Nindiyastuti et al.
/ Determinants of Mobile Voluntary Counselling and Testing Determinants of Mobile Voluntary Counselling and Testing of HIV Use among Gay in Surakarta.
Central Java Nadia Ayu Irma Nindiyastuti.
Hanung Prasetya.
Bhisma Murti.
Masters Program in Public Health.
Universitas Sebelas Maret School of Health Polytechnics.
Ministry of Health Surakarta
ABSTRACT
Background: HIV infection remains a major global health problem, especially among bisexuals, men who have sex with men (MSM), and homosexuals.
The number of AIDS patients in Indonesia from January to March 2017 was 673 people, the number of HIV infections was 10,376 people, and number of AIDS death was 61 people.
The purpose of this study was to analyze the determinants of the use of mobile VCT of HIV in MSM community in Surakarta.
Central Java.
Subjects and Method: A cross sectional study was conducted in Surakarta.
Central Java, from October to November 2018.
A sample of 200 MSM was selected by fixed disease sampling, including 50 MSM who used mobile VCT service and 150 MSM who did not use mobile VCT The dependent variable was mobile VCT of HIV use.
The independent variables were intention, attitude, cues to action, perceived benefit, perceived barrier, and perceived susceptibility.
The data were collected by questionnaire and analyzed by path analysis.
Results: Mobile VCT of HIV use was directly and positively affected by intention .
= 1.
CI= 0.
73 to 2.
p<0.
, attitude .
= 1.
95% CI= 0.
43 to 2.
p= 0.
, cues to action .
= 95% CI= 0.
29 to 2.
p= 0.
, and perceived benefit .
= 1.
95% CI= 1.
04 to 2.
p<0.
It was negatively affected by perceived barrier .
= -1.
95% CI= -2.
49 to -0.
Mobile VCT use was indirectly affected by cues to action, perceived seriousness, and perceived susceptibility.
Conclusion: Mobile VCT of HIV use is directly and positively affected by intention, attitude, cues to action, and perceived benefit, but is negatively affected by perceived barrier.
Keywords: mobile VCT use.
HIV infection, determinants, men who have sex with men.
Health Belief Model Correspondence:
Nadia Ayu Irma Nindiyastuti.
Masters Program in Public Health.
Universitas Sebelas Maret.
Jl.
Ir.
Sutami No.
Surakarta.
Central Java 57216.
Email: nadiaayu21051992@gmail.
Mobile: 081252097440.
BACKGROUND
HIV infection remains a major global health problem, especially for bisexuals and men who have sex with men (MSM) or homosexuals (Damian et al.
, 2.
The number of AIDS patients in Indonesia from January to March 2017 was 673 people and the number of HIV infections was 10,376 AIDS deaths in that period were 61 In Central Java Province, there were 1,171 HIV infections, whereas since January 2018, there were 111 MSM in Surakarta who were infected with HIV.
The e-ISSN: 2549-1172 highest percentage of HIV risk factors is risky sex in MSM .
%), heterosexual .
%), others .
%), and the use of nonsterile needles in IDU .
%) (Ministry of Health, 2.
Based on the accumulation of the number of HIV / AIDS sufferers and the risk factors that are dominated by groups of female sex workers (FSW) and MSM including transgender.
HIV prevention efforts in this group are the key to the success of overcoming the HIV epidemic (WHO.
Transmission of HIV infection can Journal of Health Promotion and Behavior .
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26911/thejhpb.
be associated with unprotected anal intercourse and drug use through needles (Adam et al.
, 2.
Other factors that can influence the incidence of HIV infection among MSM are economic inequality, sexual and physical abuse, and alcohol use (Stefan et al.
, 2.
Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 87 of 2014, globally it is estimated that half of PLWHA do not know their HIV status, even PLWHA who know their HIV status are often late to check.
Lack of access to the relationship between HIV counseling and testing and treatment leads to a delay in HIV treatment that is already at the stage of AIDS.
The delay in treatment reduces the possibility of getting good results and the transmission rate remains high.
