PMK No. 23 Th 2022 ttg Penanggulangan HIV, AIDS dan Infeksi Menular Seksual-signed

RANCANGAN PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA (Regulation Draft by the Minister of Health of the Republic of Indonesia)

Nomor 23 Tahun 2022

Tentang Penanggulangan Human Immunodeficiency Virus, Acquired Immuno-Deficiency Syndrome, Dan Infeksi Menular Seksual (Concerning the Prevention of Human Immunodeficiency Virus, Acquired Immuno-Deficiency Syndrome, and Sexually Transmitted Infections)

  • Menimbang (Considering):

    • HIV, AIDS, and STIs remain health problems impacting human resource quality and causing socio-economic issues, necessitating prevention efforts.

    • Cross-sector and public support is needed to eliminate HIV, AIDS, and STIs.

    • Existing regulations are outdated, requiring simplification and adjustment.

  • Mengingat (Regarding):

    • Legal basis includes the 1945 Constitution, and several laws concerning state ministries, health, regional government, and healthcare workers.

MEMUTUSKAN (DECIDES):

  • To establish a regulation by the Minister of Health regarding the prevention of HIV, AIDS, and STIs.

BAB I Ketentuan Umum (Chapter I General Provisions)

Pasal 1

  1. HIV (Human Immunodeficiency Virus): A virus attacking the immune system, leading to AIDS.

  2. AIDS (Acquired Immuno-Deficiency Syndrome): A collection of symptoms and signs of infection related to decreased immunity due to HIV infection.

  3. IMS (Infeksi Menular Seksual/Sexually Transmitted Infections): Infections transmitted through vaginal, anal, or oral sexual contact.

  4. Penanggulangan HIV, AIDS, dan IMS (HIV, AIDS, and STI Prevention): Efforts including promotive, preventive, curative, and rehabilitative services aimed at:

    • Reducing morbidity, disability, or mortality rates.

    • Limiting the spread of HIV, AIDS, and STIs.

    • Reducing negative impacts.

  5. Eliminasi (Elimination): Continuous reduction of a disease in a specific area to minimize its health impact.

  6. Komunitas (Community): A group with shared interests or conditions related to HIV, AIDS, and STIs.

  7. ODHIV (Orang Dengan HIV/People with HIV): Individuals infected with HIV.

  8. Populasi Kunci (Key Populations): Groups with high-risk behaviors for HIV and STI transmission, including sex workers, injection drug users, transgender individuals, and men who have sex with men.

  9. Populasi Khusus (Specific Populations): Groups at risk of HIV and STI transmission, including tuberculosis patients, STI patients, pregnant women, and incarcerated individuals.

  10. Populasi Rentan (Vulnerable Populations): Groups at risk due to physical and mental conditions, behaviors, or environment, such as street children, adolescents, sex worker clients, migrant workers, and partners of key populations/ODHIV/STI patients.

  11. Surveilans (Surveillance): Systematic and continuous monitoring of data and information on disease events or health problems and conditions affecting the occurrence of increased and transmission of diseases or health problems to obtain and provide information to direct control and prevention measures effectively and efficiently.

  12. ARV (Antiretroviral): Medications for treating HIV infection, reducing transmission risk, inhibiting opportunistic infections, improving quality of life, and decreasing viral load to undetectable levels.

  13. Tenaga Kesehatan (Health Workers): Individuals dedicated to health with relevant knowledge and skills, requiring authorization for specific healthcare efforts.

  14. Pemerintah Pusat (Central Government): The President of the Republic of Indonesia holding governmental power.

  15. Menteri (Minister): The Minister overseeing government affairs in the health sector.

  16. Pemerintah Daerah (Local Government): Governors, Regents, Mayors, and regional apparatus as elements of local government administration.

Pasal 2

The scope of HIV, AIDS, and STI prevention includes:

a. Targets and Strategies
b. Health Promotion
c. Transmission Prevention
d. Surveillance
e. Case Management
f. Recording and Reporting
g. Responsibilities of Central and Local Governments
h. Public Participation
i. Research, Development, and Innovation
j. Guidelines for HIV, AIDS, and STI Prevention
k. Funding
l. Guidance and Supervision

Pasal 3

The regulation aims to:

a. Reduce or eliminate new HIV and STI infections
b. Reduce or eliminate disability and death from AIDS and STI related conditions
c. Eliminate stigma and discrimination against people infected with HIV and STIs
d. Improve the health of people infected with HIV and STIs
e. Reduce the social and economic impact of HIV, AIDS, and STIs on individuals, families, and society.

BAB II Target dan Strategi (Chapter II Targets and Strategies)

Pasal 4

(1) To measure the success of HIV, AIDS, and STI Prevention, the target is to achieve Elimination of HIV, AIDS, and STIs by the end of 2030.

