A survey on HIV-related health-seeking behaviors among transgender individuals in Jakarta, based on the theory of planned behavior.

BACKGROUND: Male-to-female transgender (waria) individuals are at high risk for HIV. This study aims at mapping the psychological determinants of four HIV-related health-seeking behaviors. This knowledge can be used to develop effective interventions to prevent the spread of HIV/AIDS. METHODS: The study involved 209 waria from five districts in Jakarta, selected with a cluster sampling procedure. Cross-sectional data were gathered through structured interviews. The four examined behaviors are, visiting sexually transmitted infections (STIs) services regularly, adherence to STI treatment, taking an HIV test and picking up the result of HIV test. For all four behaviors, specific measures of the psychological determinants as defined by the Theory of Planned Behavior were developed: attitudes, subjective norms and perceived behavioral control (PBC). Logistic regression analyses were conducted with these three psychological measures as independent variables and the behaviors as dependent variables. RESULTS: Of the 209 waria, 20.6 % had never visited STI services in the last 6 months, while 56.5 % had visited the services once or twice, and 23 % had visited the service three or more times. A HIV test had been taken by 90.4 % of the waria, and of those, 64.6 % had picked up the results. About 85 % of the waria who did a HIV test had been tested for HIV one or two times in the last 6 months and 10 % had been tested three to four times. The variance in behaviors that was explained by the concepts defined in the Theory of Planned Behavior ranged from 15 to 70 %; PBC was the most powerful predictor. Furthermore, the results showed that in several cases the relationships of attitudes or subjective norms with the dependent variable were mediated by one or both other independent variables. CONCLUSIONS: The results regarding the prominent role of PBC suggest that interventions should increase waria's control over the behavior: Engaging in specific desired behaviors should be made easier for them. Besides, waria's attitudes and subjective norms should be addressed, by education, but possibly also by providing waria with a positive experience with the behavior, for example, by designing a professional and friendly health care system.

HIV, sexually transmitted infections, and sexual risk behavior among transgenders in Indonesia.

Behavioral surveillance was undertaken among 1,150 male-to-female transgenders (waria) in Java, Indonesia, 2007; samples were collected for HIV and STI testing (n = 748). Almost all waria had ever sold sex (median duration 10 years). Prevalence of HIV was 24.4%, syphilis 26.8% and rectal gonorrhea and/or chlamydia 47.0%. Syphilis and rectal STIs were associated with HIV infection. Consistent condom use during receptive anal sex with clients was reported by 35.9% waria and was higher among those who visited an STI clinic and who knew their HIV status. Efforts should continue to strengthen behavior change and STI care in future HIV prevention programs.

Sexual risk behaviours, HIV and other sexually transmitted infections among female sex workers in Indonesia.

OBJECTIVES: To assess the HIV/AIDS epidemic situation among female sex workers (FSW) in Indonesia using data from the 2007 Integrated Biological-Behavioural Surveillance (IBBS). METHODS: Behavioural data were collected from time-location samples of 5947 FSW in 10 cities in late 2007. HIV, syphilis, gonorrhoea and chlamydia test results were obtained for 4396, 4324, 3291 and 3316 FSW, respectively. Trends in HIV prevalence were assessed via linkage with sentinel surveillance data. Factors associated with HIV, gonorrhoea and chlamydia infection were assessed using multivariable logistic regression. RESULTS: HIV prevalence averaged 10.5% among direct and 4.9% among indirect FSW, and had increased steadily among direct FSW from 2002 to 2007. Prevalence of chlamydia, gonorrhoea and active syphilis averaged 35.6%, 31.8% and 7.3%, respectively, among direct FSW, and 28.7%, 14.3% and 3.5% among indirect FSW. Being a direct FSW, younger age and having current infection with syphilis and gonorrhoea and/or chlamydia were associated with a higher likelihood of HIV infection. Number of clients in the past week and consumption of alcohol before having sex were associated with a higher likelihood of gonorrhoea and/or chlamydia infection, while having received a STI clinic check-up in the previous 3 months and/or periodic presumptive treatment for sexually transmitted infections (STIs) in the past 6 months were associated with reduced likelihood of infection. CONCLUSIONS: The HIV/AIDS epidemic among FSW in Indonesia appears to be expanding, albeit unevenly across provinces and types of FSW. High STI prevalence is conducive to further expansion, but recent efforts to strengthen STI control appear promising.

Addressing the high prevalence of gonorrhoea and chlamydia among female sex workers in Indonesia: results of an enhanced, comprehensive intervention.

OBJECTIVES: The authors developed a comprehensive STI-control programme to decrease gonorrhoea and chlamydia prevalence, and increase consistent condom use among brothel-based sex workers in Indonesia. METHODS: The STI-control programme for brothel-based sex workers in Bintan Island (Riau Islands) and Salatiga (Central Java) included (1) provision of adequate drugs for gonorrhoea and chlamydia as periodic presumptive treatment (PPT) followed by syndromic treatment; (2) condom-use promotion by involving the local community and ensuring sufficient condom supply. Endocervical samples were collected and tested for gonorrhoea and chlamydia by PCR. Cross-sectional assessments of gonorrhoea and chlamydia prevalence, and consistent condom use with clients in the last week were made at several time points for sex workers attending the STI clinic. RESULTS: 580 sex workers participated in the programme. A steady decrease in prevalence was observed for gonorrhoea (36.1-7.6%) and chlamydia (33.7-10.2%) (both p<0.01) among sex workers in Bintan from March 2008 until June 2009. Sex workers in Salatiga showed a sharp initial decrease in prevalence, followed by an increase after provision of the old drug regimen. Gonorrhoea and/or chlamydia prevalence among those who had received at least one PPT round was lower compared with that in newcomers (p<0.01). The proportion of sex workers reporting consistent condom use doubled to 40% in June 2009 compared with November 2007 (p<0.01). CONCLUSION: The STI-control programme was effective in reducing infection prevalence and increasing condom use among sex workers. This intervention has been scaled up and may decrease national STI levels and reduce HIV transmission.

Preparatory behaviours and condom use during receptive and insertive anal sex among male-to-female transgenders (waria) in Jakarta, Indonesia.

INTRODUCTION: The male-to-female transgender (waria) is part of a key population at higher risk for HIV. This study aims to test whether psychosocial determinants as defined by the theory of planned behaviour (TPB) can explain behaviours related to condom use among waria. Three preparatory behaviours (getting, carrying, and offering a condom) and two condom use behaviours (during receptive and insertive anal sex) were assessed. METHODS: The study involved 209 waria, recruited from five districts in Jakarta and interviewed by using structured questionnaires. Specific measures were developed to study attitudes, subjective norms and perceived behavioural control (PBC) in order to predict intentions and behaviours. RESULTS: The explained variance between intentions with regard to three preparatory behaviours and two condom uses ranged between 30 and 57%, and the variance between the actual preparatory behaviours of three preparatory and two condom uses ranged between 21 and 42%. In our study, as with several previous studies of the TPB on HIV protection behaviours, the TPB variables differed in their predictive power. With regard to intention, attitude and PBC were consistently significant predictors; attitude was the strongest predictor of intention for all three preparatory behaviours, and PBC was the strongest predictor of intention for condom use, both during receptive and insertive anal sex. TPB variables were also significantly related to the second parameter of future behaviour: actual (past) behaviour. TPB variables were differentially related to the five behaviours. Attitude was predictive in three behaviours, PBC in three behaviours and subjective norms in two behaviours. CONCLUSIONS: Our results have implications for the development of interventions to target preparatory behaviours and condom use behaviours. Five behaviours and three psychological factors as defined in the TPB are to be targeted.