Agent and Structure Relation in Peer Education Based on Social
Capital for Prevention of Mother – to – Child Transmission
Argyo Demartoto, Bhisma Murti and Siti Zunariyah
Universitas Sebelas Maret, Surakarta, Indonesia
Keywords: HIV, PE, PMTCT, social capital, structuration.
Abstract: HIV prevalence of women and children in Indonesia tend to increase, until the Prevention of Mother –to–
Child Transmission or PMTCT by Peer Education or PE need to do. This study aims to analyze agents and
structures relationship in PE based on social capital for PMTCT in Surakarta Indonesia. The unit analysis of
this qualitative study by phenomenology approach is women with HIV and related stakeholders which chosen
by purposive sampling. After collecting data by observation, deep interview and documentation, analysis step
proceed by intentional phenomenology and transcendent meaning by Giddens structuration theory. In PE for
PMTCT case, women with HIV are not only main target but also as peer educator in socialization, treatment,
advocacy, field and cyber outreach as well. There are dominant rule and PMTCT guidelines arranged by
health institutions and PMTCT giver service for women with HIV. PE has legitimacy to recruit peer promoter
and peer contact, training member and PE. Family relation, religion relation and social institution become the
bridging executor of PE agenda. PMTCT is more effective through PE based on social network, belief system,
social norm and reciprocity pattern which in forms of bonding, bridging and linking.
1 INTRODUCTION
Indonesia deals with serious challenge in improving
the public health degree, because the HIV/AIDS
prevalence increases by about 48% (UNAIDS, 2016).
HIV prevalence in pregnant women is projected to
increase by 0.38% (2012) to 0.49% (2016) and those
requiring Prevention of Mother –to– Child
Transmission (PMTCT) service increases in number
from 13,189 in 2012 to 16,191 in 2016. The number
of children with HIV/AIDS will increase from 4,361
(2012) to 5,565 (2016) (Nasution et al, 2012). In
developed countries, a child’s risk of being infected
with HIV from his/her mother can be suppressed to
less than 2% because of PMTCT comprehensive
service (Demartoto et al, 2014).
PMCTC has been applied in many countries but it
still finds many constraints (Balcha et al, 2011; Koye
and Zeleke, 2013; Weiss et al, 2014). Inadequate
socialization, facilitator incapable of convincing the
people about the importance of PMTCT, limited
number of service officers and PMTCT counselors,
limited infrastructures, and limited budget result in
the low coverage of PMTCT service, so that the case
of women and children with HIV increases (Nguyen
et al, 2008; Desclaux, 2013; Iwelunmor et al, 2014).
In Indonesia, the coverage of PMTCT service is still
low - 35% in 2017, 45% in 2008, 6% in 2010
(National AIDS Commission, 2014). The
achievement of PMTCT in Surakarta is 3,799 (35%)
out of 10,829 targeted (Komisi Penanggulangan
AIDS Kota Surakarta, 2015).
Intervention of health behavior change through
Peer Education (PE) is also applied to PMTCT. In PE,
the field officer recruits Peer Educator, modifies
social norm and stimulates collective action to
support the AIDS coping program (Horizons Project,
2007). So far, PE method shows benefit for target
group (Ford et al, 2000; Leonard et al, 2000; Van
Khoat et al, 2003; Demartoto et al, 2016). The
implementation of community development
programs and activities requires social capital
(Fukuyama, 2003; Field, 2008). Social capital
contributes as well to AIDS coping (Smith and Rimal,
2009; Cenéet al, 2011; Webel et al, 2012).
Giddens said that agent or actor conducted social
practices ordered across space and time, because of
its knowledgeability, and its ability of taking action
in structuring. Rule is the procedure generalized and
methodology the agent has implicitly and uses as the
formula for action in social system (Giddens, 1984;
Stones, 2005). Agent and structure are interrelated,
86
Demartoto, A., Murti, B. and Zunariyah, S.
Agent and Structure Relation in Peer Education Based on Social Capital for Prevention of Mother – to – Child Transmission.
