 It's time to present your research, Mrs. Liska. You have 20 minutes for presenting and 10 minutes to Q&A and the time is yours. Okay. I'm sorry. Mrs. Liska is currently a student of Public Health Doctoral Programme at Universitas She is a lecturer, researcher, book outdoor consultant, speaker, reviewer and midwife who initiated and development complementary midwife therapy in Indonesia. So excellent. And this is time. Time is yours, Mrs. Liska. Okay. Thank you, Mrs. Heliana. Hello, friends. And all of them. I'm Ariska Aisyani. You can call me Riska. Thank you, Mrs. Heliana, to introduce myself. And now I currently currently a student in PhD program, Universitas de Blas Marat Indonesia. And hello, Mrs. Parah Dilla and Mrs. Juliani from Indonesia. Thank you for watching. And besides of that, I'm a member and mentor in International AIDS Society, or yes. And now I want to share my study. The title is the Burl Equity in the Midwifery Services of pregnant women living with HIV. AIDS in Indonesia has been released. So what do you think about the burl equity? What do you think about the burl equity? Is still any problem in Indonesia, maybe? You can check in the public chat. Is still any problem or not? I think it is still a problem. And now I want to share and I want to discuss how about the problems in midwifery services in hospital, in hospital, in public health center, in midwifery services, private. So how many the problem, how the big problem in HIV is in Indonesia? So let's discuss. Okay. The study I am to describe how midwife in mother and children health clinics in the primary healthcare in the hospital and midwifery services private to implement the PMTCT program for pregnant women and factors influencing their role. Okay. So I can show you the described. I can show you. I will show you the picture. HIV is prevalent in Indonesia. The cases, HIV cases in Asia and Pacific in 2019. In the 5.8 million people living with HIV and then 0.2 percent adult. HIV prevalence is 15 until 49 years old. And then 300,000 new HIV infection in Asia and the Pacific. How many, how the big, how the big the cases. And then 160, sorry, 1,068 related deaths and then 60 percent adult on antiretroviral treatment and 65 percent children on antiretroviral treatment. And in Indonesia, the joint United Nations program on HIV estimate that 30,000, 305 million people are living with HIV globally of which 4.7 million are living in the Asia Pacific region. India, China and Indonesia are the top three countries. With the highest HIV present in the region. The five provinces reporting the highest rate of HIV cases are Jakarta, East Java, Papua, West Java and Bali. So human immunodeficiency virus can be transmitted vertically. Also known as mother to child HIV transmission. During pregnancy, children, childbirth or breastfeeding. Okay, let's check this out. Okay, this is the picture described how the MPCT or PMPCT preventive mother to child transmission percent in Indonesia. Indonesia have under 50 percent to implement PMPCT. So how poor my country. Okay, and a systematic review and meta-analysis study shows that MPCT call of cure during pregnancy and postpartum with the full HIV incited rates on 3.8 percent years. The World Health Organization or WHO has started that without any prevention program and treatment. The rate of MPCT is 40 percent where two thirds of babies born are infected during delivery and the remaining third are infected during breastfeeding. So this is under 50 percent to PMPCT implementation in Indonesia. Okay, let's next slide. So this is the framework of PMPCT in mid-vibrary services. The most stigmatization of pregnant women living with HIV AIDS in Indonesia is still high. This is the main problem to HIV care in pregnant women living with HIV in labor, in breastfeeding, and then so on. So in pre-vibrary clinic, primary healthcare, hospital, it is still high to stigmatization and discrimination to a barrier of the program. And then, okay, this is the response and characteristics in my study. So you can read in the slide. And then the study findings are presented according to the type of barriers and enabling factors surrounding PCT repressed by private mid-vibrary services or practices. And this is the characteristics of HIV, marital status, education, work experience, and information availability about HIV. The study was conducted on 80 randomly selected midwives in four thin primary healthcare clinics in Indonesia that were implementing the PMPCT program. The title shows that the majority of midwives were younger than 28 years old, had Biblung III education in mid-vibrary, were married, and had worked for less than seven years. The main source of HIV information among respondents was PIA for less lectures. So the table shows characteristics the mixed method study was conducted in 80 randomly selected midwives. And the majority of midwives were younger than 28 years old. So it is randomly sampling that the study. Okay, let's go to the next slide in the next table. This shows that midwives' knowledge level, attitude, perception, and behavior is implemented in the PMPCT program. The majority of midwives' knowledge was categorized as unsatisfactory until 50%. Most respondents had negative attitudes toward PMPCT, 62.5%, and perceived that the institution where the work was supported of their efforts to implement PMPCT until 55%. So it is majority that were enough, institution of facilities to implement PMPCT until 53.8% and a similar majority until 52.5% had positive attitudes toward PMPCT. So that the show, the characteristics in knowledge level, midwives' attitudes, participation, and midwives' role. So completely the data, the show. Okay. And then the next slide shows the relationship between midwives' characteristics, knowledge level, attitude, perception about HIV-AIDS, versus their role in implementing PMPCT program. The married midwives mostly