The SeKSI Study (Survei Kesehetan Seksual Indonesia)

The challenge 

HIV prevalence among men who have sex with men (MSM) and transgender women (known locally as ‘waria’) is high in Indonesia, with very high prevalence reported in Bali (36% among MSM in 2015). There is an urgent need for high-quality behavioural and biomedical HIV prevention research in Bali province, as there is currently very limited data. The current behavioural surveillance surveys in key populations have small sample sizes and include minimal questions about sexual behaviour. The current data sources are limited in their ability to provide timely, detailed, MSM- and waria-specific information required by local community organisations, non-government organisations, governments, and health services/clinics.

The project 

The SeKSI Study (Survei Kesehetan Seksual Indonesia, or Sexual Health Survey Indonesia) is a behavioural survey focused on MSM and waria living in Bali, Indonesia. The study was initiated in 2018 as a joint project of the Kirby Institute at UNSW Sydney and the Center for Public Health Innovation at Udayana University, Bali. The study is supported by local non-government and community organisations and clinics in Bali. The study survey asks about sexual behaviour, HIV testing, sexually transmitted diseases, relationships, alcohol and other drug use, contact with HIV prevention programs, and stigma and discrimination.

The method 

The SeKSI Study is an anonymous cross-sectional survey in which respondents are recruited online or through HIV peer educators from several non-government or community organisations and clinics.

The results 

The first round of the survey in 2018 recruited over 700 MSM and waria, making it one of the largest and most detailed surveys of this population ever to be conducted in Bali or Indonesia more broadly. The results find high levels of condomless sex and nearly half reported experiences of discrimination due to being MSM or waria.

The impact 

The SeKSI Study has provided the first detailed behavioural data from MSM and waria in Bali, which can be used by organisations and service providers. The first phase of the project is focused on experimenting with recruitment methods and refinement of the survey itself. Beyond this, it is hoped that the SeKSI Study will be conducted repeatedly so as to monitor trends in behaviour over time.