doi: 10.1186/s12879-021-06100-z
Nigar N (2020). Hermeneutic phenomenological narrative enquiry: A qualitative study design. Theory and
Practice in Language Studies 10(1): 10–18. doi: 10.17507/tpls.1001.02
Ocran B, Talboys S, Shoaf K (2022). Conflicting HIV/AIDS sex education policies and mixed messaging
among educators and students in the Lower Manya Krobo Municipality, Ghana. International Journal of
Environmental Research and Public Health 19(23): 15487. doi: 10.3390/ijerph192315487
Owan VJ, Akah LU, Ekpo AJ, et al. (2022). Socioeconomic factors and the evaluation of HIV/AIDS prevention
programs: A psychometric analysis of an instrument. Electronic Journal of General Medicine 19(6): em405.
doi: 10.29333/ejgm/12320
Runiari N, Sipahutar IE, Hartati NN, et al. (2018). Traditional balinese youth groups as peer educator to improving
knowledge and attitude adolescents about reproductive health in South Denpasar. Indian Journal of Public
Health Research & Development 9(8): 1483. doi: 10.5958/0976-5506.2018.00942.7
Simooya C, Silumbwe A, Halwiindi H, et al. (2023). Exploring communication and implementation challenges
of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District,
Zambia. Implementation Science Communications 4: 51. doi: 10.1186/s43058-023-00430-6
Stonbraker S, Smaldone A, Luft H, et al. (2018). Associations between health literacy, HIV-related knowledge, and
information behavior among persons living with HIV in the Dominican Republic. Public Health Nursing
35(3): 166–175. doi: 10.1111/phn.12382
Suparmi S, Hardjanti TS, Kurniasih H (2020). Policy implementation for HIV/AIDS and sexually transmitted
infectious disease programs in the rst level of health facility. Jurnal Riset Kesehatan 9(2): 148–153. doi:
10.31983/jrk.v9i2.5702
UNAIDS (2019). Global HIV & AIDS statistics—Fact sheet. Available online: https://www.unaids.org/en/
resources/fact-sheet (accessed on 4 September 2023).
Yang H, Li X, Stanton B, et al. (2005). Workplace and HIV-related sexual behaviours and perceptions among
female migrant workers. AIDS Care 17(7): 819–833. doi: 10.1080/09540120500099902
WHO (2023). HIV and AIDS. Available online: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
(accessed on 4 September 2023).
Zakumumpa H, Kwiringira J, Katureebe C, Spicer N (2023). Understanding Uganda’s early adoption of novel
dierentiated HIV treatment services: A qualitative exploration of drivers of policy uptake. BMC Health
Services Research 23(1): 343. doi: 10.1186/s12913-023-09313-x
