The authors declare that they have no competing interests.
CP and AD were responsible for the conception and design of this study. CP and GH were responsible for the questionnaire development and adaptation in the context of Indonesia. CP and PR were responsible for selecting the sampling method, collected and assembled the data in Indonesia. CP undertook the primary data analyses under supervision of AD. CP and AD wrote the first draft of the manuscript. All authors have read and approved the final manuscript.
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.
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.
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.
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.