Exploring Determinants of Unprotected Sexual Behaviours Favouring HIV Transmission among Men who Have Sex with Men in Yogyakarta, Indonesia

Abstract

A qualitative inquiry using individual interviews explored determinants of unprotected sexual behaviours favouring HIV transmission among Men who Have sex with Men (MSM) in Yogyakarta, Indonesia. The study was conducted in July 2015 with 24 MSM participants recruited using convenience sampling technique. Data were analysed using a qualitative data analysis framework, with the Social Cognitive Theory (SCT) employed as the study conceptual framework. Findings were grouped into a reciprocal triadic relationship involving behavioural, personal (cognitive) and environmental determinants. Behavioural determinants comprised having multiple casual sex partners, engagement in group sex and transactional sex practices. Environmental factors associated with unprotected sexual behaviours included influence of unsafe sex from regular partners and lack of access to HIV-related services. Personal (cognitive) determinants favouring unprotected sexual behaviours identified were lack of knowledge of condom and HIV/AIDS, individuals' expectation of pleasurable sexual intercourse, and low self-efficacy to discuss condom use and HIV status with casual sex partners. As effort to address HIV in MSM in Indonesia is still at its infancy, the findings of the current study are insightful and will inform the development of evidence-based programs in addressing HIV/AIDS problem in MSM populations in Yogyakarta and other similar settings.

Facilitators to Accessibility of HIV/AIDS-Related Health Services among Transgender Women Living with HIV in Yogyakarta, Indonesia

“…Such support seemed to stem from their understanding of their health conditions and needs and interdependence with one another. These findings are in conformity with previous results on the positive effects of health informational support on health service accessibility among different population groups of patients [21, 52, 53]. Besides, it should also be noted that the dissemination of HIV/AIDS-related health information among the study participants as well as Waria communities in the study setting was enabled by good social relationships and social networks among them, which is in line with the findings of previous studies by Kim and colleagues [22] and Bliezber [54].…”

Perceptions of Determinants of Condom Use Behaviors Among Male Clients of Female Sex Workers in Indonesia: A Qualitative Inquiry

“…This was confirmed by the findings of the current study, with the majority of participants reporting not using condoms at all or inconsistently using condoms during sexual encounters with their FCSW partners. Consistent with the previous findings ( Basen-Engquist, 1992 ; Fajans et al, 1994 ; Fauk, Crutzen et al, 2017 ; Hounton, Carabin, & Henderson, 2005 ; Mahoney, Thombs, & Ford, 1995 ; Voeten et al, 2002 ), the findings of this study indicate an obvious relationship between low self-perceived risk of acquiring HIV infection, low perceived severity of HIV/AIDS, and condom use behaviors among the majority of the participants. The lack of knowledge of how HIV is transmitted, how it can be prevented, and HIV/AIDS consequences was the factor supportive of low HIV self-perceived risk and low perceived severity of HIV/AIDS among the clients of FCSWs, which led to sex with inconsistent and nonuse of condoms.…”

“…Lack of information or knowledge of the existence of condoms and the lack of knowledge of protective functions of condoms depicted in this study seemed to be among the main reasons for low perceived benefits of condom use behavior among the majority of the study participants, leading to condomless sexual practices that made them vulnerable to HIV transmission. Supporting the findings of previous studies ( Fauk, Crutzen et al, 2017 ; Fauk & Mwanri, 2015 ; Lin, Simoni, & Zemon, 2005 ; Steers & others, 1996 ; Zak-Place & Stern, 2004 ), the results of this study report positive relationship between self-efficacy or the belief about one’s ability to use condoms correctly and condom use behavior among several participants. Meanwhile, the majority of study participants who did not know to use condoms correctly reported having used condoms inconsistently or not using condoms at all.…”

Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia

“…A low level of education attainment, which seemed to lead to poor health literacy, including the lack of knowledge about HIV/AIDS and preventive functions of condoms, was also a structural factor that played a role in the spread of HIV among the participants, which is consistent with previous findings of studies with different population groups [ 30 , 31 , 32 , 33 ]. It is plausible to consider health literacy among waria and transgender populations in general as an important factor to address because it affects their ability to access, understand and use health information and health system successfully to manage their own health [ 34 ].…”