Next Article in Journal
The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery
Previous Article in Journal
Prevalence and Demographic Distribution of Hypermobility in a Random Group of School-Aged Children in Nigeria
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Healthcare
Volume 11
Issue 8
10.3390/healthcare11081093
healthcare-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia

by
Vimala Balakrishnan
1,*,
Kok Khuen Yong
1,
Chiong Kian Tiong
2,
Nicholas Jian Shen Ng
2 and
Zhao Ni
3,*
1
Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur 50603, Malaysia
2
Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
3
School of Nursing, Yale University, New Haven, CT 06520, USA
*
Authors to whom correspondence should be addressed.
Healthcare 2023, 11(8), 1093; https://doi.org/10.3390/healthcare11081093
Submission received: 27 January 2023 / Revised: 19 March 2023 / Accepted: 9 April 2023 / Published: 11 April 2023
Browse Figure
Versions Notes

Abstract

:
This scoping review synthesizes literature to examine the extent of research focusing on knowledge, awareness, perceptions, attitudes, and risky behaviors related to sexually transmitted infections (STIs) in Southeast Asia (SEA). The PRISMA-Scoping approach was adopted targeting articles published from 2018 to 2022, sought from CINALH, PubMed, Web of Science and Scopus. A process of screening and elimination resulted in a total of 70 articles reviewed. Most of the studies were conducted in Indonesia, Thailand, Vietnam, and Malaysia, with the majority focusing on HIV/AIDS. In general, studies examining knowledge, awareness, and risky behaviors related to STIs in SEA reported low levels across various cohorts. However, evidence suggests that these issues are more prominent among individuals with low levels of education or low socioeconomic status, those living in rural areas or those working in the sex/industrial sectors. Engaging in unsafe sex and having multiple partners are the key examples for risky sexual behavior, while fear of being rejected/discriminated/stigmatized and lacking STI awareness were identified as social risky behaviors in SEA. Overall, cultural, societal, economic and gender inequality (male dominance) greatly impact people’s knowledge, awareness, perceptions, attitudes, and risky behaviors in SEA. Education is an important factor influencing healthy behavior; therefore, this scoping review calls for increased investment in educating vulnerable populations to prevent STIs, particularly in less-developed countries/regions of SEA.

1. Introduction

Sexually transmitted infections (STIs) are caused by bacteria, viruses or parasites that spread predominantly through sexual contact including vaginal, anal, and oral sex. However, some of these diseases are known to spread through non-sexual means, such as blood or from mother to child during pregnancy and childbirth [1,2,3]. According to the World Health Organization (WHO) [4], more than 1 million STIs are acquired daily worldwide, with an estimated 374 million new infections of chlamydia, gonorrhea, syphilis, and trichomoniasis in 2020.
The prevalence of STIs is higher in low- and middle-income countries (LMIC), particularly among countries in the Southeast Asia (SEA) region. For instance, Thailand had an estimated 500,000 people living with HIV, with 12,000 people dying of AIDS-related causes in 2020 [5], and in Indonesia and Laos, HIV prevalence among individuals aged 15–49 years was reported to be growing from 2002 to 2021 at annual average rates of 8.33% and 7.89%, respectively [6]. Intervention strategies are available, though these are often hampered by low levels of knowledge and awareness, high levels of risky behaviors adopted, and a widespread stigma around STIs. As such, improving knowledge, awareness, perception, attitude, and risky behaviors about STIs is a critical component in intervention, prevention, and control strategies globally. However, there is lack of evidence in knowledge, awareness, perception, attitude, and risky behaviors among developing countries, particularly in the SEA region where STI prevalence is deemed to be high.
This scoping review aims to map the existing literature on knowledge, awareness, perceptions, attitudes, and risky behaviors related to STIs in SEA. Specifically, we aim to explore the levels of knowledge, awareness, perception, attitude, and risky behaviors, identifying the top risky behaviors, and examine the key sociodemographic factors that influence these factors across all cohorts based on publications from 2018 to 2022.