In the national policies and strategies, the concept of universal access has been established to determine HIV status, access to HIV prevention, care, support and treatment services with a vision of getting 3 zeroes, namely zero new HIV infection, zero stigma and discrimination, and zero AIDS related death ( RI Ministry of Health, 2.
HIV VCT is one of the HIV / AIDS prevention strategies.
VCT aims to identify PLWHA as early as possible and provide access to the main entrance for prevention, care, treatment and support services.
However, little is known about the factors that determine the use of VCT services (Gedefaw, 2.
The predisposing factors associated with the low participation of MSM communities in HIV testing are living in remote rural areas with health facilities (Hubach et al.
, 2.
, low socioeconomic and educational levels (Obermeyer et al.
, fear of following HIV testing (Ana et , 2.
, considered themselves not at risk of HIV infection, perception of stigma and discrimination (Stefan, 2.
, lack of trust in service providers and quality of coune-ISSN: 2549-1172 seling, and lack of support from family and society (Shrestha, 2.
In a preliminary study conducted by researchers at the Surakarta Mahardika Style Society Social Institution in March 2018, there were 3,387 MSM in Surakarta.
MSM who have attended VCT services are 2,153 people, while those who have not participated in VCT services are 1,234 Based on the problems above, the researchers wanted to examine "The determinants of the Use of Services for Mobile Voluntary Counseling and Testing in the Community of Men Who Have Sex with Men or homosexuals in Surakarta".
SUBJECTS AND METHOD
Study design This was an analytic observational study with a cross sectional design.
The study was conducted in Surakarta in November 2018.
Population and sample The population of this study was MSM community in Surakarta.
The case group in this study was MSM who used mobile VCT services amounting to 50 subjects and the control groups were MSM who did not use mobile VCT services amounting to 150 The sampling technique used in this study was fixed disease sampling.
Study variables The dependent variable was mobile VCT service use.
The independent variables were perceived seriousness, perceived susceptibility, perceived benefits, perceived barrier, cues to action, intention to use mobile VCT service, and attitude toward mobile VCT Operational definition of variables Perceived seriousness was defined as individuals consider the severity of the organic and social consequences that will occur if they continue to allow HIV / AIDS to be experienced without developing treatment Nindiyastuti et al.
/ Determinants of Mobile Voluntary Counselling and Testing from health practitioners.
The more individuals believe that a consequence will worsen, then they will feel it as a threat and take preventive action.
The measurement scale was continuous, transformed into dichotomous, 0 for low and 1 for high.
Perceived susceptibility was defined as individual experiencing HIV/AIDS is that individuals will evaluate the possibility of other health problems that will develop.
The more individuals perceive that HIV infection is at risk, it will make the individual perceive it as a threat and take treatment actions.
The measurement scale was continuous, transformed into dichotomous, coded 0 for low and 1 for high.
Perceived benefit of using VCT mobile services means that individuals judge that they will benefit when using VCT services.
Benefit perception refers to a person's judgement about the value or efficacy of doing healthy behavior to reduce the risk of experiencing illness.
The measurement scale was continuous, transformed into a dichotomous, coded 0 for low and 1 for Perceived barrier in using VCT services was individual feel obstacles when obtaining VCT services, for example in terms of cost considerations, psychological consequences .
ear of VCT test result.
, physical considerations .
istance from VCT services that are difficult to achiev.
Perceived barrier includes negative aspects of a healthy behavior and the feasibility of healthy behavior to be or cannot be done.
The measurement scale was continuous, transformed into dichotomous, coded 0 for low and 1 for high.
Cues to action was defined as the stimulus needed to trigger the decisionmaking process so that health behavior occurs, namely the use of VCT services.
Cues to action was not only external .
or example, mass media communication, e-ISSN: 2549-1172 personal interactions, information from health personne.
, but can also come from within/internally .
or example, symptoms of HIV/AIDS).
The measurement scale was continuous, transformed into dichotomous, coded 0 for low and 1 for high.
