Www.aids2014.org KEBAYA Keluarga Besar Waria Yogyakarta assisting transvestites living with HIV starting antiretroviral treatment in Yogyakarta, Indonesia.

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KEBAYA Keluarga Besar Waria Yogyakarta assisting transvestites living with HIV starting antiretroviral treatment in Yogyakarta, Indonesia Vinolia Wakijo, Priyadi Prihaswan, Ken Murray

Presentation Structure KEBAYA HIV and AIDS situations in Yogyakarta Lessons learned Future roles

KEBAYA Stands for Keluarga Besar Waria Yogyakarta Means Yogyakarta’s Big Transvestite Family

Waria Wanita (woman) Pria (man)

KEBAYA Peer based organisation Established in December 2006 A group of dedicated waria/transvestites Runs safe accommodation for waria living with HIV to commence treatments Acts as a site for VCT for HIV testing mobile clinics Relies on donations

Kebaya Safe Accommodation Two bedroom house Members/volunteers assist clients with food, support in managing ART adherence, side effects and doctors’ appointments Self referred and referred from the local HIV hospital clinics

Context Waria are marginalised Estranged from their family Approximately 75% of the 500 waria reached by KEBAYA outreach program are sex workers Waria is an important population to target in treatment as prevention program

Yogyakarta, Indonesia

Access to ARV in Indonesia Available with subsidy in 2006 Limited ARV combination options High level of adherence is required to prevent resistance Stigma and discrimination

Overview 59 waria (10% of all people with HIV accessing treatment in Yogyakarta) have utilised the service 18 have passed away 7 are lost to follow up 34 are confirmed continuing ARV Currently 2 people are staying at KEBAYA Kartu Jaminan Kesehatan Sosial

Group discussion With 12 waria and MSM with HIV Current and past clients 28 – 54 years old Interview with an HIV consultant

Lessons Learned Trust “….in here I know that I will be well cared for….” (Waria, 32 yrs) Emotional support “….it feels like living with a family. Vinolia is just like my mother…..” (Waria, 28 yrs)

Managing side effect “…I still cannot go home because I still have rash on my hands. I am not out to my family…” (MSM, 47yrs) Managing adherence “I was always reminded to take my medications” (Waria, 53 yrs) Doctors’ appointment “…they look after you very well and would take you to the doctor’s appointment...” (Waria, 44 yrs)

Challenges Medical complexity Working relationship with local Ministry of Social Welfare Moving out Life after KEBAYA Sustainable income for organisation

The future To continue current work To support Strategic Use of Antiretrovirals to help end the HIV epidemic (WHO) “KEBAYA has become the meeting point for Waria and MSM. It will play an important role to reach priority populations for HIV testing, educate them about treatments and monitor adherence” (HIV consultant)

Acknowledgement Group discussion participants Ken Murray Dr Yanri Subronto KEBAYA’s supporters

Terima kasih - Thank you