2. Materials and Method

The scoping review is part of a large review process targeting studies that have been conducted in the Asian region, focusing on knowledge, awareness, perception, attitude, and risky behaviors spanning from 2018 to 2022. A description of the method is provided below. The review follows the guidelines given in the PRISMA Extension for Scoping Reviews [7].

2.1. Research Questions

Four research questions (RQs) were formulated to guide this scoping review, as given below:
RQ1—What is the current landscape of studies reporting on knowledge, awareness, perception, attitude, and risky behaviors related to STIs in SEA?
RQ2—What are the levels of knowledge, awareness, attitude, and perception of STIs in SEA?
RQ3—What are the key sociodemographic profiles linked to knowledge, awareness, perception, attitude, and risky behaviors related to STIs?
RQ4—What are the top risky behaviors associated with STIs?

2.2. Search Strategy

Articles published from 2018 to 2022 were downloaded from four academic databases, namely PubMed, Web of Science (WoS), Scopus, and Cumulated Index to Nursing and Allied Health Literature (CINALH). The articles were limited to studies conducted within the Asian region. The main search strings are given below:
  • (sex* transm* OR STI OR STD) AND (know* OR beh* OR aware* OR attitude* OR perce* OR stigma* OR risk*)
  • (HIV OR HPV) AND (know* OR beh* OR aware* OR attitude* OR perce* OR stigma* OR risk*)

2.3. Study Selection

A total of 31,021 articles were identified based on the search strings above, and these were then filtered using the inclusion and exclusion criteria. Table 1 shows the specific criteria used for this scoping review, which resulted in the removal of 28,886 articles.
1050 duplicate entries were removed, resulting in 1085 articles. These were then examined for their appropriateness based on the titles and abstracts by three reviewers. Disagreements (if any) were resolved by the fourth reviewer. This step resulted in 513 articles. A further eligibility check was performed whereby all 513 articles were checked in entirety to ensure all the criteria in Table 1 were fulfilled. The final number of articles deemed suitable for this review was 70. The PRISMA-Scoping diagram outlining these steps are given in Figure 1.

2.4. Charting the Data

At this stage, all 70 articles were reviewed and relevant data addressing the four RQs in Section 2.1 were extracted. Specifically, details extracted include author names and year of publication, country of study, aim, cohort, focus (i.e., specific elements of knowledge, awareness, perception, attitude, and risky behaviors), instruments, and key results etc. This was accomplished by three reviewers, and the results were cross-checked by the fourth reviewer to minimize errors. The data extraction was done using Microsoft Excel.

2.5. Collating, Summarizing, and Reporting the Results

In this final stage, the outcomes of the review are summarized and presented using tables and charts as deemed fit. These are presented in the following section based on the RQs.

3. Results and Discussion

3.1. Study Characteristics

This section answers RQ1 through focusing on the current landscape of studies reporting on knowledge, awareness, perception, attitude, and risky behaviors and STIs in SEA. Table 2 shows the descriptive statistics of the studies reviewed, with the number of studies published ranging from 7 (2022) to 20 (2019). Indonesia (n = 24), Thailand (n = 21), Vietnam (n = 17), and Malaysia (n = 10) emerged to be the top four countries followed by Cambodia (n = 5). Philippines [1,8] and Singapore [8,9] had two studies each whilst only a single study was found for Myanmar and Laos [8]. No studies were found in Brunei and Timor Leste. The majority of the studies focused on HIV/AIDS (67.1%), followed by Human Papilloma Virus (HPV) (19%) and other STIs (13.9%).
The top three points of focus among knowledge, awareness, perception, attitude, and risky behaviors include knowledge (n = 43), attitude (n = 20), and risky behavior (n = 17). Five focused on perception [1,10,11,12,13], and only two on awareness [14,15]. Questionnaire surveys (n = 40) and interviews (n = 29) were the two most popular methods used in data collection. Three studies relied on existing datasets [16,17,18], while two more used the focus group method [11,12].
Most of the studies focused on students, namely those in high school (n = 10) and university (n = 9), followed by high-risk populations such as prisoners, migrants and sex workers (n = 9). Six studies were found to have targeted healthcare workers (HCWs) and (young) men having sex with men (MSM), and seven studies targeted women in general. Finally, the most common sociodemographic/behavioral factors in studies were education level (n = 28), age (n = 21), income level (n = 19), marital status (n = 11), sex (n = 9), and occupation (n = 9). Sexual behavioral risk, ethnicity, and place of birth each had five studies, while religion [19,20,21], underlying conditions [22,23,24], and an infected living partner had three studies each [22,25,26].

