122
The Role of Demographic Factors and Social Characteristics toward the Willingness to Undergo HIV
testing among Reproductive Age Women in Bandung City
1
Flora Honey Darmawan*,
2Hadayana,
3Farid Husin
1Stikes Jenderal Achmad Yani,
2Pasca Sarjana Unpad,
3Magister Kebidanan Unpad
*Email: [email protected] Abstract
HIV Voluntary Counseling and testing has been identified as the most effective way to detect HIV status. However, not all women are voluntarily access this services. This study was aimed to analyze the relationship between of demographic factor, social characteristics and the willingness to undergo HIV testing among reproductive age women in Bandung City. Research method was case control by consecutive sampling. The study was conducted in seven villages in Bandung. A samples much as 90 reproductive age women who participated in the mobile VCT, consisting of 45 respondents who are not willing to perform HIV test and 45 respondents were willing to perform HIV test. Data collected through questionnaires were analyzed by chi- square and multiple logistic regressions. Research showed all demographic factors did not shows any significant correlation with the willingness to undergo HIV testing (p>0,05) while social characteristics (lack of knowledge, the perception that she is not at risk, stigma, and lack of certainty in VCT services) were significantly correlate with the willingness to undergo HIV test (p<0,05). Based on multivariable analysis, the perception that she is not at risk was the most dominant factor in the willingness to undergo HIV testing with OR = 5,916 (CI95%:
1,563 to 22,393). It conluded demographic factors did not contributed lower the willingness to perform HIV test, while social characteristics contributed lower the willingness to perform HIV test. Perception of he/she is not at risk is a big factor towards the willingnessto perform HIV test on reproductive age women in Bandung.
Key words: Demographic factors, mobile VCT social characteristics, willingness of HIVtesting.
Introduction
Women have a heavy burden as a result of epidemic of HIV and AIDS, among others, the emergence of social stigma, discrimination, maternal morbidity and mortality. In addition, the transmission of HIV through mother to child (MTCT) tend to increase along with the increasing number of HIV-positive women were infected with their partner either from their risky behavior. Adverse effects of MTCT can be prevented when HIV in reproductive age women diagnosed early through HIV test. 1-3
Some research shows that many reproductive age women who are not willing to perform HIV test, especially those who are considered at low risk. HIV and AIDS epidemic is still dominated by injecting drug users and commercial sex users, but is expected in the next 15 years in the prevalence of high-risk groups‘ couples will also increase significantly. Therefore, early awareness of the risks of contracting HIV and AIDS in the male partner's risk needs attention considering that the focus of the research, socialization and health program focused on high-risk groups only. 4
Mobile VCT activities targeted specifically to the reproductive age women is the first pillar of the implementation of the MTCT program. Based on the reports of mobile VCT activity in 2012 found that as much as 569 reproductive age women is only 224 (39.4%) were
willing to perfom HIV test.
123 Method
The research method was quantitative analytical observational case control study (case- control). The populations were reproductive age women who stay in Bandung city and follow the activities of mobile VCT in MTCT programs at Mawar clinic of West Java in May to July 2013 period. Subjects were divided into 2 groups: 45 respondents‘ case group (reproductive age women who are not willing to perform HIV test) and 45 responder control group (reproductive age women who are willing to perform HIV test). The measurement of the independent and dependent variable used primary data. The primary data obtained by recording, interviews and questionnaires. Data collected performed logistic regression test.
Result
Characteristic of research subject
Tabel 1 Characteristic of research subject on cases control and group control Willingness to perform HIV test
Characteristic Cases (unwilling) Control (willing)
n=45 % n=45 %
Age
< 20 year 3 6,7 8 17,8
20-34 year 21 46,7 18 40,0
≥ 35 year 21 46,7 19 42,2
Education
Elementary school 6 13,3 1 2,2
Junior high school 38 84,4 34 75,6
Senior high school 1 2,2 10 22,2
College Occupation
Students 1 2,2 11 24,4
Unemployment 1 2,2 2 4,4
House wife 32 71,1 24 53,3
Employment 11 12,2 8 8,9
Marital status
Unmarried yet 7 15,6 18 40,0
38 84,4 27 60,0
Married
Viewed from the characteristics on the table 1, research subject in cases and control majority about ≥ 20 years old, secondary education (junior high school and senior high school), a housewife and married status.
1. The role of demographic factor and social characteristics towards the willingness to perform HIV test on reproductive age women
Table 2. The role of demographic factor towards the willingness to perform HIV test on reproductive age women
Variable Willingness to perform HIV test Value p* OR (IK 95%)
124 Unwilling Willing
n % n %
Age 0,671
< 20 or ≥ 35 year 24 53,3 27 60,0 0,762(0,330-
20-34 year 21 46,7 18 40,0 1,758)
Education 0,033
Less education 25 55,6 14 31,1 2,768 (1,168-
Good education 20 44,4 31 68,9 6,558)
Occupation 0,605
Unemployment 34 75,6 37 82,2 0,668 (0,240-
Employment 11 24,4 8 17,8 1,859)
Marital status 0,019
Unmarried 7 15,6 18 40,0 0,276 (0,101-
38 84,4 27 60,0 0,753)
Married
Note: based on Chi Square
Based on the table 2 above it can be seen that the less of education and unmarried status associated with willingness to perform HIV test on reproductive age women with p <0.05.
