HIV/AIDS Prevalence in Surabaya, Indonesia (Nasronudin, Yayuk Susilawati, Atika)

93
HIV/AIDS PREVALENCE IN SURABAYA, INDONESIA

Nasronudin
1
, Yayuk Susilawati
2
, Atika
3

1
Airlangga University School of Medicine, Department of Internal Medicine
2
Airlangga University School of Medicine, Department of Biochemistry
3
Airlangga University School of Medicine, Department of Public Health


ABSTRACT

The infectious disease of HIV/AIDS is a serious health problem today. In Indonesia, the disease has been a threat,
which becomes the emerging infectious disease in the last ten years. HIV virus is transmitted to other individuals
particularly through sexual contact with infected individuals, narcotic abuse using shared infected needle, maternal-
fetal transmission in perinatal period, either during pregnancy, labor, and breastfeeding, or through infected blood
donor (CDC 2003). The diagnosis of HIV/AIDS infection is established using laboratory examination with the
indication of clinical symptoms or high risk behavior. The most-commonly used methods for HIV diagnosis are ELISA,
Western Blot, and PCR. HIV patient is regarded as having AIDS if further development of HIV indicates infection and
life-threatening opportunistic cancer with CD 4 count of less than 200/mm3 (Setyono J, 2004). The number of
HIV/AIDS patients is the highest among 37 districts/majoralties in East Java, comprising 50% of all HIV/AIDS patients
in this province (Sembiring, Murphy J 2004). However, the prevalence of the disease and behaviors that lead to the
occurrence of the disease in Surabaya had never been studied. This study was conducted to address those issues. This
descriptive study was intended to identify the prevalence rate of HIV/AIDS in Surabaya and to describe human
behaviors that cause the occurrence of HIV/AIDS in Surabaya. The prevalence rate was obtained using the following
formula (Graves WW 1993): Total case in population at a certain time is divided with total population at that time and
multiplied with 1000. To find the description of the disease, the percentage of total HIV/AIDS patients according to
behavioral risk factors was estimated. Total patients in 9 hospitals at each risk factor were divided with total patients in
those hospitals, multiplied with 100. This study found the prevalence rate of HIV/AIDS in Surabaya in 2005 was 0.14
per 1000 population. The description of the disease according to behavioral risk factors in Surabaya is as follows: total
patients between January and December 2005 was 382 individuals; 204 due to sexual contact (53.40%), 161 due to
injected drug use (IDU) (42.15%), 6 perinatal cases (1.57%) and 11 with unknown causes (2.88 %). Further analytical
studies are needed to analyze correlation between human behavior and the occurrence of HIV/AIDS in Surabaya.
Identification of HIV virus types infecting the patients in Surabaya, as the basis for prevention and treatment, is also
worth to study.

Keywords: HIV/AIDS, prevalence, Surabaya, sexual contact, injected drug use, perinatal cases

Correspondence: Nasronudin, Tropical and Infectious Diseases Division, Department of Internal Medicine,
Airlangga University School of Medicine, Dr Soetomo Teaching Hospital, Jl. Mayjen Mustopo 6-8 Surabaya,
phone 62-31-5014077, email: nasronudindr@yahoo.com


INTRODUCTION

HIV/AIDS is a serious health problem today. The
problem that recently developing is its incidence, which
tends to continuously increase along with high mortality
rate. Up to the moment, however, a particular drug that
is able to totally eradicate this deadly virus has not been
invented. In Indonesia, HIV/AIDS infection has become
a threat and in the last 10 years it has also become an
emerging infectious disease. In general, HIV/AIDS may
cause significant reduction of human resource quality,
delays economic growth, and increase the burden of
public health system. By the presence of factors that
enable the epidemics, Indonesia has been widely posed
to the threat of national disaster of HIV/AIDS in 2010
(Indonesian Coordinating Ministry of Welfare 2003).

HIV virus is transmitted to other individuals particularly
through sexual contact with infected individuals,
narcotic abuse using shared infected needle, maternal-
fetal transmission in perinatal period, either during
pregnancy, labor, and breastfeeding, or through infected
blood donor (CDC 2003). High risk factors in the
transmission of this virus, such as free sex, narcotic
abuse using shared infected needle, blood donor,
perinatal period, and occupational accident, are highly
contributive to the development of HIV virus.

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East Java holds the third rank of provinces with high
prevalence of HIV/AIDS cases after Papua and DKI
Jakarta, followed by West Java, Bali, and Riau. These
six provinces have been recently included in
Concentrated Level Epidemic zone that need to receive
immediate eradication (Information and Communication
Bureau 2005). Total number of HIV/AIDS patients in
Surabaya is the highest among other 37
districts/majoralties in East Java, comprising 50% of
total HIV/AIDS patients in East Java (Sembiring,
Murphy 2004). However, there has been no study
investigating its prevalence in Surabaya and the
description of human behaviors that may cause the
emergence of HIV/AIDS in Surabaya has not been
undertaken either.