3.2. Levels of Knowledge, Awareness, Attitude, and Perception in SEA

To answer RQ2, we extracted the relevant data from studies that have specifically reported these figures. Table 3 provides a summary based on the topic of investigation and cohorts. A general observation shows a low level of knowledge among the studies, regardless of the cohorts and type of STIs. For example, knowledge levels for HPV were low not only among rural women [1], but university students as well [14]. Interestingly, the latter found Malaysian university students were only moderately aware, as 59.8% have heard about HPV (n = 425), with women having a marginally higher knowledge than men. An almost equal split of knowledge level was observed in Indonesia among 400 urbanites (50.8%), although a higher percentage (82%) reported a positive attitude towards regular HPV screenings.
It is noteworthy that high levels of knowledge about HIV/AIDS have been reported among high school students (96%) [31] and women (88.7%) [33]. For example, Rahman and his colleagues found that most of their participants had obtained knowledge about HIV/AIDS from mass media, evidenced by the high percentage of the use of television in providing such information. As for [33], the high knowledge level was mainly due to women’s demographic profiles, whereby most had high levels of education, wealth index and exposure to media/information/knowledge etc. Interestingly, the authors found that despite having a high HIV/AIDS knowledge, there is an overall negative attitude towards people living with HIV/AIDS (PLWHA) (i.e., 60.28%), thus showing that a high proportion of people with knowledge does not translate to more positive attitudes. Contrarily, another Indonesian study among 209 dentists found that only about 44% had good knowledge of HIV/AIDS, though slightly more than half the sample (53%) had a positive attitude towards PLWHA [32]. The authors agreed that the attitude score is deemed low (negative) considering that the cohort under-study is HCW, and thus they should be less discriminatory in treating PLWHA. In conclusion, findings show more education and awareness are needed to increase individuals’ knowledge, awareness, attitude, and perception to eliminate HIV-related stigma and discrimination in SEA.
In a study conducted among 60 female inmates of women shelters in Malaysia, the findings were mixed. While only 33% of the participants had good knowledge of STIs, they had an average score of 23.1 out of 25 for attitude towards STIs [18], indicating that most participants agreed they would oppose premarital sex and multiple sex partners, and would seek medical help if diagnosed with STIs. The authors generally found that many of the females opposed pre-marital sex (including people with STIs) and multiple sex partners, as well as acceptance of treatment if one is infected. Surprisingly, despite a negative attitude toward having multiple sex partners, almost half of the sample (n = 43) reported to have had more than one partner in the last three years. Such findings indicate that having sufficient knowledge alone does not necessarily guarantee an individual’s safe sexual practice.

