ANALYSIS OF POLICY IMPLEMENTATION OF HIV/AIDS MANAGEMENT IN TANJUNG MORAWA PUSKESMAS

Human Immunodeficiency Virus infection and sexually transmitted infections are still a public health problem in the world and in Indonesia. People infected with HIV are still stigmatized, this happens because the level of education in the community is still mostly elementary school graduates. Barriers also occurred when conducting outreach to the community, because it was difficult to gather the community at the same time with reasons for work, school


Infections
Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STIs) are still a public health problem in the world and in Indonesia, and extend to social, economic and cultural problems.People infected with HIV (ODHIV) are still experiencing stigma, both in their families, health workers and the general public.Stigma occurs because of a lack of knowledge and a wrong understanding of HIV and Acquired Immuno-Deficiency Syndrome (AIDS) (Indonesian Ministry of Health, 2018).
According to WHO (world health organization) data until the end of 2017, there were 36.9 million people living with HIV, with 1.8 million new infections in the same year.Based on the 2017 Progress Report on HIV/AIDS and Sexually Transmitted Infections by the Ministry of Health of the Republic of Indonesia, the cumulative number of HIV infections up to December 2017 in Indonesia was 280,263 cases, with a cumulative number of AIDS of 102,667 cases from 1987 to December 2017.In the report At the same time, it was also found that the number of new HIV and AIDS infection cases has increased every year.
Data from the P2P Directorate General of the Ministry of Health of the Republic of Indonesia states that HIV/AIDS data tends to increase every year.Data for 2017 stated that as many as 57,580 people were affected by HIV/AIDS, with details of 48,300 people with HIV and 9280 people with AIDS.Based on age group, the highest percentage 1 is in the age group 25-49 years (Directorate General of P2P, Ministry of Health, Republic of Indonesia, 2018).
Based on the health profile of Deli Serdang Regency, the number of HIV cases from the age group in 2021, <4 years is 2 people, 5-14 years is 0 people, 15-19 years is 3 people, 20-24 years is 34 people, 25-49 years is 96 people, ≥ 50 years, 9 people.The total number of people living with HIV is 144 people (Governor of North Sumatra, 2022).
After the preliminary survey was carried out at the Tanjung Morawa Health Center, information was obtained from the results of HIV/AIDS officers' reports that in 2021 there were 15 people with HIV/AIDS and in 2022 examinations had been carried out on 854 people at risk of HIV/AIDS, 475 pregnant women, sufferers 150 TB Lungs, 15 brides-to-be, 6 men having sex with men and 6 transgender women sex workers (WPS).From the examinations that were carried out from January to October 2022, there was an increase to 19 people who were positive for HIV/AIDS.
From the preliminary study conducted, there are several factors that influence the implementation of HIV/AIDS prevention policies at the Tanjung Morawa Community Health Center, such as lack of public awareness to participate in HIV/AIDS prevention.This happens because the level of public education is still a lot of elementary school graduates.Communities who have higher education generally have broader knowledge and insights so that it is easier to absorb and receive information, and can play an active role in overcoming health problems for themselves and their families.Barriers also occurred when conducting outreach to the community, because it was difficult to gather the community at the same time with reasons for work, school, or free time to be used for rest.Therefore, Policy implementation is influenced by communication, resources, disposition, and bureaucratic structure (Edward III, 2018).In line with previous research which states that communication, resources, dispositions, and bureaucratic structures are the driving and inhibiting factors that influence policy implementation (Febrian, 2017).Community support also influences policy implementation (Miranti et al., 2018).
Based on the Regional Regulation of North Sumatra Province Number 3 of 2022 concerning HIV and AIDS Prevention and Control, it is explained that it needs to be implemented in an integrated and sustainable manner through actions aimed at preventing, delaying, reducing risks, eradicating, eliminating disease, disability and adverse effects due to HIV/AIDS.AIDS and can improve the quality of life of humans or people living with HIV/AIDS (PLWHA) and reduce the socio-economic impact of HIV/AIDS on individuals, families and communities by implementing an intervention that has been proven effective so as to reduce the effects of the epidemic.

RESEARCH METHODOLOGY
This research will be carried out at the Tanjung Morawa Community Health Center, Tanjung Morawa District, Deli Serdang Regency in January 2023 until it is finished.The approach used is a descriptive approach which is generally in the form of words, pictures, or recordings (Eco Sugiarto, 2017).
The informants of this study were the Head of the Puskesmas and the HIV team 1. Head of the Tanjung Morawa Health Center 2. dr.HIV/AIDS Coordinator 3. Admin HIV/AIDS 4. HIV/AIDS Counselor 5. HIV/AIDS Analyst 6. HIV/AIDS Pharmacy 7. HIV/AIDS nurse The research instrument used was the researcher himself, an interview guide, which was an instrument in the form of a list of questions prepared to obtain information, a notebook was needed to record all information, a tape/sound recorder recorded the results of interviews with research subjects, a camera to document events in the field.

Research result
From the results of interviews that have been conducted and data collection from the Siha application at the Tanjung Morawa Health Center.In 2022 there will be 854 patients screened for HIV, 19 people suspected of being positive, and 96 people taking ARV drugs.
Implementation of the HIV/AIDS prevention policy at the Tanjung Morawa Community Health Center.The HIV/AIDS prevention policy was made to provide protection for all HIV/AIDS prevention efforts.The HIV/AIDS prevention policy at the Tanjung Morawa Community Health Center has been running for quite some time.According to the results of these interviews, it can be concluded that the socialization or training received by HIV/AIDS response staff at the Tanjung Morawa Health Center was good, this can be proven from the answers of the main informants.Socialization is a form of prevention or preventive activities through promotion in the context of eliminating HIV/AIDS transmission, where one of the responsibilities of the district/city regional government is to make and implement policies in promotive services (Indonesian Minister of Health, 2017).

