ABSTRACT
BACKGROUND: Successful antiretroviral therapy (ART) mainly depends on sustaining high rates of adherence. In the context of Indonesia, none of the previous studies have looked at determinants of HIV adherence among transgender populations. OBJECTIVES: This study aimed to explore factors associated with the adherence to ART among HIV-positive transgender women in Yogyakarta, Indonesia. METHODS: Face-to-face in-depth interviews with 29 transgender women, also known as Waria, living with HIV were conducted from December 2017 to February 2018. Participants were recruited using purposive and snowball sampling techniques. Data were analyzed thematically using a qualitative data analysis framework. RESULTS: Factors associated with ART adherence among transgender participants were divided into three major levels as follows: (i) individual factors, (ii) social factors, and (iii) structural factors. Feeling tired and lazy due to work, falling asleep before taking medicine, schedule to take the medicine, healthy physical condition of other HIV-positive friends who did not take antiretrovirals, and the lack of finances to travel to health facilities were the influencers of the participants' ART adherence. CONCLUSION: These findings indicate the need for the development of HIV/AIDS-related health service supporting system in health-care facilities and the dissemination of knowledge and information of HIV/AIDS and its related service for HIV-positive transgender women and other people living with HIV and general populations in other parts of the country and other similar settings globally.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Medication Adherence/psychology , Transgender Persons/psychology , Adult , Anti-Retroviral Agents/administration & dosage , Drug Administration Schedule , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility/statistics & numerical data , Health Status , Humans , Indonesia , Interviews as Topic , Male , Middle Aged , Social Stigma , Social Support , Socioeconomic FactorsABSTRACT
Background The spread of HIV infection among men in Indonesia continues to increase every year. Clients of female sex workers (FSWs) are a group at higher risk of acquiring HIV infection due to their frequent engagement in sexual acts with sex workers. This study aimed to identify factors of susceptibility to HIV infection among clients of FSWs. METHODS: A qualitative inquiry using one-on-one in-depth interviews was conducted in the Belu and Malaka districts of Indonesia from January to April 2017. The study participants (n =42) were the clients of FSWs recruited using the snowball sampling technique. The inclusion criteria were: being a client of FSWs and being aged 18 years or more. Data were analysed using a framework analysis. RESULTS: Findings were grouped into two main emerging themes that included behavioural and socioeconomic factors. Behavioural factors that mediated HIV susceptibility among clients of FSWs were: frequent engagement in unsafe sex with multiple sex workers; low perceptions of the relevance of available HIV and AIDS services and limited access to these services; and HIV stigma or fear of being labelled as HIV positive. Socioeconomic factors included: participants' economic situation; and individuals' household responsibility and ability to afford FSWs services. CONCLUSIONS: The study results indicate the need to reformulate and improve HIV and AIDS-related services, including increasing the level of availability of HIV service points and the dissemination of knowledge and information about HIV and AIDS and condom use and making them accessible to both FSWs and their clients in Belu and Malaka districts.