implemented PMPCT in the unsatisfactory category while single and widowed midwives implemented PMPCT in a good category. This variable was not statistically meaningful. Most respondents claimed that they never received information about PMPCT profiles in their workplace. Their variable was statistically significant. For knowledge level variable, most respondents until 71.9% with satisfactory knowledge implemented PMPCT in the good category, while those with unsatisfactory knowledge level tend to implement PMPCT in the below average or not good enough category. This variable was statistically significant. And then the attitude variable includes both those with positive and negative attitudes about implementing PMPCT score in the good category. Yet this variable was not statistically significant. And then for perception variable, on the most respondent facilities, those with good perception tend to implement PMPCT in the good category, while those with poor perception implement PMPCT in the poor category. This variable is statistically significant. Okay, so what do you think about the PMPCT in another country maybe, in another Indonesia, maybe in Kenya, Florida, it is still significant to prevent HIV transmission to child from the mother, maybe in USA or Kenya. Okay, I think in another world it is significantly to implement in HIV transmission prevention. Okay, let's next slide. Okay, this is the multi-pare analysis factors affecting its wife in the PMPCT program. So, however, mid-west no less was not affected by how much information they had but their experience in implementing PMPCT itself. Knowledge was evidently the strong indicator of behavior in implementing PMPCT as on multi-pare analysis in the study mid-west, with good knowledge implemented PMPCT for five, for times more in a satisfactory way than good with poor knowledge. So knowledge was most valuable and affected the behavior to PMPCT program. Okay, thank you, Catherine. In Kenya, there is a lot of support so the transmission has to do a good job. Okay, so this is the qualitative result in depth interview results. Sorry, this slide is small, maybe, and I think I can read to you. Okay, and the study findings in qualitative study are presented according to the type of barriers and enabling factors surrounding PMPCT's favorite referrals by private midwife practices. People living with HIV are socially stigma in Indonesia and condemned as sinful and immoral, hence it is generally taboo to talk about HIV. The three types of barriers emerged from the data are barriers faced by midwives, barriers within the referral system, institutional barriers, and barriers faced by pregnant women from the midwife perspective. And this slide shows that there are two main barriers faced by midwives, namely feeling fearful for revering pregnant women to PCT because of the highly stigmatized nature of HIV and lack of training, monitoring, and evaluation and reward mechanism for midwives. Midwives fear of being rejected by women and their families when offering HIV testing may put midwives in a very comfortable and outward position. For example, a pregnant woman who lacks knowledge of HIV might understand HIV as a dead sentence and without proper counseling and support she may refuse HIV testing. And so this is lack of knowledge in Indonesia. And this is valuable in behavior to PMDCT and to HIV testing in Indonesia. So have Indonesia still many stigma, so high stigma and discrimination in Indonesia to PMDCT program. And then midwives with their training know the importance of providing the right information to their clients. However, at the same time they face concentration between doing the right thing and protecting their clients from shame and fear. In the example about the midwife, denies the woman's right to information, ensuring that she meets an informed decision, such as practice might lead to woman lacking trust in their midwife, in midwifery private services. And then private midwives may also be afraid of losing their patience, good relationship even when they have instances of deception, cause-provide means by which midwives survive in their private practice and directly asking a woman to undergo visitation can be frightening for both the midwife and the pregnant woman. Hence the deception and lies might be the safest way to manage and negotiate the potential tension that may hamper and the midwife relationship with their clients. So participant suggested that deception is a normal practice where in a woman are not given a full account of the purpose of the referral process and another service. So midwives in the such study also discuss institutional barriers that prevent them from referring pregnant woman for visitation. And then including full communication between VCT and Internet of Care services, a particular institutional barrier mentioned by participant was linked to full referral communication and follow-up from the VCT clinic. And then participant expected to receive a return referral letter from the VCT clinic and participant wanted to have communication from the VCT clinic regarding the results that would inform their practice and treatment for the woman. So in Indonesia the Public Health Center is one of places and midwife places to HIV testing. The only places in the, one of the places to HIV testing besides a hospital. In midwifery services are practice private, not services in HIV testing. So it is the lack of services in midwifery Indonesia. And the main theme is regarding and bringing factors related to our reward system and acknowledgement of midwife work. Participant expressed feeling this hard and lack of support from the district public health office or public health center. Private midwife practice continue to need local support to implement the referral system. The lack of acknowledgement of their work and role in PMTCT services as well as lack of ongoing