Intention in the use of mobile VCT services was defined as the desire or inclination of someone to use or not to use VCT services.
The measurement scale was continuous, transformed into a dichotomous, coded 0 for low and 1 for high.
The attitude toward mobile VCT service was defined as the opinion or judgment of a person towards VCT service.
Attitude had three components, namely affective which refers to the emotional reaction .
, behavior, and cognitive which refers to one's thoughts and beliefs.
The measurement scale was continuous, transformed into a dichotomous, coded 0 for negative and 1 for positive.
The use of mobile VCT services was defined as MSM ever (Ou1.
uses mobile VCT service.
The measurement scale was dichotomous, code 0 for no and 1 for yes.
Study Instrument The data collection is done using a questionnaire that has been tested for The reliability test was carried out with Alpha Cronbah test on 20 research Data Analysis The results of the characteristics analysis of the research subjects and univariate analysis in the form of categorical/ dichotomous data are described in the form of frequency .
and percentage (%).
The bivariate analysis was carried out using the Chi Square test.
The multivariate analysis was done using path analysis with following stages: .
Model specification, .
Model identification, .
Model suitability, .
Estimation, and .
Model re-spesification.
Journal of Health Promotion and Behavior .
, 3.
: 155-165 https://doi.
org/10.
26911/thejhpb.
Research ethics The research ethics was obtained from the Research Ethics Committee at the Faculty of Medicine.
Universitas Sebelas Maret.
Surakarta.
Central Java with number 361/UN27.
6/KEPK/2018.
Research ethics in this study include informed consent, anonymity, and confidentiality.
RESULTS
Sample characteristics Table 1 showed sample characteristics.
Most of the sample were at age Ou25 years old, education OuSenior high school .
%), and low income .
5%).
Most of the study subjects did not using mobile VCT service .
%).
Half of the study subjects had strong intention .
%).
As many as 128 study subjects had positive attitude .
%), 114 .
%) had low perceived seriousness, low perceived barrier .
5%), high perceived susceptibility .
5%), high perceived benefit .
%), and high cues to action .
%).
Table 1.
Sample characteristics Characteristics Perceived seriousness High Low Perceived susceptibility High Low Perceived benefit High Low Perceived barrier High Low Cues to action High Low Intention Strong Weak Attitude Positive Negative Mobile VCT service use Yes e-ISSN: 2549-1172 Bivariate analysis Table 2 showed bivariate analysis on the determinants of mobile VCT service use.
Table 2 showed that perceived seriousness (OR= 7.
95% CI= 3.
66 to 16.
p<0.
, perceived susceptibility (OR= 95% CI= 2.
44 to 11.
p<0.
perceived benefit (OR= 7.
95% CI= 3.
p<0.
, cues to action (OR= 95% CI= 2.
50 to 11.
p<0.
intention (OR= 5.
95% CI= 2.
64 to p<0.
, and attitude (OR= 5.
95% CI= 2.
32 to 14.
p<0.
increased mobile VCT service use.
Strong perceived barrier reduced mobile VCT service use among MSM community (OR= 0.
95% CI= 0.
12 to p<0.
Path Analysis The structural model with estimation of path analysis was shown in Figure 1.
The data were analyzed using the Stata 13.
The observed variables were 8, the endogenous variable was 6, the exogenous variable was 2, and the parameter was 8.
The formula for determining the degree of freedom, as follows: df = .
bserved variable x .
bserved variable .
) / 2 - .
ndogenous variable exogenous variable paramete.
= .
) / 2 - .
= 20 so that path analysis can be done.
The results of path analysis are shown in Table 3.
Table 3 showed the results of path analysis on the determinants of mobile VCT service use.
Mobile VCT service use was directly affected by intention, attitude, perceived benefit, perceived barrier, and cues to action.
Mobile VCT service use was directly and positively affected by cues to action and it was statistically significant.
High cues to action have a logodd score for mobile VCT service use by 1.
22 units higher than low cues to action .
= 1.