3.3. Sociodemographic Profiles

Table 4 presents the summary of the sociodemographic profiles affecting the levels of knowledge, awareness, attitude, or perception related to STIs, as per RQ 3. It is noted that a study is listed in Table 4 if it reports at least one significant result (p < 0.05) for knowledge, awareness, attitude, or perception. Categorization as high or low is determined by the respective studies.
Based on the sex profile, most of the studies reported females to have higher levels of knowledge, awareness, attitude, and perception compared to males (n = 7). It is to noted however that a fair comparison is not possible, as many of these studies had a skewed distribution whereby females outnumbered males [10,40,43]. Additionally, some of these studies also specifically targeted female participants [1,14,39]. Nevertheless, some of the reasons provided by researchers for a lower level of knowledge and awareness among males include having a more uninvolved parenting style or lower parental monitoring, as well as more sex approval (for younger males/boys), and thus there is a lack of responsible communication on STIs among this cohort [40].
Most of the studies also show higher levels of knowledge, awareness, attitude, and perception among those with a higher education (n = 12), akin with higher socioeconomic status [2,9]. It is claimed that individuals with a higher education level (regardless of their cohorts) are better in accurately reading, processing, and understanding written and verbal information from sources such as newspapers, magazines, health pamphlets etc. Furthermore, such individuals are more exposed to social media and are more adept in seeking information related to STIs, unlike those with a lower education level. Being in a higher socioeconomic stratum also indicates that such individuals have means to own/access media such as technology devices (smartphones, computer, tablets), Internet access and/or televisions, and thus have better access to educational programmes pertaining to STIs [1,2,35].
Higher education and socioeconomic status can be linked to living area as well, with the majority of studies reporting a higher level of knowledge, awareness, attitude, and perception among urbanites [2,27] as opposed to those living in rural areas [39]. Individuals living in urban areas are known to have better access to information through the Internet, healthcare centers, NGOs etc., a notion supported by other studies reporting individuals with better accessibility to medical device and information as having higher levels of knowledge, awareness, attitude, and perception [25,44,46,48,49] than those without [39,42].
In terms of religiosity, studies involving participants from conservative nations such as Malaysia [20] or Muslim/Christian participants reported low levels of knowledge, awareness, attitude, and perception. For example, university students in Malaysia reported the absence of a comprehensive education of sex, relationships, and STIs, with teachers preaching abstinence. In fact, openly discussing the practicalities of safe sex and condom use, for example, is deemed as taboo in the country [20]. Being a Christian woman was found to have a significant association with a low level of HPV knowledge [41], most likely as staunch Catholics abstain from pre-marital sex, and thus do not seek information pertaining to said disease. In contrast, a study conducted in Laos reported that participants who followed any religion that accepts the use of birth control had higher levels of knowledge and awareness regarding STIs [35].
Finally, results based on participants’ occupation status revealed healthcare professionals, including medical students, to have a higher level of knowledge, awareness, attitude, and perception—a pattern that is absolutely expected considering their background [11,14,17,32]. Contrarily, the knowledge level was found to be extremely low among professions such as industrial workers (migrants) [42] and sex workers [29,50]. For example, [42] found a low average score for STI knowledge among 289 industrial workers in Vietnam. Similarly, [29] found a very low level of STI knowledge among male sex workers, especially among those who started serving clients at a young age, and therefore have not been exposed to safe sex practices. Overall, research suggests that lower levels of knowledge, awareness, attitude, and perception regarding STIs tend to be among socioeconomically disadvantaged populations, particularly in less developed countries/regions such as Vietnam [42] and Indonesia [29,50]. This is probably due to gaps in policies and healthcare access targeting these vulnerable cohorts, and thus the findings suggest the need for a higher investment in educational interventions to promote STI knowledge in this population. Providing stronger incentives for local community HCWs and NGOs to educate these individuals about STIs prevention and sexual health may also help promote higher knowledge.

