HIV / AIDS Prevalence and Risk Factors: Analysis of Changes over

Time at H. Adam Malik General Hospital in Medan

Frihastina Lubis

, Tambar Kembaren

Division of Tropical Disease and Infection of the Internal Medicine Department

Faculty of Medicine Universitas Sumatera Utara, H. Adam Malik General Hospital Medan

Keywords: HIV/AIDS, heterosexual, homosexual

Abstract: Introduction: HIV / AIDS has long been one of the epidemic diseases in the world. Some risk factors have

proven to be the cause of transmission of HIV / AIDS, such as through sexual intercourse, through non-

sterile needles, and others. Until now there are no accurate data on the number of cases and risk factors that

influence the development of HIV transmission. This study aims to provide an overview of the

characteristics and risk factors for people with HIV / AIDS. Methods: This type of research is a descriptive

study with a cross-sectional approach. The sample in this study was all HIV / AIDS patients in Haji Adam

Malik General Hospital from 2003 to 2018. Inclusion criteria were: All patients with HIV / AIDS were

recorded in the Inpatient Installation of the General Hospital of Haji Adam Malik Medan in 2003 - 2018

The exclusion criteria were HIV / AIDS patients who had never been treated at H. Adam Malik General

Hospital Medan. Results: From 2003-2018 there were 5639 new cases of HIV / AIDS. Of all patients, male

patients were 3990 cases (71%) and women were 1649 cases (29%). In 2003 the male ratio: women with

HIV was 3.6: 1, whereas in 2018 the ratio of men: women was 1.8: 1. The highest prevalence of age for

HIV patients was age 25-49 as much as 68%. Most HIV/AIDS sufferers came from the city of Medan as

many as 2264 patients (40%). The most recent education of HIV sufferers was high school graduates with

2959 cases (52%). A total of 2347 people with HIV (42%) worked and as many as 2597 (46%) patients did

not work. Risk factors for HIV/AIDS sufferers, namely: 4160 cases (73%) heterosexuals, 722 cases (13%)

injection users, 303 cases (5%) homosexuals, 144 cases (3%) perinatal, 134 cases (2%) blood transfusions ,

124 cases (2%) unknown, 52 cases (1%) bisexual. Conclusion: This study illustrates the distribution of

characteristics and risk factors for HIV/AIDS that occurred from 2003-20018.

1 INTRODUCTION

1.1 Background

HIV/AIDS has long been one of the epidemic

diseases in the world. From the beginning of the

discovery of HIV disease, it is estimated that more

than 70 million people are infected with the HIV

virus and around 35 million people have died from

HIV disease. Globally, as many as 36.9 million of

the world's population suffer from HIV by the end of

2017, with total mortality of 940,000 deaths in 2017.

As many as 0.8% of the world's population aged 15-

49 are HIV sufferers, although the HIV epidemic

differs between countries and regions. Africa was

most severely affected, with almost 1 in every 25

adults (4.1%) being HIV sufferers and a total of

almost two-thirds of the entire HIV population in the

world (WHO, 2019).

In 2017, in the Asia Pacific, around 5.2 million

people living with HIV. HIV prevalence at 15-49

years of age is around 0.2%. 280,000 new cases of

HIV were found throughout 2017, followed by the

death rate due to HIV was around 170,000 deaths.

Only 53% of HIV-infected adult patients who

received antiretroviral therapy and 71% of HIV-

infected children also received antiretroviral therapy.

In Indonesia HIV cases up to March 2017 accounted

for 242,669 cases, with the highest prevalence of

HIV incidence in the 25-49 age group as much as

70% and more suffered by men as much as 66% of

all HIV cases. North Sumatra is the top 10 region

with the most HIV cases in Indonesia, with seventh

ranking having 13,454 HIV cases until March

2017(WHO, 2019).

Some risk factors have been proven to be the

cause of transmission of HIV / AIDS, such as

through sexual intercourse, through blood

Lubis, F. and Kembaren, T.

HIV / AIDS Prevalence and Risk Factors: Analysis of Changes over Time at H. Adam Malik General Hospital in Medan.

DOI: 10.5220/0009861200970101

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 97-101

ISBN: 978-989-758-469-5

transfusions or blood products that have been mixed

with the HIV virus, through non-sterile needles,

transplanting HIV-infected organs and transmission

from mother to child while at the womb. Until now

there are no accurate data on the number of cases

and risk factors that influence the development of

HIV transmission in the H. Adam Malik General

Hospital in Medan. Therefore, it is necessary to

conduct a study of the characteristics and risk factors

of HIV/AIDS sufferers in Medan. By knowing the

risk factors for HIV / AIDS transmission clearly, it

is hoped that it can be an input to hospitals and the

government to prioritize HIV/AIDS prevention

programs appropriately, effectively in accordance

with existing resources.

