SPATIO-TEMPORAL AND DETERMINANTS OF HIV INCIDENCE AMONG MSM IN JEMBER KIDUL, INDONESIA

Human immunodeficiency virus (HIV) remains a major public health issue, particularly among men who have sex with men (MSM), who are estimated to have more than 20-fold higher risk of HIV infection than the general population. In Indonesia, MSM are disproportionately affected, with surveillance data showing steady annual increases. In Jember Regency, East Java, HIV cases have risen over the past decade, with MSM contributing significantly to new diagnoses. Despite available therapy and prevention programs, transmission persists, suggesting geographic and social factors play a role. Spatio-temporal analysis using Geographic Information Systems (GIS) and spatial statistics such as Moran's I and Local Indicators of Spatial Association (LISA) provides tools to detect clustering and identify high-incidence ``hotspots.'' At the same time, demographic and behavioral determinants strongly influence the risk of infection. This study aimed to describe the spatio-temporal distribution of HIV among MSM in Jember Regency (2021–2024) and to identify both geographic clusters and determinants for targeted interventions. A descriptive quantitative study was conducted using secondary HIV case data from Jember Kidul Primary Health Centre. Cases were mapped by subdistrict. The authors assessed spatial autocorrelation with Moran's I (global clustering) and LISA (local clustering). Temporal comparison tracked hotspot changes over four years. We performed determinant analysis using the Chi-square and logistic regression. Moran's I was positive and significant across all years, confirming clustered patterns. LISA revealed persistent high-high clusters in central urban and nearby subdistricts, with low-low clusters in peripheral areas. High-high cluster subdistricts increased from 5 in 2021 to 9 in 2024, indicating expansion of high-risk zones. Spatial shifts were observed, with new clusters emerging in previously non-significant areas. Determinant analysis demonstrated that younger age (20–29 years), multiple sexual partners, and inconsistent condom use were significantly associated with HIV incidence, and these factors remained significant in multivariable analysis. HIV incidence among MSM in Jember Regency exhibited significant and expanding clustering over time, with demographic and behavioral determinants strongly influencing transmission. Integrating spatio-temporal mapping with determinant analysis provides essential evidence for geographically focused and behavior-specific prevention strategies.