95% CI= 0.
29 to p= 0.
Nindiyastuti et al.
/ Determinants of Mobile Voluntary Counselling and Testing Table 2.
Bivariate analysis on the determinants of mobile VCT service use Mobile VCT service use Variable Yes
95% CI
Perceived seriousness High 66 Ae 16.
<0.
Low Perceived High 44 Ae 11.
<0.
Low Perceived benefit High 10 Ae 16.
<0.
Low Perceived barrier High 12 Ae 0.
<0.
Low Cues to action High 50 Ae 11.
<0.
Low Intention High 64 Ae 12.
<0.
Low Attitude Good 32 Ae 14.
<0.
Poor Figure 1.
Path model of mobile VCT service use determinants Mobile VCT service use was directly and positively affected by perceived benefit.
High perceived benefit has a logodd for e-ISSN: 2549-1172 mobile VCT service use 1.
99 higher than low perceived benefit .
= 1.
95% CI=
04 to 2.
p< 0.
Journal of Health Promotion and Behavior .
, 3.
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26911/thejhpb.
Mobile VCT service use was directly intention has a logodd for mobile VCT and positively affected by perceived barrier.
service use 1.
67 higher than low intention High perceived barrier has a logodd for .
= 1.
95% CI= 0.
73 to 2.
p<0.
mobile VCT service use 1.
58 higher than Mobile VCT service use was directly low perceived barrier .
= -1.
95% CI=and positively affected by attitude.
Positive 49 to -0.
p= 0.
attitude has a logodd for mobile VCT serMobile VCT service use was directly vice use 1.
47 higher than negative attitude and positively affected by intention.
High .
= 1.
95% CI= 0.
43 to 2.
p= 0.
Table 3.
The results of path analysis on the determinants of mobile VCT service Independent Variables Dependent Variables Direct effect Mobile VCT service use Indirect effect Perceived Seriousness Perceived Benefit Intention Attitude Perceived Susceptibility N observation= 200 Log likelihood= -718.
CI 95%
Lower Upper Limit Limit Cues to action Perceived benefit Perceived barrier Intention Attitude <0.
<0.
Cues to action Cues to action Cues to action Perceived seriousness Perceived susceptibility Cues to action Perceived seriousness Perceived seriousness Mobile VCT service use was indirectly affected by cues to action through perceived seriousness .
= 0.
95% CI= 0.
28 to 1.
p= 0.
Mobile VCT service use was indirectly affected by of cues to action through perceived benefit .
= 0.
95% CI= 0.
p= 0.
Mobile VCT service use was indirectly and positively affected by cues to action mobile VCT services through intention .
= 95% CI= 0.
55 to 1.
p= 0.
Mobile VCT service use was indirectly and positively affected by perceived seriousness through intention .
= 0.
95% CI= -0.
05 to 1.
p= 0.
Mobile VCT service use was indirectly and positively affected by perceived suscepe-ISSN: 2549-1172 Path Coefficient tibility through intention .
= 0.
95% CI=
08 to 1.
p= 0.
Mobile VCT service use was indirectly and positively affected by cues to action through attitude .
= 0.
95% CI= 0.
02 to p= 0.
Mobile VCT service use was indirectly and positively affected by perceived seriousness through attitude .
= 0.
CI= 0.
01 to 1.
p= 0.
Mobile VCT service use was indirectly and positively affected by perceived seriousness through perceived susceptibility .
= 0.
95% CI= 0.
01 to 1.
Nindiyastuti et al.
/ Determinants of Mobile Voluntary Counselling and Testing DISCUSSION The effect of cues to action on the use of mobile VCT service The result of this study showed that high cues to action could increase the use of mobile VCT services.
Cues to Action was a part of Health Belief Modelwhich was something that support the decisions in changing a behavior (Horne et al.
, 2.
Cues to actioncan come from people or events that were the reasons of behavioral or habit changes in individuals or communities.
For example, the experience of previous illness or healthy individuals who became someone's role model in acting.