1.2 Methods

This type of research is a descriptive study with a

retrospective study design, which collects secondary

data on patients with HIV / AIDS at the Haji Adam

Malik Central General Hospital in Medan from 2003

- 2018. Samples in this study the entire study

population, namely all HIV / AIDS patients in Haji

Adam Malik Hospital from January 2003 to

December 2018. Inclusion criteria were: All patients

with HIV / AIDS were recorded in the Inpatient

Installation of the Adam Malik Haji Central Hospital

Medan from 2003 - 2018. Exclusion criteria were

HIV / AIDS patients who never went to H. Adam

Malik General Hospital in Medan.

1.3 Operational Definition

Diagnosis of HIV infection is based on

clinical examination and laboratory examination.

Laboratory tests include serological tests and

virological tests. Criteria for risk factors:

heterosexuals are unprotected sexual relations in

heterosexuals; homosexuals are unprotected sexual

relations with homosexuals (fellow men); bisexual is

unprotected sexual intercourse on bisexuals;

perinatal is the mother to child transmission during

the 20-28 week pregnancy period up to 7-28 days

after delivery.

1.3.1 Data Analysis

Data from the research results were analyzed

statistically with the help of computer programs.

Descriptive analysis is used to see an overview of

the basic characteristics of patients and risk factors.

1.3.2 Results

Patients with HIV / AIDS in Medan Haji Adam

Malik Hospital in the period 2003 - 2018 which

were sampled in this study amounted to 5,639

people. Most people with HIV / AIDS in Medan

Haji Adam Malik General Hospital are men with a

percentage of 71% (3,990 people), while women are

29% (1,649 people).

Table 4.2 Distribution of HIV / AIDS patients in Haji

Adam Malik General Hospital in 2003 - 2018 based on sex

and incidence per year

Year

Gender Ratio

(M: F)

Total

Percentages

(%)

Male

(M)

Female

(F)

2003 11

3 3.6:1

14 0.25

2004 58

18 3.2:1

76 1.35

2005 83

15 5.5:1

98 1.74

2006 159

37 4.3:1

196 3.48

2007 224

87 2.5:1

311 5.52

2008 258

97 2.6:1

355 6.30

2009 405

105 3.8:1

510 9.04

2010 201

88 2.2:1

289 5.13

2011 437

167 2.6:1

604 10.71

2012 407

191 2.1:1

598 10.60

2013 436

164 2.6:1

600 10.64

2014 411

186 2.2:1

597 10.59

2015

295

157 1.8:1

452 8.02

2016

161

98 1.6:1

259 4.59

2017

182

91 2.0:1

273 4.84

2018

262

145 1.8:1

407 7.22

Total 3.990 1649 5639 100,0

Graph 4.2: Overview of the incidence of HIV / AIDS from

2003 to 2018 according to sex

In general, HIV / AIDS infection in Haji Adam

Malik Hospital is mostly experienced by the age

100

200

300

400

500

600

700

2003

2006

2009

2012

2015

2018

Male

Female

Total

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

group 25-49 years with a total of 3,809 people

(68%). While the lowest incidence was found in the

age group under one year with a total of 47 people

(1%).

Diagram 4.2 Distribution of HIV/AIDS patients based on

age groups 2003 – 2018

From 2003 to 2018, most HIV / AIDS patients in

Haji Adam Malik Hospital came from Medan City

with a percentage of 40.15% (2,264 cases), followed

by Karo and Deli Serdang Districts with a

percentage of 11.54% respectively. (651 cases) and

9.54% (538 cases). While those from outside the

Province of North Sumatra mostly came from Aceh

Province with a percentage of 1.56% (88 cases).

Table 4.4 Distribution of HIV / AIDS patients in Haji

Adam Malik General Hospital based on region origin in

the period 2003 - 2018

Origin Total (n) Percentages

(%)

Asahan regency

Batubara Regency

Dairi regency

Deli Serdang regency

Humbang Hasundutan

Regency

Karo Regency

Labuhan Batu regency

South Labuhan Batu

regency

North Labuhan Batu

regency

Langkat regency

Mandailing Natal

regency

Nias regency

Phakpak Barat regency

Samosir Regency

Simalungun Regency

Tapanuli Selatan

regency

Tapanuli Utara regency

Tapteng regency

538

651

302

103

2264

361

1.29

0.60

1.76

9.54

0.64

11.54

0.67

0.43

0.39

5.36

0.62

0.76

0.43

0.69

1.83

0.83

1.01

0.69

1.68

0.39

1.47

40.15

0.55

6.40

Toba Samosir regency

Kalimantan Province

Binjai city

Medan city

Padang Sidempuan city

Pematang Siantar city

Sibolga city

Tanjung Balai city

Tebing Tinggi city

Aceh Province

Bengkulu Province

DKI Jakarta Province

West Java Province

Lampung Province

Riau Province

Sumatera Barat

Province

Sumatera Selatan

Province

Unknown

290

0.98

0.53

0.69

1.56

0.04

0.16

0.07

0.02

0.96

0.09

0.04

5.14

Total 5.639 100,00

The most cases of HIV / AIDS were experienced by

sufferers with the last history of high school

education with a total of 2,959 people (52.5%),

while those with the least amount were those with

the most recent education history of the elementary

school with 105 people (1.9%).