(2) The Elimination target as intended in paragraph (1) for HIV is based on the following indicators:

a. The number of new HIV infections (incidence) becomes 7 (seven) per 100,000 (one hundred thousand) residents aged 15 years and over who are not infected.

b. 95% (ninety five percent) of people living with HIV (ODHIV) are found from estimates;

c. 95% (ninety five percent) of ODHIV receive ARV treatment;

d. 95% (ninety five percent) who are still on ARV treatment have undetectable viruses; and

e. Decrease in new HIV infections in infants and toddlers from mothers less than or equal to 50 (fifty) per 100,000 (one hundred thousand) live births.

(3) The Elimination target as intended in paragraph (1) for AIDS is based on the indicator of realizing "End AIDS", namely;

a. Reducing new HIV infections by 90% (ninety percent) from 2010;

b. Reducing deaths from AIDS; and

c. Eliminate stigma and discrimination related to HIV.

(4) The Elimination target as intended in paragraph (1) for STIs is based on the following indicators:

a. The number of new cases of syphilis (incidence) in men becomes 6 (six) per 100,000 (one hundred thousand) residents aged 15 years and over who are not infected;

b. The number of new cases of syphilis (incidence) in women is 5 (five) per 100,000 (one hundred thousand) residents aged 15 years and over who are not infected; and

c. New syphilis infections in children (congenital syphilis) are less than or equal to 50 per 100,000 live births.

Pasal 5

(1) Achievement of the HIV, AIDS, and STI Elimination targets as intended in Article 4 is carried out through the application of the National Strategy for HIV, AIDS, and STI Elimination.

(2) The National Strategy for HIV, AIDS, and STI Elimination as intended in paragraph (1) is as follows:

a. Strengthening commitment and leadership from related ministries/agencies at the central, provincial and district/city levels;

b. Increasing and expanding public access to comprehensive and quality HIV, AIDS, and STI screening, diagnostic and treatment services;

c. Intensifying HIV, AIDS and STI Prevention activities which include health promotion, transmission prevention, Surveillance, and case management;

d. Strengthening, improving, and developing partnerships and participation of cross-sectors, the private sector, community/community organizations, the community and related stakeholders;

e. Increasing research and development and innovation that supports the HIV, AIDS, and STI Prevention program; and

f. Strengthening program management through monitoring, evaluation, and follow-up.

BAB III PROMOSI KESEHATAN (Chapter III Health Promotion)

Pasal 6

(1) Health promotion is aimed at empowering the community to be able to play an active role in supporting behavior and environmental changes and maintaining and improving health so as to avoid HIV, AIDS and STIs.

(2) Health promotion is carried out through community empowerment, advocacy, and partnerships by communicating behavioral changes, information and education.

(3) The targets of health promotion include policy makers, the private sector, community/community organizations, and the community, especially in Target Populations and Key Populations.

Pasal 7

(1) HIV, AIDS, and STI Health Promotion is carried out by health promotion and behavioral science personnel and/or program managers at district/city health offices, provincial health offices and the Ministry of Health.

(2) In addition to being carried out by personnel as intended in paragraph (1), health promotion can be carried out by other trained health workers.

(3) Cross sectors, the private sector, community/community organizations, and the community can help carry out health promotion in coordination with community health centers and/or district/city health offices.

Pasal 8

(1) HIV, AIDS, and STI health promotion is carried out integrated with health services or other health promotions.

(2) Health promotion as intended in paragraph (1) can be done using printed media, electronic media, and face-to-face meetings that contain messages on HIV, AIDS, and STI prevention and control.

(3) Health promotion for HIV, AIDS, and STIs that is integrated into health services as intended in paragraph (1) is prioritized in services:

a. Hepatitis;
b. reproductive health and family planning;
c. maternal and child health;
d. Tuberculosis;
e. adolescent health; and
f. drug rehabilitation.

BAB IV PENCEGAHAN PENULARAN (Chapter IV Transmission Prevention)

Bagian Kesatu Umum (Part One General)
Pasal 9

(1) Prevention of HIV and STI transmission is a variety of efforts or interventions to prevent someone from being infected with HIV and/or STIs.

(2) Prevention of HIV and STI transmission as intended in paragraph (1) is directed to prevent:

a. transmission through sexual relations;
b. transmission through non-sexual relations; and
c. transmission from mother to child.

(3) Prevention of HIV and STI transmission is carried out in the following ways:

a. application of safe and non-risky behavior;
b. counseling;
c. education;
d. STI management;
e. circumcision;
f. immunization;
g. harm reduction for drug abuse;
h. prevention of HIV, Syphilis and Hepatitis B Transmission from Mother to Child;
i. provision of ARV prophylaxis;
j. screening of donor blood, blood products, and body organs; and
k. application of standard precautions.