MSM who knew that his community members were infected by HIV and have received information from health personnel was a strong encouragement for the MSM to use VCT service (Nareswara et al.
, 2.
The effect of perceived benefit on the use of mobile VCT service The result of this study showed that high perceived benefit could increase the use of mobile VCT service.
Perceived benefit refer to individual perceptions related to perceived benefits or advantages in reducing the risk of an illness.
Individuals or communities would conduct health behaviors if they felt the benefit from these actions to reduce threats.
Perceived benefits played an important role for individuals or groups in conducting secondary prevention behaviors, for example the use of VCT to detect HIV.
Individuals or groups who felt the benefits of VCT were more likely to use VCT services than those who did not see VCT services as a benefit (Abolfotouh.
The effect of perceived barrier on the use of mobile VCT service The result of this study showed that high perceived barrier could reduce the use of VCT services.
This perception refer to the perception of individuals or groups about e-ISSN: 2549-1172 barriers in conducting health behavior.
Individuals who felt embarrassed, lazy, afraid of being mocked by others and afraid of being gossiped by health care providers could inhibit the use of VCT services (Qiao et al,.
Other barriers including low perceived HIV risk and privacy concerns (Murphy et al.
, 2017.
Logie et al.
, 2.
The effect of intention on the use of mobile VCT service The result of this study showed that high intention could increase the use of VCT Intention would be a behavior under the control of willingness.
Willing control was the ability of a person to decide to do or not to conduct a behavior.
The intention to use VCT services was mainly due to attitude and norm (Abamecha.
Godesso.
Girma 2.
The Effect of Attitude on the Use of Mobile VCT Services The result of this study showed that good attitude toward VCT and HIV/AID service could increase the use of VCT services.
Attitude was the readiness or willingness to Attitude was an action predisposition of a behavior.
Attitudes were divided into two, namely positive attitudes and negative A positive attitude mean the tendency of actions to approach, like, and expect certain objects.
Negative attitude was indicated by a tendency to stay away from, avoid, hate, and dislike certain The majority of respondents agreed with the statement that AIDS was a disease that caused embarrassment, fear, and also could lead to death, so that the respondents were afraid to come to VCT services and find out the results of HIV test.
Respondents were afraid to meet their family or friends if they come to VCT services because they thought that they would be shunned and got bad treatment if the results of HIV test were positive or risky.
The result of this study was also supported Journal of Health Promotion and Behavior .
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26911/thejhpb.
by Pharr.
Lough, and Ezeanolue .
who stated that Respondents said that if their family or even friends knew they would spread to other friends that the respondent had sexually transmitted diseases and it would affect the respondent's daily The effect of cues to action on the use of mobile VCT services through perceived seriousness The result of this study showed that high cues to action could increase perceived Health personnel support was a supporting factor in the utilization of VCT The result of this study was in line with a study done by Wang et al.
which stated that support was in the form of information support about HIV and AIDS and also giving a motivation to conduct every step of VCT services.
Support from health personnel regarding HIV/AIDS could increase perceived seriousness of an individual on the danger of HIV/AIDS Another supporting factor was family.
Family was two or more than two individuals who were affiliated because of blood relations, marital relations or adoption and they live in one household, interact with each other, create and maintain the culture in their respective roles.
Family support can be in the form of information support, assessment support, instrumental support, and emotional support, so that family members could give attention (Washington et al.
, 2.
The effect of cues to action on the use of mobile VCT service through perceived benefit The result of this study showed that high cues to action could increase perceived Perceived benefit would tend to use VCT services.
Most of MSM did not know the benefits of VCT services so they did not conduct VCT checks.
Thus, health persone-ISSN: 2549-1172 nels were expected to be able to actively promote health regarding the importance of conducting VCT tests.
This was in line with research by Obermeyer.
Makhlouf, and Osborn .
which stated that future health promotion must strengthen the confidence among MSM.
Health promotion must target MSM and service providers.
Service providers must understand the concerns of MSM who did not know the benefits of VCT services.