supervision, monitoring and evaluation left midwives feeling isolated and out there regarding chance and status. Okay, next slide. Okay, this is a study finding or conclusion in my study. The one social stigma, the first social stigma against PLHIV, namely people living HIV or p-pregnant women living with HIV, including HIV positive pregnant women have been ingrained in society and normalized within the health system resulting a practice that potentially abused and disrespectful midwives no less level about HIV and PMTCT are mostly below operating and most respondents have negative attitudes to implementation of PMTCT. They had preconception toward institutional support claiming the institutional were less supportive to PMTCT. They also declared their perception of facility availability are included in the good category. They implemented PMTCT in the good category but the poor category was still high. The findings had highlights the needs for PMTCT programs to a different level of barriers at institutional community and private midwife practice. This is going on. Okay, thank you. This is the last slide. Okay, the last slide. In conclusion, birth equity had not released in the midwifery services of pregnant women living with HIV in Indonesia. So what should we do? We should do target effort needs to focus on strengthening factors that enable midwives to make effective PMTCT or PMTCT which may include one group service, improvement availability of mobile PCT and then the clinic opening hours with street working women as well as ongoing training, supervision, monitoring and evaluation of PCTCT service on pregnant women. So private midwives in Indonesia are a key component in PMTCT their roles need to be strengthened and their contribution to PMTCT programs and knowledge. Thank you. Thank you so much and see you next time. Thank you. Assalamualaikum warahmatullahi wabarakatuh. Okay, thank you. Riska Ayu, it's nice and good finding for strengthening midwife and midwifery. This is the important thing that you cite for midwife to focus on women living with HIV and AIDS. So I think there's a lot of questions and clarification or comment. So please, brush your head and turn off your phone when you have time to ask questions. Okay, thank you. Mrs. Parazilla for your comment. I think the Public Health Centre in Indonesia is a good services with still many problems in HIV AIDS. And Mrs. Parazilla is the head of Pusket Mass for the Public Health Centre in Solo. So it is a surprise. Thank you, Mrs. Parazilla. Yes, for all audience here, please give your comment or clarification or question for Mrs. Riska Ayu. There's a good information about how midwife, midwifery services for pregnant women living with HIV AIDS. Mrs. Saptina. Mrs. Saptina, have you any question or comment? Mrs. Saptina, click your microphone if you want to give an equation. Okay, maybe before we have an equation, Riska Ayu, do you think... do you say that one roof surface is a good idea to improve to make effective visitative roles? Maybe you can explain again as on your study. What do you mean? What do you mean about one roof surface? Okay. I mean this is integration. It means that integration services in midwifery private services to public health centre, to hospital, it is linkage to care, linkage to services. For Indonesia, this is different. Maybe it's one of one. In midwifery services, private and then... in midwifery services, and in the public health centre, it's HIV testing in public health centre or hospital. So it is confused. So it is make confused in past year. Maybe in midwifery services, in private, give a chance or give an opportunity to have a testing for HIV, for syphilis, or another testing independently. Yes, nice. I think so. It's a good idea to make one roof surface. Okay. Is there any comment in chapter? Yeah. For you all audience, you can write your comment or your question in chat box or you can directly to give a question to Riska Ayu. Yeah. Okay, Riska Ayu. Well, we... Well, there is a question. Hi. Hi. Interesting for the training for midwife. Training for midwife, especially for practicing midwife. Is it enough to build a knowledge for midwife? From the government programme or another delivery for a training for midwife in the empty city or in Bremen, it's for women pregnant women. So is it enough for midwife? I think it's not enough now. But midwife still needs training or education or another to to HIV education. Because the lack of the education for midwife in HIV is still lack of the behavioural and lack of the empty city programme in implementation. So midwife can get a training, maybe HIV counsellor or HIV testing. And so on. Because I read your conclusion that midwife knowledge level about HIV and MDCT are mostly below average. So I think it's a good idea to strengthen the knowledge for midwife. Sometimes midwife have a high level of knowledge but low level of attitude. Any factor influence for midwife during their practice and private practice. I hope midwife does not have a stigma in HIV especially for women and especially for people for pregnant women living in HIV and labour and breast mother in living with HIV. Okay, one again I am addressing to social stigma as I write in a project book. Social stigma is the play that is like a taboo. Anything is like a taboo. So this part midwife have to strengthen in partnership with women with family and community but social stigma is very important to focus in healthcare. What do you think about the social stigma? For example in midwifery still midwife still some activities to feel afraid to HIV mother especially in midwifery cases for example is what is it? Maybe it's afraid like Covid-19 this is very terrible. It is 5 minutes left to discuss. It's time to end for discussion although we are discussed together but I'm sure all the audience have a good idea and good information about your study. Thank you.