Understanding Reasons for Lack of Acceptance in HIV Programs Among Indigenous: a Qualitative Study in Indonesia

Abstract Background: Melanesians are Indigenous Papuans that are racially and culturally different from most Indonesians. Poverty and inequalities remain high in this region despite having the highest revenues. Furthermore, Papua has the highest HIV prevalence rate, which is 24 times higher than other regions. Therefore, this study aimed to develop an understanding of the acceptance of HIV programs among Papuans.Methods: This is a qualitative study carried out using the grounded theory with data collected from 23 Papuans through semi-structured face-to-face interviews. All interviews were conducted in Bahasa Indonesia, audio-recorded, summarized, and transcribed for analysis.Results: The results showed that to “keep being a good Papuan," emerges from 4 interconnected categories, including 1) Culture and Religion, 2) Dealing with modernisms, 3) Tailoring program and 4) Stigma reduction. As a substantive theory underpinning the experiences of indigenous people with the programs, “Keep being a good Papuan” was a way of overcoming a series of problems and dealing with modernism to eliminating HIV. This is largely focused on the local culture, therefore any adjustment needs to balance keeping their tradition and welcoming modernism.Conclusions: Therefore, the future of the programs needs to be agreed upon, funded, implemented, measured, and achieved. One of the strategies used to achieve this is by elaborating a supportive culture and community-based interventions. Further, implementation needs to be prioritized to integrate and improve the quality of the programs due to the needs of the community and the available resources.