Diagram 4.3 Distribution of HIV / AIDS patients based on

recent education history

Based on employment status, HIV / AIDS cases are

mostly experienced by patients who do not work

with a percentage of 46% (2,597 people). But the

number is not much different from the group of

patients who work, where the percentage is 42%

(2,347 people).

1000

2000

3000

<1year

1‐14…

15‐19…

20‐24…

25‐49…

>50years

Frekuensi(n)

Tahun

Male

Female

15%

52%

10%

Noeducation

Elementary

JuniorHigh

Highschool

Academy

University

Unknown

HIV / AIDS Prevalence and Risk Factors: Analysis of Changes over Time at H. Adam Malik General Hospital in Medan

Diagram 4.4: Distribution of HIV / AIDS patients based

on employment status

From 5,639 HIV / AIDS cases handled at Adam

Malik General Hospital Medan from 2003 to 2018,

the majority of cases were experienced in patients

who had risk factors for heterosexual risky sex

history with a percentage of 73% (4,160 cases),

shared needles and drug users. Intravenous drug

(IVDU) is 13% (722 cases) and risk sex offenders

are 5% (303 cases).

Diagram 4.5 Percentage of risk factors in patients with

HIV / AIDS in Haji Adam Malik Hospital Medan 2003 –

2018

In patients with homosexual behavior, initially there

were 31 people (2003 - 2007), increasing in 2008 -

2012, namely 64 cases and in 2013 - 2017 there

were 162 cases. Conversely, a decrease in the

incidence in patients with IVDU risk factors. In

2008 - 2013, the incidence in patients with IVDU

risk factors was 342 cases. Looks decreased in 2013

- 2017 to 124 cases.

Graph 4.4: HIV / AIDS incidence per 5 years based on

risk factors

2 DISCUSSION

In this study, it was found that there was an increase

in new cases of HIV each year. This is in line with

data from UNAIDS and the Ministry of Health

which also shows an increase in the number of

people infected with HIV and die of AIDS globally.

Male HIV sufferers more than women with HIV.

But if you look at trends every year between 2003

and 2008, the number of female HIV sufferers is

increasing. According to WHO, 47% of all AIDS

cases worldwide are women. At present, almost half

of all new HIV infections are reported in women

Non-marital sex that is not protective and sex with

commercial sex workers by husbands is described as

the most likely source of infection among women.

Women can also transmit HIV to their offspring. So

AIDS in women is a separate epidemic and the

approach to control must be gender specific (WHO,

2009)

The most age group in HIV patients is the age of 25-

49 years. This is in line with data from the Ministry

of Health

and WHO

. Adolescence and young

adults are a period of considerable biological and

physiological changes and are a developmental

phase when involvement in high-risk sexual

behavior and alcohol and other drug use peak and

the risk of acquiring HIV infection increases

. Most

HIV-AIDS sufferers are at a level of education that

is quite good and adequate. A study in Kenya and

the Dominican Republic reported that higher

education has a positive correlation with safer sex

(higher condom use). However, although education

can increase knowledge about condoms as HIV

prevention, there is still a gap between knowledge

and behavior (Minaya, 2008)

42%

46%

12%

Working

Notworking

Unknown

74%

13%

Heterosexual IVDU

Homosexual BloodTransfusion

Bisexual Perinatal

Unknown

235

342

124

162

100

200

300

400

2003

‐

2007

2008

‐

2012

2013

‐

2017

Frekuensi(n)

Tahun

IVDU

Homosex

ual

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

100

In this study, the risk factors including the top 3

were heterosexual, injecting drug users and male

fellow men. A unique trend in the number of risk

factors for male fellow men is increasing every year,

where the number of risk factors for injecting drug

users tends to decline from year to year. Risk groups

Men with Men (MWM) generally have multiple sex

partners and the proportion of unprotected sex is

higher than non-MWM, indicating that they are a

high-risk population for HIV transmission (Koblina,

2006)

3 CONCLUSIONS

In this study, there was an upward trend in the

incidence of HIV / AIDS from 2003 to 2018.

Knowing the prevalence of risk factors found in HIV

/ AIDS patients in Haji Adam Malik Hospital can be

input to hospitals and the government in making

HIV / AIDS prevention programs right, effective,

and in accordance with existing resources.

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