Between policy intentions and practical challenges: Local HIV responses in Belu and Yogyakarta, Indonesia

Indonesia has experienced a substantial increase in new HIV infections over the past decade, accompanied by persistent challenges in responding to the epidemic, particularly at the local level, where program implementation and resource allocation vary considerably. Drawing on data from a larger qualitative study, this paper presents findings from interviews with policymakers and healthcare professionals (HCPs) working in Belu and Yogyakarta, Indonesia. The interviews explored HIV policies and programs implemented by local government institutions and non-governmental organisations (NGOs), implementation challenges, and potential strategies to strengthen local HIV responses. Interview data were analysed thematically. The findings show that HIV policies in both settings primarily focused on prevention and treatment, with limited emphasis on rehabilitation and long-term support. The policy comparison shows that decentralisation created uneven capacity for cross-sector programming: Yogyakarta's multi-actor network supported prevention, treatment, and socioeconomic empowerment initiatives, whereas Belu’s response remained largely health-sector-led and prevention-oriented. Implementation was constrained by supply-side limitations, including inadequate funding, shortages of trained HCPs, limited diagnostics and restricted program coverage, and by demand-side barriers, including economic and transport burdens, fear of diagnosis, persistent HIV stigma and discrimination. Participants recommended expanding program coverage, strengthening local government funding, enhancing HCP capacity, and improving essential HIV services within the healthcare systems and formalising intersectoral collaboration. The Ottawa Charter for Health Promotion is applied to empirical data as a diagnostic framework to identify the breadth and gaps in the local responses. The findings support a more holistic and sustainable local HIV response that combines biomedical care with psychosocial, economic, and structural support.