BACKGROUND:The Asia-Pacific regional roadmap for the triple elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and Hepatitis B virus emphasises the importance of data-driven policymaking and private sector engagement. Utilising secondary data from a nationally representative household-based Indonesian Health Survey 2023 (IHS 2023), we examined the role of public and private sectors in the coverage of triple antenatal tests as an indicator for EMTCT. METHODS:Using data from IHS 2023, the analysis was limited to women and girls aged 10-54 years who self-reported a pregnancy with an antenatal care (ANC) visit between 2018 and 2023. Test coverage was defined as a self-reported history of antenatal testing for HIV, syphilis, and hepatitis B during their most recent pregnancy. Independent variables included access and utilisation of public & private healthcare facilities. Covariates included demographics, obstetric history, and socioeconomic status. Multivariable logistic regression models were developed using complex sample weighted analysis. RESULTS:Antenatal testing coverage for all three infections was 58.0 %. Unavailability of public health centres (PHCs, or puskesmas locally) (aOR=0.61, 95 %CI=0.45-0.84), hospitals (aOR=0.76, 95 %CI=0.66-0.89), laboratories (aOR=0.73, 95 %CI=65-0.83), and private providers (aOR=0.84, 95 %CI=0.75-0.94) were found as negative predictors, as was reliance on private providers for ANC compared to PHCs (aOR=0.65, 95 %CI=0.61-0.71). CONCLUSION:Testing coverage of these infections among pregnant women was below both the national (100 %) and global (95 %) targets. Poor access to healthcare facilities and reliance on private providers for ANC were negative predictors of testing for HIV, syphilis and Hepatitis B, suggesting potential gaps in private sector engagement with the EMTCT effort.

BackgroundTransgender women commonly experience poor health outcomes. However, little is known about older transgender women's experiences of government healthcare and social welfare programs in low and middle-income countries, in the context of discrimination and neglect.AimsThis article discusses older transgender women's barriers to accessing government health and social welfare programs in Indonesia, and how intersecting factors like gender, age, and poverty contribute to poor health outcomes.MethodA transgender community-led participatory study utilized rapid ethnographic assessment (REA), comprising surveys with 48 older transgender women, interviews with a subset of 15 transgender women, and interviews with five government officials.ResultsApplying an intersectional lens, the following themes were identified from the data: 1) document ownership and program enrollment; 2) healthcare needs and challenges; 3) employment and poverty; 4) housing, family, and social network; 5) barriers to accessing government health and social security programs; 6) consequences of exclusion from programs; and 7) enablers of accessing government health and social security programs. Across these themes, cisgender norms embedded in Indonesia's bureaucratic practices exacerbated participants' vulnerability to poor health.DiscussionA transgender-led research project helped to identify barriers and advocate for the government to adopt a transgender health equity lens. Exclusion from government health and social welfare programs was due to both gender expression and criteria centered on nuclear family structures, which were misaligned with all participants, who were unmarried. These cisgender norms are a form of structural violence that results in poor health, exacerbated by poverty, old age, and housing insecurity.

Transgender health, and the scientific and medical knowledge underpinning it, has been transformed over the past two decades. Since the 2000s, coalitions of activists, doctors, and scientists have made important if fragile gains in an effort to depathologize trans people's encounters with medicine. However, both research and activism in the field has tended to center knowledge and controversies that take place in Euro-American societies. Three new books on transgender life in different locations—in Brazil, Argentina, the United States of America, and India—reveal how alternative ways of knowing and enacting trans health are emerging on a world-wide scale. Each book's engagement with the world-wide politics of trans knowledge from situated local and national contexts aligns with historical interest in science and technology studies in what Susan Leigh Star called the “high tension zone” produced by binary sex classification. Looking to experiments in trans knowledge beyond the locations where it is usually thought to be produced provides new opportunities to consider both how and why cisgender normativity is naturalized as a biological condition with powerful political effects.

There have been consistent calls to incorporate gender frameworks into One Health research and policy. Men's and women's roles in relation to animals in many rural and agricultural communities may influence potential pathogen exposure and transmission patterns of zoonotic infectious diseases. However, men's and women's roles related to animals in rural societies are not static but change over time. This article draws on the results of qualitative research about perceptions and practices related to animal species and animal products in five sites located in Eastern Highlands Province and East New Britain, two provinces in Papua New Guinea (PNG). The qualitative research, which aimed to explore animal-human interactions that may pose a risk of zoonotic infections through focus group discussions, formed part of a broader study of zoonotic association and risks for extrapulmonary tuberculosis in PNG. We first introduce participants' descriptions of symptoms of illness that they attributed to zoonotic disease, as well as the animals that they attributed those diseases to. We then draw on an in-depth case study of practices related to rearing pigs - animals with important economic and social value in PNG - to illustrate the impact of social and ecological change on the interplay of gender and relationships with animals. One Health strategies at the community level can focus on gender as a way to understand changes underway in the type and intensity of interactions with animals in rural communities, including their potential impact on zoonotic diseases.