A. Resource
In the prevention program there are two types of human resources involved, namely the first are medical personnel such as: doctors, nurses, and others, the second are non-medical personnel such as NGOs.Based on the results of these interviews, it can be concluded that the human resources at the Tanjung Morawa Health Center are sufficient.In tackling HIV/AIDS, adequate human resources are needed, both from medical personnel and non-medical personnel so that the HIV/AIDS prevention can run well.

B. Disposition
The implementer's attitude towards the policy greatly influences the successful implementation of the policy, the implementer's understanding of general goals and basic measures is an important thing, but skill alone is not enough without the willingness and commitment to implement the policy.

Matrix table of interview results regarding the attitude of the implementer
Key "UnFor the attitude of the informants 1 executor, I think they are already good, for the commitment they are also committed."

Main informant 2
"In terms of attitude, I think it's good and the commitment has also been committed, but if the participation of the community is still lacking, they feel that HIV is for what I have no complaints, even though it is not certain if a positive or negative blood test is not done."Based on the results of these interviews, it can be concluded that the attitude and commitment of the executors are good, and the executor's understanding is also good, it's just that community participation is still lacking in these activities for reasons of work and others.

C. Bureaucratic structure
The bureaucratic structure is important in policy implementation, this aspect of the bureaucratic structure includes the first two important things, namely the mechanism, and the implementing organizational structure itself, the fragmentation implementation mechanism is usually established through standard operating procedures (SOP) included in the policy program guidelines.A good SOP includes a framework that is clear, systematic, uncomplicated and easy for anyone to understand, because it will become a reference in work.

Matrix table of interview results
regarding SOP Key informants 1 "There are SOPs at the Puskesmas, yes, for understanding too.In my opinion, they already understand because they immediately go to the field, they will definitely understand, if for example the implementer does not comply with the SOP, they may be given a warning, but that is rare because they already understand what the risks are if they do not comply with the SOP."Main informant 2 "If there is an SOP, it is made based on a team, for understanding it must be understood because we also know the dangers of HIV, if the executor does not comply with the SOP they will be reprimanded." Based on the results of these interviews, it can be concluded that the SOP (standard operating procedure) at the Puskesmas has been running well and the implementers' understanding of SOP is also good.

DISCUSSION
The HIV/AIDS prevention policy is an effort intended to provide protection to the public from the risk of HIV/AIDS transmission and to provide services to people with HIV/AIDS.The objectives of the HIV/AIDS prevention policy in Deli Serdang Regency are to improve public health status, meet the community's need for health information and services, protect the community from all possible events that can transmit HIV/AIDS, improve the quality of human resources, prevent and break the chain of transmission, provide care and treatment for people living with HIV (ODHIV), as well as improve the quality of life for PLHIV.The implementation of HIV/AIDS prevention policies at the Tanjung Morawa Community Health Center has been quite good, although there are several obstacles that have resulted in the implementation of HIV/AIDS prevention not being maximized.

A. Communication
Communication is very decisive in policy implementation.Communication isthe process of conveying a message by one person to another to inform or to change attitudes and behavior, either directly orally or indirectly through the media.Even though the policies produced are of good quality and have goals for the benefit of the community, if the implementers do not have a clear and broad understanding then the implementers will convey vaguely and limitedly (Effendy, 2015).

Delivery
of messages or information provided by Tanjung Morawa Health Center HIV officers to the community is good.And it is carried out in two ways, first in the puskesmas building through interpersonal communication and counseling to patients, as well as installing information media in the room.secondly outside the building through socialization in schools or village communities with the help of NGOs.

B. Resource
Resources are one of the important factors in the implementation of public policy.
Resources include human resources, budgetary resources, and facility resources, George Edward in (Subarsono, 2015).Human resources are very influential on the success of implementation, because without reliable human resources policy implementation will run slowly.Therefore, the human resources at the Tanjung Morawa Health Center are sufficient and they are optimal in carrying out their duties.

C. Disposition
If policy implementation is to succeed effectively and efficiently, the implementers (implementors) not only know what to do and have the ability to carry out the policy, but they must also have the will to implement the policy.Edward III, 2018.In this study, it was found that the disposition in implementing HIV/AIDS prevention policies at the Tanjung Morawa Health Center was quite good in terms of the commitment and understanding of the officers who provided information to the public.

D. Bureaucracy
The bureaucratic structure in implementing policies has a very important influence on a policy.According to Edward, there are two main characteristics of bureaucracy, namely work procedures, basic measures or often referred to as Standard Operating Procedures (SOP) and fragmentation (Sugiyono, 2016).
The bureaucratic structure at the Tanjung Morawa Health Center is good, this can be seen from the standard operating procedures (SOP) indicators.Where all officers carry out However, from 2015 to 2022 the discovery of new cases at the Tanjung Morawa Health Center has increased.In 2015, from 5 cases it increased to 19 cases in 2022.The Tanjung Morawa Health Center in carrying out policies related to HIV/AIDS, formed a VCT team counselors, HIV/AIDS pharmacists and HIV/AIDS nurses.The success of a policy is inseparable from the ability of the implementer to carry out the policy.Therefore, to find out how far the implementation of HIV/AIDS prevention policies at the Tanjung Morawa Community Health Center according to North Sumatra Provincial Regulation Number 3 of 2022 concerning HIV/AIDS Prevention and Control, can be measured through several variables according to Edward III, namely communication, resources, disposition and bureaucracy.A. CommunicationSubmission of communication between the communicator and the communicant must be clear and unambiguous and adapted to the conditions in the field while taking into account the obstacles that may be experienced.