Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia
Abstract
:1. Introduction
2. Methods
2.1. Conceptual and Theoretical Frameworks
2.2. Participants Recruitment Procedure
2.3. Data Collection and Ethical Consideration
2.4. Data Analysis
3. Results
3.1. Participants’ Sociodemographic Information
3.2. Structural Factors
3.2.1. Poor Economic Condition of Waria’s Families
“Our family life [economic condition] was very difficult in the village, that was the reason I decided to take care of myself and the work I could do was to be a ‘kupu-kupu malam’ [sex worker, literally means night butterfly]”.(P29, 36 years old, junior high school graduate)
“After graduating from junior high school, I started going out at night [being a sex worker] because I was aware that the economic condition of my family was difficult, and my parents could not afford to support my further schooling. I wanted to be independent and it [sex work] was the easiest work [available job she could find] I could do at that time...”.(P14, 41 years old, junior high school graduate)
“I work like this [selling sex] from afternoon to dawn because I need to help the necessities of my family and to alleviate my parents’ economic burden. You know the whole night is the time for me to work as a ‘kupu-kupu malam’”.(P2, 51 years old, did not complete elementary school)
“One of the reasons I decided to be a sex worker is to help my family, my dad and mom got sick very often and couldn’t work. They passed away few years ago. I do this because I want help my parents and my brothers and sisters”.(P23, 42 years old, senior high school graduate)
3.2.2. Limited Employment Opportunities
“Many waria choose to become sex workers because this is the easiest job we can do even though it makes us vulnerable to HIV. We do not have many choices like others [non-waria]. I do not see any opportunities for us in terms of job”.(P23, 42 years old, senior high school graduate)
“I have engaged in this work [sex work] for many years because I do not find other suitable jobs. …. Many institutions do not accept waria”.(P1, 55 years old, did not complete elementary school)
“I do not have many [employment] options to choose. I realise that because I do not have higher education background, I cannot access better employments”.(P18, 33 years old, elementary school graduate)
“It is very difficult for me to find a job, I am not eligible to get a good job because I do not have diploma or undergraduate certificate”.(P6, 50 years old, junior high school graduate)
3.2.3. Low Education Attainment Level
“I did not even complete elementary school and you know the level of knowledge of people who do not attend formal education like me and who live in the villages. I did not know anything about HIV before I was tested, and I did not search for information about it [HIV] because I did not know anything about it back in my village. I did not even know how and where to search information. So, the thoughts about HIV or condoms did not come to my mind even though I engaged in unprotected sex for many years with different people”.(P2, 51 years old, who did not complete elementary school)
“When I was at junior high school, topics like HIV or condoms were not taught, so I did not know anything at all about them. If I continued my study to university level, then I might have known and learned about these things since long time ago. I gained information about HIV, condoms and ARV therapy after the HIV diagnosis”.(P13, 47 years old, junior high school graduate)
“There was no information about HIV/AIDS or condoms at all. So, I did not know anything about HIV or condoms back in those days [before she moved to Yogyakarta]. There was not any HIV programs or activities. Now, nurses, doctors and NGOs create HIV programs and carry out activities to help HIV positive people or to educate people within communities. So, at the beginning of my engagement in this work [sex work], I was not scared of HIV and did not use condoms because I was not aware of these things. I first heard about HIV/AIDS and condoms from my friends [waria] once I moved here [Yogyakarta] and was tested HIV positive. Now, most of the time I do not use [condoms] once having sex with clients because they do not want to use, but what I can do is adhere to ARV therapy so that my viral load is undetected [suppressed] and I do not transmit it to them [sex clients]”.(P16, 55 years old, junior high school graduate)
3.3. Personal Factors: Personal Needs and Savings for the Future
“I need cash to fulfil my essential needs, so I do this [selling sex] because this the quicker way for me to earn money to support my life everyday”.(P15, 33 years old, junior high school graduate)
