Are well-informed Waria more likely to use condoms consistently? Post hoc evaluation of a nationwide survey in Indonesia

Abstract

Background: As one of most-at risk HIV population, the growing of waria (transgender) in Indonesia as well as their sexual partner, has a huge contribution to the increase of HIV prevalence in Indonesia. Waria are at high risk of getting HIV due to unprotected anal sex. Despite the complexities of gender identity, the behaviour change-promotion programs on waria, are highly relying on the individual knowledge and awareness of HIV-AIDS to enable waria adopt safer sex practice. This study aimed to assess the association between having knowledge on HIV-AIDS and the condoms use behaviour among waria from five urban cities in Indonesia. Methods: This cross-sectional study utilised the existing database of Integrated Biological Behavioural Surveillance (IBBS) collected between February-April in 2015. Sample size was 1003 waria. The Phi and Chi-Square tests were used to assess association between waria with different knowledge of HIV and their condoms use behaviour in the last sex with the different sexual partners (p-value<0.05). Binary logistic regression analysis was performed in SPSS v.25 to identify the independent associated factors to condoms use behaviour among waria. Result: The waria in five urban cities in Indonesia were knowledgeable about HIV-AIDS with 81,5% having moderate to a high-level comprehensive knowledge of HIV-AIDS. Nevertheless, the rates of condoms use among waria were relatively low and also varied based on the type of the partners. Overall, the bivariate analysis showed that, there was a significant association between well-informed waria and the condoms use behaviour in the last sex with their permanent partners (X2=6.03; p=0.01), non-permanent-non-commercial partners (X2=11.1-23.4; p<0.001) and commercial partners (X2=9.5-15.7; p=0.002). However, the effect of the association was low and negligible (Phi 0.08-0.17). Despite the low effect of the associations, well-informed waria are 1.4 to 3.8 times more likely to use condoms compared to waria without knowledge of HIV-AIDS. Predictors of condoms use behaviour among waria were identified and varied depending on the partner type. “Get free condoms” and attitude that “always bring condoms” were found as the major associated factors to the condoms use behaviour among waria in Indonesia. Conclusion and Recommendation: The assumption that, by providing information and education about HIV may lead to consistency of condoms use does not occur as expected. In order to enable waria make an effort on choosing low-risk sexual behaviour, an increase in health literacy that enables waria fill the gap of condoms use efforts; an increase of the positive demand pressure from inside the group as well as the availability of free condoms might be an intervention option.