title: Preparatory behaviours and condom use during receptive and insertive anal sex among male-to-female transgenders (waria) in Jakarta, Indonesia.
abstract: BACKGROUND
  The male-to-female transgender (waria) is part of a key population at higher risk for HIV. This study aims to test whether psychosocial determinants as defined by the theory of planned behaviour (TPB) can explain behaviours related to condom use among waria. Three preparatory behaviours (getting, carrying, and offering a condom) and two condom use behaviours (during receptive and insertive anal sex) were assessed.
  
  
  METHODS
  The study involved 209 waria, recruited from five districts in Jakarta and interviewed by using structured questionnaires. Specific measures were developed to study attitudes, subjective norms and perceived behavioural control (PBC) in order to predict intentions and behaviours.
  
  
  RESULTS
  The explained variance between intentions with regard to three preparatory behaviours and two condom uses ranged between 30 and 57%, and the variance between the actual preparatory behaviours of three preparatory and two condom uses ranged between 21 and 42%. In our study, as with several previous studies of the TPB on HIV protection behaviours, the TPB variables differed in their predictive power. With regard to intention, attitude and PBC were consistently significant predictors; attitude was the strongest predictor of intention for all three preparatory behaviours, and PBC was the strongest predictor of intention for condom use, both during receptive and insertive anal sex. TPB variables were also significantly related to the second parameter of future behaviour: actual (past) behaviour. TPB variables were differentially related to the five behaviours. Attitude was predictive in three behaviours, PBC in three behaviours and subjective norms in two behaviours.
  
  
  CONCLUSIONS
  Our results have implications for the development of interventions to target preparatory behaviours and condom use behaviours. Five behaviours and three psychological factors as defined in the TPB are to be targeted.
authors.affiliation: Social Psychology Department, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; C.Prabawanti@rug.nl; cprabawanti@gmail.com.
authors.forename: Ciptasari
authors.initials: C
authors.lastname: Prabawanti
authors.affiliation: Social Psychology Department, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: Dijkstra
authors.affiliation: Department of Population Studies and Biostatistic, Faculty of Public Health, University of Indonesia, Depok, Indonesia.
authors.forename: Pandu
authors.initials: P
authors.lastname: Riono
authors.affiliation: Faculty of Psychology, University of Indonesia, Depok, Indonesia.
authors.forename: Gagan
authors.initials: G
authors.lastname: Hartana Tb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007214:Indonesia; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D063106:Transgender Persons; D055815:Young Adult
keywords: HIV/AIDS; Indonesia; condom use; preparatory behaviours; theory of planned behaviour; transgender