Implementation of HIV Screening Services among Populations at Risk of HIV Infection in Musi Rawas Utara District, Indonesia: A Qualitative Study

Abstract

HIV screening is one of the Minimum Service Standards (MSS) in the health sector aimed at facilitating the early detection of HIV infection among populations at risk of HIV infection. Although regulated under the Indonesian Minister of Health Regulation No. 6 of 2024, the implementation of HIV screening at the local level continues to face challenges that affect the achievement of program targets. This study aimed to analyze the implementation of HIV screening in Musi Rawas Utara District using the Van Meter and Van Horn policy implementation framework. A descriptive qualitative approach was employed involving 15 purposively selected informants. Data were collected through in-depth interviews, focus group discussions (FGDs), observations, and document reviews, and were analyzed thematically using NVivo software. The findings revealed that the implementation of HIV screening has generally been carried out; however, it has not yet achieved optimal program performance. Implementation was supported by clear policy regulations, the availability of essential resources, coordination among health service facilities, supportive organizational characteristics, and strong commitment from program implementers. Nevertheless, several challenges remained, including limited operational funding, high workload among health workers, difficulties in reaching high-risk populations, suboptimal cross-sectoral coordination, and persistent HIV-related stigma, fear, and limited public literacy. In conclusion, optimizing HIV screening implementation requires strengthening health system capacity, enhancing cross-sectoral collaboration, and developing community empowerment strategies to improve access among high-risk populations while reducing HIV-related stigma.