3.4. Risky Behaviors and STIs

This final subsection addresses RQ4 by focusing on the risky behaviors related to STIs. We categorize these behaviors as sexual (e.g., multiple sexual partners and having unprotective sex) and social, for any behaviors that are not directly related to sexual activities such as discrimination or stigmatization [26,51]. Table 5 presented the social and sexual risky behaviors reported in studies conducted in SEA.
For risky sexual behaviors, the two most prominent behaviors include having unsafe sex (n = 15) and having multiple sexual partners (n = 12), both of which were mainly reported by studies targeting vulnerable/high-risk cohorts, including (Y)MSM and transgender people [26,53,54,59], female sex workers (FSW) and their clients [50,55,56], adolescents [13,40,51,52], and HIV-positive individuals [57,58]. For instance, a study involving 506 HIV individuals in Vietnam found that 83.2% of participants engage in sex without using a condom, and 27.9% had multiple sex partners. Studies specifically focusing on FSWs and their clients [50,55,56] show a very low negotiation in condom use—a behavior that was found to be significantly associated with HIV-risk sexual behavior. A low proportion of FSWs negotiating condom use in Indonesia [50,56] and Vietnam [55] reflects a cultural issue where male dominance determines the final decision on condom use or safe sex.
Interestingly, having unprotected sex and/or multiple sex partners were reported to be more common among male adolescents [40,52] and university students [8]. Such a tendency was particularly noted among boys with low parental control/monitoring [40] and male students who live away from their parents [8], thus suggesting that these individuals choose to engage in sexual risky behaviors due to a sense of freedom. Furthermore, this also provides an insight into a potentially risky environment in the community, particularly norms regarding males’ sexual behavior. An interesting point to note is that despite being young, the dominance of men in influencing condom use is profound in SEA. Unprotected sex and having multiple sex partners are often reported as root causes of STIs, and therefore urgent interventions, including at the school level, are necessary.
In the context of risky sexual behaviors, fear of being rejected/stigmatized/discriminated against (n = 4) and lacking knowledge and awareness emerged as the top two most-reported behaviors (n = 9). Lack of awareness/knowledge about STIs was not limited to high-risk or vulnerable cohorts, though they were also observed among youths and students [20,49]. For instance, Malaysian university students reported a lack or absence of sex education, particularly during their teenage years, with the majority relying on the Internet or teachers who informally preach abstinence without any discussion of the practicalities of condom use and safe sex. A similar observation was made by [49], based on a large-scale study involving 22,864 youths in Indonesia, with results indicating a mere 14.1% having knowledge of HIV. Similar to the Malaysian participants, more than half the sample relied on peers or oneself for sex-related discussions. One of the main reasons for this could be religion, with both countries being mostly populated by Muslims, and thus, tending to be more conservative. These findings further emphasize the importance of sex education being introduced to age-appropriate children, and implemented based on the sensitivity of cultural norms, local beliefs, and practices.
Fear of rejection/stigmatization/discrimination was also identified as a key risky social behavior for STIs. Individuals who are at a higher risk in contracting STIs were reported to be afraid to seek information or help from the society with matters pertaining to these diseases for fear of being stigmatized by society—a phenomenon particularly observed among cohorts such as FSW clients [56] and female migrant workers [19]. For example, female migrant workers (n = 18) in Thailand refrained from disclosing to having multiple sexual partners to their husbands/community for fear of marital conflict, resulting in them living in secrecy and engaging in unsafe sex (low condom use negotiation), with the latter also suggesting that male dominance over women influenced decision-making for safe sex [19]. A similar observation was also noted among university students in Malaysia where participants reported avoiding seeking STI-related information or going for free HIV testing (especially in government health centers) for fear of being discriminated or judged [20]. Such environments, including societal perception, undermine STI prevention, thus leading to increased levels of risky behavior.
Various other risky behaviors were reported, such as difficulty in purchasing condoms [20], substance/alcohol use [40,50,57], and partner/childhood sex abuse [23,52], among others. Other risky behaviors that are related to HIV transmission, such as injecting drugs [22,61] and sharing needles [37], were also reported. Interestingly, difficulty in purchasing condoms was reported in a study among Malaysian university students [20], with the participants mainly citing embarrassment associated with purchasing condoms as a barrier to their use in preventing HIV transmission, as buying condoms is often seen as a taboo—another pattern observed in a conservative nation. Substance/alcohol abuse, particularly consumption prior to engaging in sexual activities, was found to be associated with sexual and social risky behaviors [22,40,50,57]. For example, FSWs who had high levels of alcohol consumption (before or during sex) tend to engage in unsafe sex, as their abilities to negotiate safe sex (using condoms) are affected, along with the desire to use them [50]. Men and women who consume drugs such as heroin and crystal meth were also found to engage in high-sexual risk behaviors [22,23]. Findings generally show that sexual intercourse under the influence of drugs/alcohol reduces an individual’s self-control of sexual behaviors, leading to impulsive risky sexual behavior.