(4) Prevention of HIV and STI transmission as intended in paragraph (1) is organized by program managers at health service facilities, district/city health offices, provincial health offices,

Ministry of Health, cross sectors, and the community.

Bagian Kedua Penerapan Perilaku Aman dan Tidak Berisiko (Part Two Application of Safe and Non-Risky Behavior)
Pasal 10

(1) Everyone must apply safe and non-risky behavior to avoid HIV and STI infections.

(2) Application of safe and non-risky behavior as intended in paragraph (1) includes:

a. not having sexual relations before marriage or not having sexual relations while experiencing an STI;
b. being faithful to only one sexual partner (not changing partners);
c. prevent transmission of STIs and HIV infection through sexual relations by using condoms correctly; and
d. not abusing drugs.

Bagian Ketiga Konseling (Part Three Counseling)
Pasal 11

(1) Counseling as intended in Article 9 paragraph (3) letter b is carried out to motivate people to carry out HIV and/or STI Examinations, to undergo treatment obediently if the test results are positive, to prevent transmission of HIV and STIs, and not to engage in risky behavior.

(2) Counseling as intended in paragraph (1) is carried out by Health Workers or trained non-health workers.

(3) Counseling can be carried out integrated with maternal and child health services, family planning, reproductive health, STI services, Hepatitis services and Drug services, or separately by

special clinic.

Bagian Keempat Edukasi (Part Four Education)
Pasal 12

(1) Education as intended in Article 9 paragraph (3) letter c is aimed at providing the community with knowledge, understanding and being able to carry out prevention of HIV and STI transmission.

(2) Education as intended in paragraph (1) is carried out to everyone who is at risk of contracting HIV and STIs.

(3) People who are at risk of contracting HIV and STIs as intended in paragraph (2), include people who meet the categories of Key Population, Special Population, and Vulnerable Population.

Bagian Kelima Penatalaksanaan Infeksi Menular Seksual (Part Five Management of Sexually Transmitted Infections)
Pasal 13

(1) STI management as intended in Article 9 paragraph (3) letter d is an activity of upholding the diagnosis and treatment of STI patients which is aimed at reducing the risk of HIV transmission.

(2) STI management in the form of enforcing a diagnosis as intended in paragraph (1) is prioritized to:

a. Key Population;
b. Pregnant women; and
c. People who come to health service facilities with STI symptoms.

(3) STI management is carried out at first-level health service facilities and advanced-level referral health service facilities following applicable STI examination and treatment standards.

Bagian Keenam Sirkumsisi (Part Six Circumcision)
Pasal 14

(1) Circumcision as intended in Article 9 paragraph (3) letter e is a medical action to remove the foreskin of the penis which aims to reduce the risk of HIV and STI transmission.

(2) Circumcision as intended in paragraph (1) is carried out on people mainly in areas with widespread HIV epidemics and who do not have traditions or

circumcision culture.

Bagian Ketujuh Pemberian Kekebalan (Part Seven Immunization)
Pasal 15

(1) Immunization as intended in Article 9 paragraph (3) letter f is the provision of immunization from an early age which is aimed at preventing Human Papiloma Virus (HPV) infection.

(2) Human Papiloma Virus (HPV) immunization as intended in paragraph (1) is given to women from the age of over 9 (nine) years.

(3) Provisions regarding the dose, schedule and procedures for implementing Human Papiloma Virus (HPV) immunization are carried out in accordance with the provisions of laws and regulations.

Bagian Kedelapan Pengurangan Dampak Buruk Napza (Part Eight Harm Reduction for Drug Abuse)
Pasal 16

(1) Harm reduction for drug abuse as intended in Article 9 paragraph (3) letter g is focused on people who inject drugs (IDUs).

(2) Harm reduction for drug abuse as intended in paragraph (1) is carried out through:

a. implementation of sterile syringe services;
b. encouraging people who inject drugs (IDUs), especially opioid addicts to undergo methadone maintenance/opioid substitution therapy in accordance with the provisions of laws and regulations;
c. encouraging people who inject drugs (IDUs) to carry out prevention of sexual transmission;
d. HIV Examination services and ARV treatment for those who are HIV positive;
e. Tuberculosis screening and treatment;
f. STI screening and treatment; and
g. Hepatitis C screening and treatment.

Bagian Kesembilan Pencegahan Penularan Human Immunodeficiency Virus, Sifilis, dan Hepatitis B dari Ibu ke Anak (Part Nine Prevention of Transmission of Human Immunodeficiency Virus, Syphilis, and Hepatitis B from Mother to Child)
Pasal 17

(1) Prevention of HIV, syphilis and Hepatitis B transmission from mother to child as intended in Article 9 paragraph