Toxoplasma & Viral Antibodies among HIV Patients & Inmates in Central Java, Indonesia

In Indonesia, Toxoplasma and its associations with blood-borne viruses have been poorly studied. In order to study the association between anti-Toxoplasma antibodies and blood-borne viral antibodies, blood samples from 497 participants (375 inmates from four prisons in Central Java, Indonesia and 122 HIV patients at a Voluntary Counseling and Testing Clinic in Surakarta, Indonesia) were tested for serological markers of Toxoplasma, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and human T-lymphotropic virus types I and II (HTLV-1/2). 

Anti-Toxoplasma IgG and IgM positivity rates were 41.6% and 3.6%, respectively. One point two percent of participants was positive for both anti-Toxoplasma IgG and IgM antibodies. Sixteen point five percent, 11.3%, 2.6% and 2.8% of participants were positive for anti- Toxoplasma IgG combined with anti-HCV antibodies, anti-Toxoplasma IgG combined with anti-HIV antibodies, anti-Toxoplasma IgM combined with anti-HIV antibodes and anti-Toxoplasma IgG combined with both anti-HIV and anti-HCV antibodies, respectively. Anti-Toxoplasma IgM seropositivity was associated with anti-HIV (aOR = 4.3; 95% CI: 1.112-16.204, p = 0.034). Anti-Toxoplasma IgG antibodies were associated with anti-HCV (aOR = 2.8; 95% CI: 1.749-4.538, p < 0.001) and history of injection drug use (aOR = 3.1; 95% CI: 1.905-5.093, p < 0.001). 

In conclusion, we recommend patients with HIV, HCV infection and injection drug users should be screened for Toxoplasma infection in Indonesia.

Via:   http://goo.gl/NRlZKA

By:  Sari Y, Haryati S, Raharjo I, Prasetyo AA.

Southeast Asian J Trop Med Public Health. 2015 Nov;46(6):977-85.

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Impacts of Stigma on HIV Risk for Women Who Inject Drugs in Java: A Qualitative Study

Highlights

• Javanese women who inject drugs felt stigmatized by health professionals and others.
• This stigma contributed to feelings of shame.
• Drug use was hidden by avoiding those who do not inject and harm reduction services.
• Trust in their small group of injecting friends contributed to sharing needles.

Background

People who inject drugs have experienced stigma around the world. Stigma has been found to have negative consequences for individuals in relation to health-service use, psychological wellbeing and physical health; and for populations in terms of health inequalities. Indonesia has experienced a rapid growth in injecting drug use and HIV and little is known about drivers of HIV risk among Indonesian women who inject drugs. The purpose of this paper is to describe and consider the multiple impacts of stigmatization of injecting drug use on injecting behaviors among women who inject drugs in Java.

Methods

In-depth interviews were conducted with 19 women who inject drugs in Java. Mean age was 25 years, all but one was employed or at college. The interviewers were Indonesian women.

Results

Significant stigma around women's drug use was reported from multiple sources in Java including family, friends and health services, resulting in feelings of shame. To avoid this stigma, most of the study participants hid their drug use. They lived away from family and had few friends outside their drug-injecting circle, resulting in isolation from mainstream society and harm-reduction services. Sharing of injecting equipment was restricted to a small, closed circle of trusted friends, thus limiting possible HIV transmission to a small number of injectors.

Conclusions

The stigmatization of drug use, particularly of drug use by women, in Indonesia appears to have contributed to significant shame, isolation from mainstream society and high rates of sharing injecting equipment with a small group of trusted friends (particularly the partner).

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By:  Catherine Spooner^a, , , Antonia Morita Iswari Saktiawati^b, , Elan Lazuardi^b, , Heather Worth^a, ,Yanri Wijayanti Subronto^b, , Retna Siwi Padmawati^b, 

^a UNSW Australia, Sydney, NSW 2052, Australia

^b Center for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Bulaksumur, Yogyakarta 55281, Indonesia

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Balancing Benefits & Harm: Chemical Use & Bodily Transformation among Indonesia's Transgender Waria

Members of Indonesia's diverse male-to-female transgender community often describe themselves as waria.Waria do not equate being feminine with being female. They do not want to be women; they aspire to be likewomen. It entails cultivating mannerisms and wearing make-up and women's clothes, shaving one's legs and styling one's hair. But some go further in their practices of self-administered, chemically assisted bodily transformation.

Field research took place in Makassar, the capital city of South Sulawesi; in a smaller town in the regency of Bulukumba on the south coast of Sulawesi; and in the special region of Yogyakarta in Java. Data were collected through repeated in-depth interviews with ten waria youths aged between 18 and 26 in each site; interviews with pharmacists, drug and cosmetics store clerks; three focus group discussions at each site; and participant observation.