“…. I think of my future as well, that is why I am motivated to continue engaging in this work [sex work]. I want to earn more and save some amount I earn every night for my future. I am aware that this is a very risky work and I will not be strong forever to do this. I save some mount so that I can use to support my life once I am old and stop doing this”.(P17, 44 years old, elementary school graduate)
“If I propose it [condom use] they [sex clients] would not agree because they spend money, they pay, so they do not want to use, and I cannot do anything. On the other side, I also need to earn to support my life and help the others [her families]. So, I cannot put higher price either. … I may have got it [HIV] from any of them because of that [lack of condom use]”.(P5, 39 years old, senior high school graduate)
“I am trying to earn money every day so every time I have a client, I always ask how much money he has, if he has IDR 20,000 or IDR 30,000 (±USD 1.5 or 2) then I am okay with that. If I put the price a little bit higher and he can’t afford it then I will not get anything, I need money to support my life”.(P2, 51 years old, who did not complete elementary school)
3.4. Socioenvironmental Factors
3.4.1. Social Relationships and Influence
“All waria in the city are well connected to each other …. We meet each other almost every night at the meeting points [places to meet sex clients] …. It seems like all of us [waria] do this [engage in sex work], it is common among us. I am very sure all of us [waria] get HIV because of our work”.(P4, 39 years old, senior high school graduate)
“To be honest, all waria here go out every night [selling sex] to meet clients. Everyone [waria] is doing this [sex work], so I just do it, just like the others. Now I am still doing it [selling sex] even though I have been diagnosed with HIV. I may have got it from any of the clients, but I do not know who he is”.(P10, 53 years old, senior high school graduate)
“Initially I was asked by a friend of mine [waria] to accompany her to the meeting points with her [sex] clients. So, I know about this [sex work] through her. I accompanied her a few times and then I started to do this [selling sex]. Finally, I get this HIV”.(P27, 39 years old, junior high school graduate)
“I was told by a friend mine [waria] about this [sex work], she told me how much she earned every night, so I was tempted by the money and got involved in it. …. This [sex work] made me get HIV because clients do not want to use condoms”.(P3, 41 years old, who did not complete elementary school)
“As I have been involved in this kind of work [sex work] for many years, I am familiar with many faces at the meeting spots. I often exchange mobile number with them [sex clients], so they often call me once they need me [to have sex]. It helps us easily reach each other”.(P12, 50 years old, 50 years old, senior high school graduate)
“I go out every night [to meet clients at the meeting points] and have sex with different persons every night. So, I know many of them [sex clients], some clients exchange contact numbers with me and they can contact me at any time [for sex purposes)”.(P14, 41 years old, junior high school graduate)
3.4.2. The Living Environmental of the Participants
“There are spots to meet clients and some hotels where we can rent a room for short time [to have sex]. Everybody knows these spots and hotels”.(P29, 36 years old, junior high school graduate)
“There are many well-known spots here [Yogyakarta] to find clients. I just need to go there and wait for them [sex clients]. There are many of them who come to the meeting spots to look for us [waria]. …. If I get a [sex] client then we just need to go to nearby hotel to rent a room for short term [just for sex] and after that I go back to the meeting spot. People in the hotels already know if we [waria] want to rent a room”.(P20, 37 years old, elementary school graduate)
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Fauk, N.K.; Merry, M.S.; Siri, T.A.; Mwanri, L.; Ward, P.R. Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia. Int. J. Environ. Res. Public Health 2021, 18, 5814. https://doi.org/10.3390/ijerph18115814
Fauk NK, Merry MS, Siri TA, Mwanri L, Ward PR. Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia. International Journal of Environmental Research and Public Health. 2021; 18(11):5814. https://doi.org/10.3390/ijerph18115814
Chicago/Turabian StyleFauk, Nelsensius Klau, Maria Silvia Merry, Theodorus Asa Siri, Lillian Mwanri, and Paul Russell Ward. 2021. "Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia" International Journal of Environmental Research and Public Health 18, no. 11: 5814. https://doi.org/10.3390/ijerph18115814