Table 3. Role of Social Characteristics towards the willingness to perform HIV Test on Reproductive Age women
Willingness to perform HIV test
Variable Unwilling Willing p Value * OR (IK 95%)
n % n %
Knowledge 0,009
Less 24 53,3 11 24,4 3,532(1,440-
Good 21 46,7 34 75,6 8,665)
Perception at risk 0,001
Not 40 88,9 25 55,6 6,400(2,130-
Yes 5 11,1 20 44,4 19,227)
Stigma
High stigma 34 75,6 18 40,0
0,001
4,636(1,877-
Low stigma 11 24,4 27 60,0 11,454)
Confidence in VCT 0,024
services 20 44,4 9 20,0 3,200(1,253-
Less 25 55,6 36 80,0 8,173)
Good
Note: * based on chi-square test
Table 3 shows that knowledge is lack, the perception that he/she is not at risk, high stigma, and less confident of VCT services associated with the willingness to perform HIV test on reproductive age women (p <0.05).
2. The role of Multivariable Analysis of Demographic factor and Social Characteristics towards the Willingness to perform HIV test Reproductive Age women
Table 4. Factors that Contribute towards The Unwillingness to Perform HIV Test on Reproductive Age Women
Variable Coefficient Value OR (IK 95%)
p**
125 0,314 1,754 (0,587-
5,240) 0,078 0,328 (0,095-
1,134) 0,032 3,358 (1,113-
10,128) 0,015 5,297 (1,377-
20,375) 0,027 3,290 (1,145-
9,452) Less confidence to VCT 1,735 0,015 5,667 (1,407-
services 22,827)
Konstanta -2,777
Stage Unmarried status -1,190 0,055 0,304 (0,090-
1,025)
Ending Less of knowledge 1,264 0,024 3,540 (1,181-
10,605) Perception that he/she is not at 1,778 0,009 5,916 (1,563-
risk 22,393)
High stigma 1,192 0,026 3,295 (1,154-
9,403) Less confidence to VCT 1,690 0,015 5,420 (1,386-
services 21,197)
Constanta -2,618
Description: ** based on logistic regression analysis, the model's accuracy 76.7%
Based on the results of the final model which are illustrated in table 4, obtained that the variable that have a role towards the willingness to perform HIV test is a variable that has a value as much as p≤0,05 knowledge, perception that he/she is at risk, stigma and confidence in the VCT services. From the results of logistic regression test it can be concluded that the perception that he/she is not at risk is the most dominant factor plays a role in the willingness to perform HIV test.
Based on PAR analysis showed as much as 80% the proportion of women who are not willing to perform HIV test can be prevented by eliminating the perception that she is not at risk of contracting HIV. In addition, 41% the proportion of women who are not willing to perform HIV test can be prevented if they have a good confidence in VCT services.
Discussion
1. The role of demographic factor towards the willingness to perform HIV test on reproductive age women
From the results, the further analysis of the differences can be concluded that there are no significant differences between demographic factors in the group who are not willing to perform HIV test and the groups that are willing to perform HIV test with p> 0.05. Statistical test showed that age, education, occupation, and marital status do not risk lowering the willingness to perform HIV test on reproductive age women (p values> 0.05).
Demographic variables classified into predisposing factors. Predisposing factors are the factors that facilitate or predispose the person's behavior. Antesenden factors predisposing factor is the behavior of the basis or motivation for behavior. Results of research is not consistent with the theory that explains that affect how the state of a person's age, increasing
Stage Less of education
0,562 Beginning Unmarried status
-1,113 Less of knowledge
1,211 Perception that he/she is not at
1,667 risk
High stigma
1,191
126 age, the experience and knowledge is increasing.5 Age is just one predisposing factors that do not stand alone in influencing the behavior of a person's health, but also influenced by other factors.
Knowledge of someone associated with the reasoning of the information related to age. In this case, the mental abilities required to learn and adjust than new situations, such as remembering ever studied, analog reasoning and creative thinking achieved pursue in the age of twenties. 6 In this research, occupation has no significant correlation with the willingness to perform HIV test. This can be said because the occupation is not a risk factor that directly influence the health of a person's behavior. In addition, the type of occupation performed by the research is not a job that can give rise to the risk of contracting HIV and AIDS, so that respondents do not need to perform HIV test. On the other hand, women who do not work have more time than women who do not. Considering the implementation of HIV test on mobile VCT that coincide with working hours and also because of the cost of HIV tests free of charge.
Marital status can affect a person's perception towards conditions experienced. The emergence of consciousness on the subject of the status is not married yet to perform HIV test can be influenced by the transition agricultural society to an industrial society and globalization in various fields, expand and increase the number of cities, the rapid advancement of communication technology, the looseness of the social structure and the structure of the family, all of whom impact on the behavior of individuals and communities, which will certainly have an impact on the risk of contracting HIV and AIDS.