In Proceedings of the 2nd International Conference on Sociology Education (ICSE 2017) - Volume 1, pages 86-89
ISBN: 978-989-758-316-2
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

play some parts in social practice, and their structural
principle patterns are the same, including significant,
domination and legitimation (Craib, 2011). This
research studies the agent-structure relation in social
capital-based PE (Peer Education) for PMTCT in
Surakarta, Indonesia.
2 METHODS
This research was conducted in Surakarta Indonesia
from February-April 2017. Data and information in
this qualitative research using phenomenological
approach were subjective meaningful experience of
HIV-infected women and stakeholders related to
PMTCT. Data collection was carried out using
observation, in-depth interview and documentation,
while data validation using data source and method
triangulations. Phenomenological analysis on
intentionality started with objectification,
identification, and connecting and constitution, then
addictive reduction to reveal the essence, overriding
non-essential and incidental data and information,
and giving transcendent meaning as the integral part
of analysis (Moran, 2000; Patton, 2015).
3 RESULT AND DISCUSSION
Solo Plus Peer Group Support (PGS) aims to
empower People Living with HIV/AIDS (PLWHA)
in Surakarta using PE method. As the one responsible
for the program, AIDS Coping Commission (ACC)
of Surakarta in cooperation with NGO holds training
for the target group in order to be peer educator. Peer
educator plays an important part in supporting the
PLWHAs psychologically to remove anxiety, stress,
and depression due to their HIV status. In addition,
this commission communicates, provides information
and education related to HIV/AIDS, treatment and
medication, and reaching and facilitation both in the
field and cyber outreach through sms gateway,
twitter, facebook, Whatsapp, BBM, and Instagram
related to PMTCT.
The secretary of ACC of Surakarta states that
PMTCT using PE method is supported with social
network, belief system, norm, and reciprocity pattern.
Individuals or institutions related and involved in
PMTCT are Health Service, Work Group of ACC of
Surakarta, NGO caring about AIDS, Solo Plus,
People Caring about AIDS (PCA) and PMTCT
service providers, including hospital and Public
Health Center with HIV-infected women as the
service recipient. Belief system between social
networks in PMTCT becomes guidelines and is
embodied in various forms. The norm of PMTCT
should be complied with by HIV-infected women and
all stakeholders during using the service. Meanwhile,
reciprocity pattern is established in individual
components of structure.
The chairperson of Solo Plus said that PMTCT
should be supported by social capital including
bonding, bridging, and linking. Bonding refers to a
bond on which PLWHAs rely to care about, support,
and treat each other, thereby can survive and live
healthily. PLWHAs affiliated with PGS generally are
homogenous, for example, Injection Drug Users,
Female Sex Workers, having same family relation or
religion, moreover when they join and do collective
activity in religious institution. So it is more exclusive
and there is a factor distinguishing our people
strongly (members of groups) and others (out of
group members). PGS in the context of idea, relation
and more inward looking rather than outward
looking, as it maintains the values taken for granted
and implemented as the part of the community or
entity’s code of conduct and code of ethics. Social
bonding capital contributes to PMTCT with PE, while
Peer Educator educates each other, helps, gives, and
receives its member. The activity conducted becomes
an effective media for PMTCT socialization. It is the
opportunity that can be utilized to improve the
PMCTC service coverage.
Meanwhile, bridging refers to the diverse
relationship between network that tends to be
heterogeneous and can bridge inter-individual and
inter-group relations. Some activists argue that the
membership of Solo Plus is open in nature, because
PWLHAs come from various social, economic, and
cultural backgrounds, without discriminating the risk
factor causing HIV/AIDS infection. In Surakarta, PE
in PCA program develops as its members are
heterogeneous. In addition social institutions such as
neighborhood association, citizens associations,
Family Wellbeing Building and Tourist-Conscious
Group also result in other institutions such as arisan
(Indonesian rotating saving and credit association) so
that social solidarity is established through various
activities conducted. Bridging opens opportunity and
a community’s potency can be accessed because the
principles held on are commonality, freedom,
plurality and humanity values, openness and
independency. The group tends to be outward
looking, so that adaption is unnecessary and the
opportunity of cooperating with other groups is
opened.