Interventions were targeted to service providers to increase their knowledge of MSM sub-culture and reduce the stigmatization of MSM.
The effect of cues to action on the use of mobile VCT service through The result of this study showed that high cues to action could increase the intention in using VCT services.
This study was in line with a study by Wang et al.
which stated that communication with NGO staff related to HIV test might have reduced their concerns and increased their self-efficacy to conduct HIV test.
The perceived self-efficacy was another construct of health belief model which was significantly related to behavioral intention to use VCT services.
The effect of perceived seriousness on the use of mobile VCT service through Intention The result of this study showed that high perceived seriousness could increase the intention in using VCT services.
The result of this study was in line with a study done by Lau et al.
which stated thatgood knowledge about HIV/ADIS and VCT could affect someone's desire to visit a VCT clinic.
The better the knowledge about HIV and VCT, the more able to assess the risky behavior of HIV infection and also assume that HIV/AIDS as a serious disease that could lead to death.
The ability to assess the risk of infection and the seriousness of Nindiyastuti et al.
/ Determinants of Mobile Voluntary Counselling and Testing HIV/AIDS would encourage someone to know their HIV status, therefore, the person would have the intention to conduct VCT.
The effect of perceived susceptibility on mobile VCT use through intention The result of this study showed that high perceived susceptibility could increase the intention in using VCT services.
Health behavior change theory showed that perceived susceptability to disease preceded intentions and health protection and Individuals used their past behaviors combined with perceived susceptibility to AIDS to adjust for subsequent HIV risk behaviors (Adams et al.
, 2.
The effect of cues to action on mobile VCT use through attitude The result of this study showed that high cues to action could increase the attitude in using VCT services.
Friend's encouragement and invitation was one of the reasons for MSM in conducting VCT.
This was in line with Scott et al.
who stated that MSM who did not conduct VCT tests were more likely to happen in those who did not have cues to action.
MSM got information about HIV/AIDS and VCT from those who were engaged in HIV/AIDS prevention, namely from NGO.
KPA, and the health Information obtained in the form of HIV/AIDS were prevention, transmission, and treatment of HIV with various media, one of them was leaflets, as well as information about the benefits of VCT.
VCT process, and service place.
The effect of perceived seriousness on the use of mobile VCT service through attitude The result of this study showed that high perceived seriousness could increase the attitude in using VCT services.
According to Rosenstock .
, in line with Health Belief Model theory,someone would take e-ISSN: 2549-1172 medication or prevention if they were threatened by a severe diseases than not severe ones.
Similarly, high perceived seriousness about HIV/AIDS would make a person take precautions or early detection of the disease.
This was in line with Wang .
who stated that perceived seriousness was needed to form a threat,so that it could provoke a hazard control response .
or The effect of perceived seriousness on mobile VCT use through perceived susceptibility The result of this study showed that high perceived seriousness could increase perceived susceptibility.
The result of this study was in line with a study done by Bock .
which stated that High-risk people who used VCT felt a strong vulnerability to HIV/AIDS.
Preventive behavior toward HIV/AIDS would arise if someone felt that he/she was at risk of developing the Susceptibility was a subjective condition so that the acceptance of individuals, especially those at high risk of susceptibility to infection with HIV/AIDS might vary.
Someone might be declared to have a very strong vulnerability to HIV/ AIDS if they have the belief that they were at risk of suffering from HIV/AIDS, have friends or partners who were infected with HIV/AIDS, or have a history of behavior that was at risk of contracting to HIV/AIDS.
On the contrary, someone might be able to be declared to have a very weak vulnerability to HIV/AIDS if he/she did not have the belief that he/she was at risk of suffering from HIV/AIDS, has no friends or partners who were infected, and did not have a history of risky behavior.
High risk people who have a very strong vulnerability to HIV/AIDS were likely to be encouraged to use VCT services.
Journal of Health Promotion and Behavior .
, 3.
: 155-165 https://doi.
org/10.
26911/thejhpb.
REFERENCE