Human Immunodeficiency (HIV) is a virus that attacks
human immunity system and subsequently leads to
AIDS (Acquired Immunodeficiency Syndrome). AIDS
is a collection of disease symptoms resulting from the
reduction of immunity system. Progressive damage in
immunity system makes people living with HIV/AIDS
(PLWHA) highly susceptible to various types of
diseases. Even a generally harmless disease may lead
the patient to have severe disease and even to death. The
experts identify two types of HIV virus, HIV-1 and
HIV-2. HIV-1 is the primary cause of AIDS worldwide,
while HIV-2 is mostly found in West Africa (De Cock
et al. 1991; Kotula 2004). Death resulting from HIV-2
progresses more slowly than that from HIV-1 (De Cock
et al. 1991; Grant, Djomand, 1997).

Clinical manifestations of HIV infection can be caused
by the HIV itself (acute retroviral syndrome, HIV
dementia), opportunistic infection, or AIDS-related
cancer. The course of HIV disease is divided into stages
according to clinical condition and CD4 count: acute
retroviral infection, asymptomatic period, early
symptom period, and advanced symptom period. HIV
and AIDS diagnosis can be established from clinical
manifestations and supporting examinations. Early
diagnosis is established from laboratory examination
based on the indication from clinical symptoms or the
presence of high risk behaviors. The examinations
commonly used for HIV diagnosis are ELISA, Western
blot, and PCR. AIDS diagnosis is the latest stage of HIV
infection. A patient is declared to have AIDS if in the
subsequent HIV infection development indicates
opportunistic infection and cancer that is threatening the
life of the patient with CD4 count of less than 200/mm
(Setyono 2004).

The development of HIV/AIDS epidemics in Indonesia
is highly influenced by interaction among high risk
groups, such as commercial sexual workers, narcotics
abusers, and those who commit free sexual life
(Gsianturi 2002; Information and Communication
Bureau, East Java, 2004). Epidemiological studies on
human behavior in its role to induce HIV/AIDS in
Indonesia have not been widely performed, while there
are many areas in Indonesia where the development of
HIV virus is highly potential.

Individual is an inseparable part of social environment
where he/she lives. Psychologically, individual behavior
has a high complexity and difficult to learn without
relating it with lifelong learning process, which
manifests in his/her experiences. Rotter, a psychologist,
provides the concept of psychological behavior (Faisal
S, Mappiare A, no year): 1) Behavior is an event in
which living individual organism acts as subject, 2)
Behavior always have direction and goals, and the latter
is highly influenced by reinforcing conditions.
Reinforcement is a pleasing situation accepted by
individuals from their social environment as well as
from the outcome of their behavioral activities.

The general objective of this study was to find the
prevalence of HIV/AIDS infection in Surabaya, while
the particular objective was to find the description of
behaviors that cause the emergence of HIV/AIDS
infection in Surabaya. Data obtained in this study were
expected to be useful for health stakeholders as
references to determine preventive actions to suppress
the distribution rate or epidemic rate of HIV/AIDS,
especially in Surabaya, and also as a reference for
further studies in the future.


MATERIALS AND METHODS

This was a descriptive study to find the prevalence rate
of HIV/AIDS in Surabaya and the nature of human
behavior that serves as the cause of HIV/AIDS
emergence in Surabaya. Population comprised all
HIV/AIDS patients in Surabaya. Samples were
HIV/AIDS patients who came for examination in nine
hospitals in the area of Surabaya city. The area selected
to be the location of study was Surabaya. It was based
on the consideration that there was no data on
HIV/AIDS prevalence and the nature of human
behavior that may cause the emergence of HIV/AIDS in
Health Office, Surabaya. This study was conducted in
nine hospitals within the area of the city of Surabaya.

Data required in this study were primary and secondary
data. Primary data were obtained from study
instruments, which were presenting as questionnaire
sheets that were given to HIV/AIDS patients who were
examined in nine hospitals in Surabaya. Secondary data
were obtained from HIV/AIDS patients' data collected,
either actively or passively, by those nine hospitals.
HIV/AIDS Prevalence in Surabaya, Indonesia (Nasronudin, Yayuk Susilawati, Atika)

95
Active data were those obtained actively from the
activities within the hospital in the examination of
HIV/AIDS patients as well as the activities serving
referral system from other health units. Passive data
were those obtained from external parties
(community/community organization, governmental
institution, non-governmental organization, etc).