The results showed that there was significant relationship between knowledge, perception that he/she is at risk, stigma, and confidence VCT services to willingness to perform HIV test (p
<0.05). Lack of knowledge, perception he/she is not at risk, high stigma, and less confidence in VCT services potentially lowers the willingness to perform HIV test on reproductive age women with OR 1 and KI above 95% does not cut the number 1. The research in the context of VCT concluded several factors influencing the willingness to perform HIV tests include lack of knowledge about the risks of HIV and the level of formal education. 7
Knowledge is something that is needed in order to change the mindset and behavior in society. Knowledge is related to the environment in which the respondent resides. In addition, exposure to the communications media will affect the level of knowledge. They may not be exposed to conditions up to date while the area where their lives far away from the hustle and accessibility, and supported with the level of education that is relatively lack.
Based on the Health Belief Model, behavioral prevention towards HIV and AIDS will arise when a person feels that he/she is at risk for contracting the disease. The vulnerability is a subjective condition so that the acceptance of the individual against HIV infection and AIDS susceptibility varies widely. Someone is likely to have a very strong vulnerability when he convinced he/she is at risk of contracting HIV and AIDS, having a friend or spouse who are at risk of HIV infection, or have a history of risky behavior. Instead, someone can be declared to have vulnerabilities that are very weak when he/she was not sure that he/she is at risk of contracting HIV and AIDS. 8-9 Stigma and discrimination towards ODHA appears to be related to ignorance about the mechanisms of HIV transmission, the estimated excess risk of contracting through casual contact, and negative attitudes toward social groups disproportionately affected by the HIV and AIDS epidemic. This is coupled with the belief that less precise (many misleading myths) that can add fear and discrimination, which can be a stigma towards ODHA and this is an obstacle in efforts to prevent and testing HIV. 10-11
VCT counselor or VCT practitioner has an effect on the willingness of HIV test. The research in Mozambique in 2009 found that the perception of the quality of health services is an important predictor of test HIV.12 Widiyanto et al in their research also suggests that beliefs about VCT has the most significant relationship to the strength of the practice VCT. 13
2. The role of Multivariable Analysis of Demographic factor and Social Characteristics towards the Willingness to perform HIV test Reproductive Age women
127 The results showed that the self-risk perception dominated the category stating that no risk of contracting HIV. In Multivariable, risk perceptions have a positive relationship with the willingness to perform HIV test at constant + 1.778. This variable is the most dominant factor role on the willingness to perform HIV test with OR = 5.916, which means that respondents with no risk of self-perception had 5.9 times greater odds for not willing to perform HIV test compared to respondents with risk perception.
The low perception of vulnerability due to the persistence of the notion that only people including to the high risk are susceptible to contracting HIV. This can happen due to lack of knowledge about how HIV is transmitted clearly. Low perception of the benefits can be caused by lack of socialization about the benefits of HIV test including HIV testing clearly, so it can make them worry about the discrimination that will be received if the HIV test results positive.
The research in North Vietnam found that the unwillingness to perform HIV test associated with a person's perception that he/she not at risk. Women do not always realize that their partner might have contracted HIV risk behaviors. It will influence the low risk perception and acceptance of HIV test on women.14 Respondents who are married have a lower risk perception than the unmarried. In addition, knowing or recognize people who are infected with HIV or died of AIDS would affect risk perception. This is possible because when someone more concerned with HIV and AIDS, he/she will understand that he/she may be at risk and realize the consequences of the disease as well as to realize the importance of prevention and testing to determine their HIV status. 15-17
Conclusion
Demographic factors that consist of age, education, occupation, and marital status, do not contribute to lower the willingness to perform HIV test on reproductive age women. Social characteristics that consist of less knowledge, perception that he/she is not at risk, high stigma, and less confidence of VCT services, contribute to lower the willingness to perform HIV test on reproductive age women. The perception that he/she is not at risk is a big factor towards the willingness to perform HIV test on reproductive age women.
Suggested for further researcher in order to minimize bias by controlling all the limitations and develop research with qualitative methods, especially the dominant role of variables. For the parties concerned, especially to Mawar Clinic at PKBI West Java in order to improve the provision of information and the knowledge that every person who has sexual intercourse, at risk for contracting HIV (growing perception that he is at risk), through various media such as advertising on radio, television, information in newspapers, leaflets, calendars, video playback, and so on. In addition, the need to develop a more effective strategy by observing the service area while maintaining privacy and social marketing methods to maintain service standards to improve public confidence in mobile VCT services.
Acknowledgment
Praise to ALLAH SWT for all the abundance of grace and love Him so that Authors can complete this study. Thanks and deepest appreciation to the counselors, beloved family prayer, encouragement and support during this time, as well as the sister of the deceased author on the wisdom and inspiration provided. Thank you to all those who cannot be mentioned one by one which has given supports, moral support, and helpful suggestions for the author. May Allah SWT give all the goodness in the world and the hereafter.
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