4. Conclusions

The scoping review examined the knowledge, awareness, perception, attitude, and risky behaviors related to STIs in SEA based on scientific papers published in the last five years. Most studies were conducted in Indonesia, Thailand, Vietnam, and Malaysia, and reported on various cohorts such as high-risk populations (i.e., MSMs, FSWs, migrant workers), adolescents, students, HCWs, and women. Low levels of knowledge and awareness, as well as negative perceptions and attitudes, were reported by the majority of the studies—a pattern that is particularly profound among individuals with low levels of education and low socioeconomic status, rural residents, and sex workers. Most high-risk populations were found to engage in unsafe sex practices, including having multiple partners, due to a low condom use negotiation skill, which were further exacerbated by alcohol/substance abuse, as well as a lack of awareness and education on STIs and safe sex practices. The review highlights the urgent need for targeted interventions to improve STI education, access to resources, and addressing substance abuse, which are important to mitigate the spread of STIs in SEA.

Author Contributions

Conceptualization, formal analysis, supervision, drafting and revision, V.B.; Formal analysis, resources, editing and project administration, K.K.Y., C.K.T. and N.J.S.N.; drafting and revision, Z.N. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Imoto, A.; Honda, S.; Llamas-Clark, E.F. Human Papillomavirus and Cervical Cancer Knowledge, Perceptions, and Screening Behavior: A Cross-Sectional Community-Based Survey in Rural Philippines. Asian Pac. J. Cancer Prev. APJCP 2020, 21, 3145–3151. [Google Scholar] [CrossRef] [PubMed]
  2. Son, N.V.; Luan, H.D.; Tuan, H.X.; Cuong, L.M.; Duong, N.T.T.; Kien, V.D. Trends and Factors Associated with Comprehensive Knowledge about HIV among Women in Vietnam. Trop. Med. Infect. Dis. 2020, 5, 91. [Google Scholar] [CrossRef] [PubMed]
  3. Rahman, M.M.; Arif, M.T.; Safii, R.; Tambi, Z.; Jantan, Z.; Ismail, M.F. Perceived Knowledge, Attitude towards HIV/AIDS, and Sexual Behavior among Migrant Workers in Malaysia: A Structural Path Analysis. HIV AIDS Rev. 2021, 20, 213–222. [Google Scholar] [CrossRef]
  4. World Health Organization. Sexually Transmitted Infections (STIs). Available online: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections--(stis) (accessed on 20 December 2022).
  5. Manosuthi, W.; Charoenpong, L.; Santiwarangkana, C. A Retrospective Study of Survival and Risk Factors for Mortality among People Living with HIV Who Received Antiretroviral Treatment in a Resource-Limited Setting. AIDS Res. Ther. 2021, 18, 71. [Google Scholar] [CrossRef]
  6. World Data Atlas. Indonesia—Prevalence of HIV as a Share of Population Aged 15–49. Available online: https://knoema.com/atlas/Indonesia/HIV-prevalence (accessed on 22 December 2022).
  7. Tricco, A.C.; Lillie, E.; Zarin, W.; O’Brien, K.K.; Colquhoun, H.; Levac, D.; Moher, D.; Peters, M.D.J.; Horsley, T.; Weeks, L.; et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann. Intern. Med. 2018, 169, 467–473. [Google Scholar] [CrossRef] [Green Version]