The estimation of prevalence rate was obtained using
the formula as follows (Greaves 1993): total case in a
population in certain time was divided with total
population in certain time, multiplied with 1000. To
identify the feature of HIV/AIDS we estimated the
percentage of total HIV/AIDS patients related to the risk
factor of behavior. Total patients in 9 hospitals of each
risk factor were divided by total patients in nine
hospitals, multiplied with 100%.


RESULTS



Table 1. Positive HIV patient distribution based on behavior risk factor in January - December 2005 in Surabaya


Risk Factors
Sexual Contact Injected Drug
Use (IDU)
Blood
Transfusion
Perinatal Unknown
Total
Hospitals
N % N % N % N % N % N %
Dr. Soetomo 157 50.00 151 48.09 0 0 6 1.91 0 0 314 100
Angkatan Laut 37 100.00 0 0 0 0 0 0 0 0 37 100
Dr. Soewandhi 3 100.00 0 0 0 0 0 0 0 0 3 100
Karang Tembok 4 80.00 1 20.00 0 0 0 0 0 0 5 100
Darmo 0 0 3 60.00 0 0 0 0 2 40.00 5 100
Al Irsyad 0 0 0 0 0 0 0 0 6 100.00 6 100
Budi Mulia 2 25.00 5 62.50 0 0 0 0 1 12.50 8 100
Dankesda 0 0 0 0 0 0 0 0 2 100.00 2 100
Angkatan Udara 1 50.00 1 50.00 0 0 0 0 0 0 2 100
Total 204 53.40 161 42.15 0 0 6 1.57 11 2.88 382 100


IDU,
42.15%
0.00%
1.57%
2.88%
53.40%
Sex. Contact IDU Blood Transfusion
Perinatal Unknown



Figure 1. Percentage of HIV/AIDS-causing behavior risk factor in Surabaya 2005



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Table 2. Distribution of HIV patients according to the risk factor of sexual contact in January - December
2005 in Surabaya :

Heterosexual Homosexual Bisexual Total Hospitals
N % N % N % N %
Dr.Soetomo 142 90.45 15 9.55 0 0 157 100
Angkatan Laut 24 64.86 0 0 13 35.1 37 100
Dr.Soewandi 2 66.67 1 33.33 0 0 3 100
Karang Tembok 3 75 1 25 0 0 4 100
Budi Mulia 2 100 0 0 0 0 2 100
Angkatan Udara 1 100 0 0 0 0 1 100
Total 174 85.29 17 8.33 13 6.37 204 100



DISCUSSION

Data were taken between February and August 2006 in
nine hospitals receiving HIV/AIDS patients and willing
to participate in this study. From the data obtained, the
prevalence rate and the percentage were estimated
according to the risk factor. Results showed that total
number of HIV/AIDS patients in 2005 in Surabaya in
nine hospitals were 382 persons. Total population of
Surabaya in 2005 was 2,701,312 persons (article about
Surabaya, 2005). The estimation of the prevalence rate
was formulated as follows: (Total number of HIV/AIDS
patients in Surabaya in 2005 : Total population of
Surabaya in 2005) x 1000 = (382 : 2,701,312) x 1000 =
0.14. Thus, the prevalence rate of HIV/AIDS in
Surabaya in 2005 was 0.14 per 1000 population.

From the result of this study, it can be reported that
from January to December 2005 there were 382 persons
with positive HIV test result, in which 204 persons
(53.40%) obtained from sexual contact in 161 persons
(42.15%), injected drug use (IDU), pediatric patients
receiving HIV from their mothers in perinatal cases
during pregnancy, delivery, or breastfeeding, 6 persons
(1.57%), and 11 persons with unknown causes (2.88%).
Data distribution on total HIV/AIDS patients in
Surabaya between January - December 2005 are shown
in Table 1. The risk factor of sexual contact was found
in 204 persons, among those 174 persons (85.29%) were
heterosexual and 13 persons (6.37%) were bisexual.
Data distribution of total HIV patients based on the risk
of sexual contact are displayed in Table 2.


CONCLUSION

Prevalence rate of HIV/AIDS in Surabaya in year 2005
was 0.14 per 1000 population. The feature of HIV/AIDS
according to the patients' risk factor in Surabaya:
between January - December 2005 there were 382
HIV/AIDS patients in Surabaya. Among these, 204 had
disease from sexual contact (53.40%), 161 from injected
drug use (42.15%), 6 from perinatal cases (1.57%), and
unknown causes (2.88%). Further analytic studies are
needed to analyze correlation between human behavior
and the emergence of HIV/AIDS in Surabaya and to
identify the type of HIV virus infecting the patients in
Surabaya as the basis for attempting preventive and
curative efforts.


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