Our respondents saw their bodies as ‘projects’ they can manipulate with pharmaceutical products and cosmetics. To lighten their skin, they experimented with different brands of exfoliating liquid, whitening cream, powder, foundation, face soap and skin scrub. To grow breasts and reduce muscle mass, they experimented with different brands and dosages of contraceptive pills and injections in order to get faster, better and longer-lasting results.

Harm reduction programs often neglect chemicals that are not narcotics, not related to sexually transmitted infections, and which are legally and freely available. Safety issues arise when otherwise safe products are used off-label in large quantities. Drug policy-makers are paying insufficient attention to the safety of cosmetics.

Below:  The most popular brands for pills and injections

Table 1

Contraceptive products used to feminize bodies.

Product	Manufacturer/licence	Content	Product information
Andalan pill	Marketing: DKT Indonesia	Each tablet contains: 0.15 mg Levonolgestrel 0.03 mg Ethinylestradiol	Begin taking on the first day of menstruation
	Manufacturer: PT Sydna Farma, Jakarta, Indonesia		Indication: low dosage oral contraceptive for breast-feeding mothers
	License: NV Organon, Netherlands		By prescription only
Marvelon 28 pill	Marketing: DKT Indonesia	Each pack consists of 21 large tablets, each containing: 0.150 mg Desogestrel 0.030 mg Ethinylestradiol No active ingredient in the small tablets	By prescription only
	Manufacturer: PT Sydna Farma, Jakarta, Indonesia
	License: NV Organon, Netherlands
Trinordiol pill	Manufacturer: Wyeth, Germany & Republic of Ireland	Each light brown tablet contains: 0.03 mg Ethinylestradiol 0.05 mg Levonorgestrel	Synthetic oestrogen and Levonorgestrel is a synthetic form of progesterone
		Each white tablet contains: 0.04 mg Ethinylestradiol 0.075 mg Levonorgestrel Each ochre tablet contains: 0.03 mg Ethinylestradiol 0.125 mg Levonorgestrel	Each 21-day pack contains three types of tablets (six light brown, five white, ten ochre), each with a slightly different hormone dosage
Microgynon pill	Manufacturer: Schering do Brasil Quimica Farmaceutica Ltda, Sao Paolo, Brazil	21 Sugar-coated tablets, each containing: 0.15 mg Levonorgestrel 0.03 mg Ethinylestradiol 7 Sugar-coated tablets, each containing 48.25 mg Lactosa	By prescription only
	Importer: PT Bayer Indonesia
Microdiol 30 pill	Manufacturer and distributor: Kimia Farma Indonesia	Each small tablet contains: 0.150 mg Levonorgestrel 0.030 mg Ethinylestradiol No active ingredient in the large tablets	By prescription only
Cyclogynon pill	Marketing: PT Tunggal Idaman Abdi, Indonesia	Each tablet contains: 0.15 mg Levonorgestrel 0.03 mg Ethinylestradiol
	Manufacturer: PT Sunthi Sepuri, Indonesia
Andalan Laktasi pill KB	Marketing: DKT Indonesia	Each tablet contains: 0.15 mg Levonorgestrel 0.03 mg Ethinylestradiol	By prescription only
	Manufacturer: PT Sydna Farma, Indonesia
	License: NV Organon, Netherlands
Andalan contraceptive injection	Manufacturer: Harsen, Indonesia, incorporated under DKT Indonesia	Each 1 ml contains: 150 mg Medroxyprogesterone acetate	By prescription only
		Sterile suspension of Medroxyprogesterone acetate in water
Cyclofem contraceptive injection	Manufacturer: PT Tunggal Idaman Abdi, Indonesia	Each vial contains: 25 mg Medroxyprogesterone acetate 5 mg Estradiol USP sterilized micronized	By prescription only
	License: Concept Foundation, Thailand

Below:  A shelf in a market cosmetics stall in Makassar

Below:  Exfoliating products

Full article at: http://goo.gl/22f55E

By: Nurul Ilmi Idrusa,b,⁎ and Takeo David Hymansb

^aDepartment of Anthropology, Faculty of Social and Political Sciences, Hasanuddin University, Makassar, Indonesia

^bEuropean Research Council Chemical Youth project, University of Amsterdam, The Netherlands

Nurul Ilmi Idrus: moc.oohay@surdiimlilurun; Takeo David Hymans: moc.liamtoh@snamyhdivad: moc.liamtoh@surdiimlilurun

^⁎Corresponding author at: Department of Anthropology, Faculty of Social and Political Sciences, Kampus Unhas Tamalanrea, KM 10, Makassar 90245, Indonesia. Email: moc.oohay@surdiimlilurun

   

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