  8. Yi, S.; Te, V.; Pengpid, S.; Peltzer, K. Social and Behavioural Factors Associated with Risky Sexual Behaviours among University Students in Nine ASEAN Countries: A Multi-Country Cross-Sectional Study. SAHARA-J J. Soc. Asp. HIV/AIDS 2018, 15, 71–79. [Google Scholar] [CrossRef] [Green Version]
  9. Tan, R.K.J.; Teo, A.K.J.; Kaur, N.; Harrison-Quintana, J.; I-Cheng Chen, M.; Wong, C.S. Cost and Anonymity as Factors for the Effective Implementation of Pre-Exposure Prophylaxis: An Observational Study among Gay, Bisexual and Other Men Who Have Sex with Men in Singapore. Sex. Health 2018, 15, 533. [Google Scholar] [CrossRef]
  10. Badgujar, V.B.; Ahmad Fadzil, F.S.; Balbir Singh, H.K.; Sami, F.; Badgujar, S.; Ansari, M.T. Knowledge, Understanding, Attitude, Perception and Views on HPV Infection and Vaccination among Health Care Students and Professionals in Malaysia. Hum. Vaccines Immunother. 2018, 15, 156–162. [Google Scholar] [CrossRef] [Green Version]
  11. Susanto, T.; Rif’ah, E.N.; Susumaningrum, L.A.; Rahmawati, I.; Yunanto, R.A.; Evayanti, N.L.P.; Utami, P.A.S. Human Papillomavirus Vaccine Acceptability among Healthcare Workers, Parents, and Adolescent Pupils: A Pilot Study in Public Health Centers of Bali, Indonesia. Germs 2020, 10, 184–194. [Google Scholar] [CrossRef]
  12. Spagnoletti, B.R.M.; Bennett, L.R.; Wahdi, A.E.; Wilopo, S.A.; Keenan, C.A. A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java, Indonesia: Understanding Community Readiness for Prevention Interventions. Asian Pac. J. Cancer Prev. 2019, 20, 2429–2434. [Google Scholar] [CrossRef] [Green Version]
  13. Thapa, R.; Yang, Y.; Nget, M. Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men. Am. J. Men’s Health 2019, 13, 155798831984857. [Google Scholar] [CrossRef] [Green Version]
  14. Widjaja, V.N. Awareness, Knowledge and Attitudes of Human Papillomavirus (HPV) among Private University Students- Malaysia Perspective. Asian Pac. J. Cancer Prev. 2019, 20, 2045–2050. [Google Scholar] [CrossRef] [Green Version]
  15. Shafik, N.; Deeb, S.; Srithanaviboonchai, K.; Ayood, P.; Malasao, R.; Siviroj, P.; Musumari, P.M.; Wood, M.M. Awareness and Attitudes toward HIV Self-Testing in Northern Thailand. Int. J. Environ. Res. Public Health 2021, 18, 852. [Google Scholar] [CrossRef]
  16. Kurniawati, H.F.; Kurniawati, H. Characteristics, Source of Information and Knowledge of Housewives about Transmission of HIV and Aids. Pak. J. Med. Health Sci. 2021, 15, 555. [Google Scholar]
  17. Sianturi, E.I.; Latifah, E.; Pane, M.; Perwitasari, D.A.; Satibi; Kristina, S.A.; Hastuti, E.B.; Pavlovich, J.; Taxis, K. Knowledge, Empathy, and Willingness to Counsel Patients with HIV among Indonesian Pharmacists: A National Survey of Stigma. AIDS Care 2021, 34, 21–28. [Google Scholar] [CrossRef]
  18. Zin, N.M.; Ishak, I.; Manoharan, K. Knowledge, Attitude and Practice towards Sexually Transmitted Diseases amongst the Inmates of Women Shelters Homes at Klang Valley. BMC Public Health 2019, 19, 639. [Google Scholar] [CrossRef] [Green Version]