Agent and Structure Relation in Peer Education Based on Social Capital for Prevention of Mother – to – Child Transmission
87

Meanwhile, social linking capital has weak and
more formal bond because PMTCT stakeholders
come from hierarchically different social strata. This
social capital power lies on the members’ loyalty to
norm and clear mechanism for the program
sustainability. PE in PMTCT is a community-based
intervention supporting AIDS coping program. PE
method is applied to PMTCT because it is culturally
appropriate. PE is an appropriate medium of
delivering the culturally sensitive messages, so that
the conflict of values can be avoided as it is conducted
by peer educator. This method is acceptable to
targeted group because complaining their problems
(particularly personal problem) to peer groups is more
comfortable, and allows the availability of broad
social service with more economic and effective cost.
Therefore, for the PE program to be effective, peer
educator should be selected from those acceptable to
targeted group, having conducive personality to
obtain training and appropriate to reach the special
population target of a health service (Medley et al.,
2009).
The social capital-based PE for PMTCT is more
effective through the planned network, recruiting and
training peer educator; recruiting a number of peer
promoter, and giving training about PE and PMTCT.
Having obtained training, peer promoter recruits
some people from their community (peer contact) and
conducts PMTCT actively. Structured model
attempts to establish the norms in target group
including: preventing risky behavior; improving
group interaction regularity; developing discourse
systematically with formal discussion guideline;
organizing a planned activity to achieve the objective
of program; and facilitating peer educator intensively
with systematical supervision (Centre for
Development and Population, 2003).
Peer educator in PMTCT is a purposive agent,
because it wants to achieve the objective by
interacting, cooperating and coordinating with each
other continuously. In addition, it is supported with
infrastructure and human resource having potency for
PMTCT and beneficial to all parties. The structure of
PMTCT is the rule and guidelines specified by health
institution, and PMTCT service provider. The
relationship between peer educator as agent, and
health institution and service provider as well as
PMTCT guidelines as the structure tends to ignore the
social economic setting of each individual or group.
PMTCT guidelines mention that the administration of
formula milk and delivery with sectio-caesarea in
HIV-infected women should be conducted to prevent
the infant from being infected with HIV, however the
HIV-infected poor pregnant women’s accessibility to
formula milk and delivery with sectio-caesarea is low
(Demartoto et al, 2016).
Signification is suggested by PLWHA’s labeling
to HIV-infected women as the target group of
socialization and treatment in PGS and PCA activity.
Meanwhile, peer educator becomes an actor to
disseminate information and to give education about
PMTCT. Thus, the targeted object and subject in
PMTCT is clear. Peer educator is more dominant
because it has attended PE training earlier than
PLWHA newly joining PGS or non-peer educator
HIV-infected women. In the presence of PMCTCT’s
rule and guidelines, peer education and target group
are subordinated to health institution and service
provider. It means that the structure is more
dominant. Legitimation can be seen from peer
educator authorized to recruit peer promoter and peer
contact in PE. Communication, power, and sanction
are the foundation of the establishment of
signification, domination and norm legitimized later
in PMTCT supported with social, economic, and
cultural capitals.
4 CONCLUSION
PE is a disseminating medium and appropriate
communication channel for HIV-infected women as
the targeted group. PE for PMTCT can be achieved
through interaction, cooperation, and coordination
with each other. Rule and guideline of PMTCT are
the normative foundation of PE implementation for
PMTCT, supported with high-quality resource,
budget, infrastructure and social capital existing
within society, so that HIV/AIDS incidence rate can
be controlled.
ACKNOWLEDGEMENTS
This work was supported by grants from the Ministry
of Research, Technology and Higher Education,
Indonesia Number: 873 /UN27.21/PP/2017 to Argyo
Demartoto, Bhisma Murti and Siti Zunariyah.
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