title: A survey on HIV-related health-seeking behaviors among transgender individuals in Jakarta, based on the theory of planned behavior.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Social Psychology Department, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1 9712 TS, Groningen, The Netherlands. 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, Grote Kruisstraat 2/1 9712 TS, Groningen, The Netherlands. arie.dijkstra@rug.nl.
authors.forename: Arie
authors.initials: A
authors.lastname: Dijkstra
authors.affiliation: Population Studies and Biostatistic Department, Faculty of Public Health, University of Indonesia, Kampus UI, Depok, 16424, West Java, Indonesia. pandu.riono@gmail.com.
authors.forename: Pandu
authors.initials: P
authors.lastname: Riono
authors.affiliation: Faculty of Psychology, University of Indonesia, Kampus UI, Depok, 16424, West Java, Indonesia. gagan.hartana@gmail.com.
authors.forename: Gagan
authors.initials: G
authors.lastname: Hartana
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D015438:Health Behavior; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D011582:Psychological Theory; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology*