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

Abstract

BackgroundMale-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.MethodsThe 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.ResultsOf 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.ConclusionsThe 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.

Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices

“…HIV prevalence among transgender women Transgender individuals are those whose gender identities and/or gender expression do not fully align with their assigned sex at birth. Many cultures around the world recognize transgender people using varied terms such as ''Kathoeys'' in Thailand [1]; ''Hijras'' in India, Bangladesh and Pakistan [2Á4]; ''Warias'' in Indonesia [5]; the ''Rae Rae's'' and ''Mahu's'' in French Polynesia [6]; and ''Travestis'' of Latin America [7]. Currently, there are no national-level estimates of the prevalence of transgender identity for any country, although India, Bangladesh, Nepal and Pakistan have recently added a third gender option to the census.…”

Nystatin Profile on Candida Species in HIV/AIDS Patients with Oral Candidiasis: A Phenomenology Study

“…The ARV administration to HIV/AIDS patients could significantly reduce oral candidiasis. Some patients in this study previously had ARV therapy, while the new HIV/AIDS patients had not received the therapy yet 21, 22 . Fungal infection was still found in most patients with antifungal therapy history, both systemic and topical 23 .…”

High perceived discrimination and no family support increase risk of poor quality of life in gender dysphoria

“…Basar et al (29) stated that high perceived discrimination, poor social support, and poor family support can affect self-esteem and gender dysphoria mental health by degrading the quality of life. Prabawanti et al (17) stated that MtF gender dysphoric individuals are often stigmatized and discriminated, forcing them to become sex workers because it is difficult to compete for employment in Jakarta, when only having a high school education. Although discriminatory acts are legally prohibited, MtF gender dysphoric individuals experience discrimination that causes difficulties in completing education, job search, housing ownership and access to general health services.…”

“…They have a low economic status (earning less than Rp 3.100.000 /month) and most live in villages, occupying a narrow boarding-house room. Research by Prabawanti et al (17) in MtF gender dysphoric individuals in DKI Jakarta showed that 42% had junior high school education, 60% were commercial sex workers (34.9% as sex worker Table 3. Factors associated with quality of life in MtF gender dysphoric individuals (n=106) Note: CI= 95% confidence interval for the mean; p*= significant association; @ Adjusted odds ratio controlled for variables for their main income and 24.4% for additional income).…”

“…The many barriers of access to education and the right to decent work cause many of the gender dysphoric individuals to be of low income and low education, and employed in sex work. Prabawanti et al (17) argues that the frequently stigmatized and discriminated MtF gender dysphoric individuals are forced to become sex workers because it is difficult to compete for decent jobs in Jakarta, with a degree of education that is limited to junior and senior high school. Despite employment opportunities, transgender individuals are often denied work because of their identity as transgender individuals and are judged as a violation of community values and norms.…”