Queer Generationsoffers a groundbreaking study of sexual citizenship, based on the coming of age narratives of two social generations of LGBTQ people in Australia. The open access book’s assembly and analysis of narrative accounts demonstrates the differences contained in people’s experiences of LGBTQ youth sexual citizenship. It is the first book to provide a robust empirical account of the diverse ways in which sexual citizenship is experienced and understood by different social generations of LGBTQ people growing up. By so doing,Queer Generationsoffers a unique analysis of ongoing contestations over the place of sexual and gender diversity in relation to citizenship. The ebook editions of this book are available open access under a CC BY-NC-ND 4.0 licence on bloomsburycollections.com. Open access was funded by the Bloomsbury Open Collections Library Collective.

The history of HIV/AIDS is often told from the Global North, a viewpoint that is naturalized in policies and programs that privilege biomedical models of treatment and prevention. This article explores how one Indonesian transgender population known as waria became the subject of various forms of research since the 1980s. Research was one way that waria came to be classified as part of the key population of "transgender people." Drawing on an oral history project conducted in 2021/2022, we show how - while necessarily hierarchical - ethnographic accounts of other HIV/AIDS histories can rethink fundamental global health concepts.

The COVID-19 pandemic generated a renewed focus on the impact of inequality on health and the role of research in critiquing the social and political decisions that drive such forms of inequality.Ethically grounded research conducted in collaboration with the communities most affected by health inequities has demonstrated how pandemics can amplify discrimination and stigmatisation (see for example Garcia-Iglesias et al. 2021;Manderson et al. 2022;Banerjea et al. 2022).In this chapter, we draw on findings from an ethnographic study of HIV peer outreach to men who have sex with men at one community organisation in Indonesia during the COVID-19 pandemic in 2020.During this time, the conditions of the COVID-19 pandemic placed great strain on 'Indonesia's brittle, patchy and under-resourced health system' (Bennett and Dewi 2022, p. 223).Under such conditions, ethnography is much more than a method that can offer context for public health interventions.Instead, it provides a critical interpretive framework for interrogating how normative models of data collection and evidence-making conceal the origins and even the violence of inequality.The very different yet overlapping conditions of the HIV and COVID-19 pandemics lay bare the need for analyses grounded in the lives of those subject to the most significant impacts of inequality.Ultimately, this means that the questions asked and theoretical frameworks used must emerge from the methods that are only possible through long-term commitments to individuals recruited as participants in a study.Scholars have recently drawn on decolonising frameworks to grapple with the thorny ethical problem of whose and what interests global health research serves (Kelly-Hanku et al. 2021;Bhakuni and Abimbola 2021).One component of successful approachesthose that are embedded within and respond to the concerns of affected communities -is the proximity forged through close, long-term interactions.During the early AIDS pandemic, anthropologists drew on long-term research based on participant observation to develop ethnographic theories of 'the social body' (Scheper-Hughes 1994), highlighting the structural forms of inequality that give rise to disease and death. 1 Ethnographic research continues to provide an important basis for critiquing the assumptions of individual DOI: 10.

Community activists, policymakers and researchers have long identified human rights as central to addressing the HIV epidemic. Over the past 10 years, efforts to incorporate human rights into the HIV response have focused on reforming laws which criminalise sex work and male-to-male sex. Laws criminalising sex work and male-to-male sex drive communities underground, making HIV prevention, testing, and treatment efforts more difficult. This article draws on a qualitative study conducted in Papua New Guinea (PNG) which examined stakeholder views on prospects for law reform, the impact of criminal laws on communities, and the role of law reform in addressing the HIV epidemic. While efforts to reform criminal laws related to sex work and male-to-male sex have taken place in PNG, these have been unsuccessful. Stakeholders identified that strategies for addressing criminal laws and the impacts of law reform must be grounded in the PNG context, that there must be material support for community members to engage with criminal laws and human rights, and that dignity rather than HIV should be the justification for law reform.

Attention to the role of bureaucracy in classifying and governing sex in anthropology has been a topic of diverse interest. The historical role of anthropological theories of kinship and genealogy in establishing systems of classification highlights the lasting influence of racial and colonial legacies on binary sex. In the 1990s, interest in gender as performative resulted in a shift in focus from what sex is to what sex does. Ethnographic studies of sex classification have provided robust concepts for understanding the social, political, and technological processes invested in sex as a bureaucratic object. Anthropologists have investigated these material and semiotic processes, attending to how some jurisdictions expand possibilities for changing legal gender even as others further entrench essentialist definitions of biological sex. Ethnographic investigation of the primacy granted to sex/gender located in the body/mind allows for a fuller evaluation of state efforts to assert a monopoly over powers of recognition.

Anthropological accounts of sexual and gendered difference often serve the role of footnotes that buttress and even expand the reach of Euro-American concepts. In contrast to this contained role for anthropology, queer footnotes can push the discipline toward more capacious and experimental engagements with powerful knowledge. In 2020, governments around the world introduced lockdowns and border-control measures in response to the COVID-19 pandemic. This was the case in Australia, where I undertook fieldwork with trans- and queer Indonesians living in Melbourne. In Australia, COVID-19 public health measures paralleled and exacerbated migration restrictions on people living with HIV and the criminalization of sex work. Asian, queer, trans-, and sex worker bodies were addressed as a moral and physiological contagion. Queer anthropology is good for maintaining a critical ethnographic focus on how the state governs through a racial biopolitics of containment, and generates concepts for public health that shift the focus from security to care.

ABSTRACT Following the authoritarian New Order in Indonesia (1965–1998) the state‐issued identity card was transformed into a symbol available for reproduction by ordinary citizens. One Indonesian transgender population known as warias used the card to engage with the terms of recognition offered by the state. In 2014, warias in Yogyakarta made organizational membership cards that closely mimicked but did not copy the visual form of the original. Warias efforts to expand the state's bureaucratic form through the manipulation of the symbolic and material qualities of cards raised the possibility that the state did not hold a monopoly over powers of recognition.

Images linking 'LGBT' to sexually motivated crime are a common feature of reporting in the Indonesian online news media. In particular, 'gay sex parties' are a spectacle shaped by the images produced by journalists in collaboration with the police. This combination of crime and entertainment plays a crucial role in managing both in what ways LGBT is seen and by extension what is defined as belonging to the public sphere. Media images of raids take the form of videos and photographs, press conferences and reconstructions filmed at the crime scene. Although same-sex sexual acts between consenting adults are not a crime in Indonesia, the 2008 Pornography Law and various regional regulations do provide scope for detaining people on public decency grounds. However, the connection between sex and crime as a form of entertainment in which the police are central protagonists is shaped by histories of visual power that can be traced to the authoritarian New Order. By contextualising and interpreting media images of a police raid on a 'gay sex party' in September 2020, I describe how the genre conventions and affective force of images of LGBT are central to the state's governance of the public sphere. Considering the relationship between sex, crime and entertainment helps to address the central role played by both unruly images and media power in regulating the boundaries of political participation and claims for justice.

Images linking ‘LGBT’ to sexually motivated crime are a common feature of reporting in the Indonesian online news media. In particular, ‘gay sex parties’ are a spectacle shaped by the images produced by journalists in collaboration with the police. This combination of crime and entertainment plays a crucial role in managing both in what ways LGBT is seen and by extension what is defined as belonging to the public sphere. Media images of raids take the form of videos and photographs, press conferences and reconstructions filmed at the crime scene. Although same-sex sexual acts between consenting adults are not a crime in Indonesia, the 2008 Pornography Law and various regional regulations do provide scope for detaining people on public decency grounds. However, the connection between sex and crime as a form of entertainment in which the police are central protagonists is shaped by histories of visual power that can be traced to the authoritarian New Order. By contextualising and interpreting media images of a police raid on a ‘gay sex party’ in September 2020, I describe how the genre conventions and affective force of images of LGBT are central to the state’s governance of the public sphere. Considering the relationship between sex, crime and entertainment helps to address the central role played by both unruly images and media power in regulating the boundaries of political participation and claims for justice.

This essay contains an introduction and a translation of an account provided in Indonesian by Rully Mallay, a transgender community leader and activist at the Kebaya Foundation, a shelter for people living with HIV in the province of Yogyakarta. It describes the impact of restrictions imposed to reduce the spread of COVID-19 and mobilization in response to it by those who identify as “waria” between February and September 2020. Waria played a pivotal role in mobilizing a community response in that city, providing support not only to their own community but also to other marginal groups impacted in similar ways. Harsh lockdown measures imposed to respond to COVID-19 disproportionately affected waria, cutting off access to economic and community support. This was particularly acute for the many waria without state-issued identity cards. Nevertheless, Rully expresses her hope that through the skills and adaptability they have demonstrated in their response to the public health emergency, they might achieve recognition and acceptance from Indonesian society.

The COVID-19 pandemic has had a significant impact on HIV services globally, including community-based outreach programmes. This article draws on a qualitative study of HIV outreach workers for men who have sex with men (MSM) in Jakarta, Indonesia undertaken between July and September 2020. The research documented the impact of the COVID-19 pandemic on HIV outreach programmes for MSM based on interviews, focus group discussions and video diaries collected from outreach workers. As a result of the pandemic, and in response to the guidelines issued by international donors and the Indonesian government, outreach workers shifted activities to 'virtual outreach' where possible. However, outreach workers consistently performed in-person work to address what they referred to as 'urgent' cases (e.g. required them to attend the clinic). Regardless of delivery mode, the steps comprising outreach work during the pandemic aligned with the 'cascade of care', which forms the dominant policy narrative for the management of HIV. Outreach work during the pandemic therefore continued to be based primarily on the objective of maintaining testing and treatment rates. Although outreach workers responded innovatively to the pandemic, including to the risk of COVID-19 infection, they were limited by the prevailing emphasis on targets in HIV programmes.