  19. Ayuttacorn, A.; Tangmunkongvorakul, A.; Musumari, P.M.; Srithanaviboonchai, K.; Jirattikorn, A.; Aurpibul, L. Disclosure of HIV Status among Shan Female Migrant Workers Living with HIV in Northern Thailand: A Qualitative Study. PLoS ONE 2019, 14, e0216382. [Google Scholar] [CrossRef]
  20. Burch, W.J.; Hart, G.J.; Lim, S.H. A Qualitative Study of Young Men Who Have Sex with Men and Multilevel Factors Related to HIV Risks in Malaysia. AIDS Educ. Prev. 2018, 30, 85–95. [Google Scholar] [CrossRef]
  21. Grandahl, M.; Chun Paek, S.; Grisurapong, S.; Sherer, P.; Tydén, T.; Lundberg, P. Parents’ Knowledge, Beliefs, and Acceptance of the HPV Vaccination in Relation to Their Socio-Demographics and Religious Beliefs: A Cross-Sectional Study in Thailand. PLoS ONE 2018, 13, e0193054. [Google Scholar] [CrossRef] [Green Version]
  22. Ngor, C.; Sopheab, H.; Mam, S.; Gorbach, P.; Chhea, C. Factors Associated with Sexual Risk Behaviors among People Who Use Drugs in Communities in Cambodia. Asia Pac. J. Public Health 2019, 31, 335–347. [Google Scholar] [CrossRef]
  23. Stoicescu, C.; Cluver, L.D.; Spreckelsen, T.; Casale, M.; Sudewo, A.G.; Irwanto. Intimate Partner Violence and HIV Sexual Risk Behaviour among Women Who Inject Drugs in Indonesia: A Respondent-Driven Sampling Study. AIDS Behav. 2018, 22, 3307–3323. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Tuot, S.; Teo, A.K.J.; Chhoun, P.; Mun, P.; Prem, K.; Yi, S. Risk Factors of HIV Infection among Female Entertainment Workers in Cambodia: Findings of a National Survey. PLoS ONE 2020, 15, e0244357. [Google Scholar] [CrossRef] [PubMed]
  25. Nguyen, S.; Dang, A.; Vu, G.; Nguyen, C.; Le, T.; Truong, N.; Hoang, C.; Tran, T.; Tran, T.; Pham, H.; et al. Lack of Knowledge about Sexually Transmitted Diseases (STDs): Implications for STDs Prevention and Care among Dermatology Patients in an Urban City in Vietnam. Int. J. Environ. Res. Public Health 2019, 16, 1080. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  26. Seekaew, P.; Pengnonyang, S.; Jantarapakde, J.; Meksena, R.; Sungsing, T.; Lujintanon, S.; Mingkwanrungruangkit, P.; Sirisakyot, W.; Tongmuang, S.; Panpet, P.; et al. Discordance between Self-Perceived and Actual Risk of HIV Infection among Men Who Have Sex with Men and Transgender Women in Thailand: A Cross-Sectional Assessment. J. Int. AIDS Soc. 2019, 22, e25430. [Google Scholar] [CrossRef] [PubMed]
  27. Winarto, H.; Habiburrahman, M.; Dorothea, M.; Wijaya, A.; Nuryanto, K.H.; Kusuma, F.; Utami, T.W.; Anggraeni, T.D. Knowledge, Attitudes, and Practices among Indonesian Urban Communities Regarding HPV Infection, Cervical Cancer, and HPV Vaccination. PLoS ONE 2022, 17, e0266139. [Google Scholar] [CrossRef]
  28. Koning, S.M.; Flaim, A.; Baldiga, L.; Feingold, D.A. Legal Status as a Life Course Determinant of Health: Parent Status, Adjudication Stages, and HIV Knowledge among Highlanders in Thailand. BMC Public Health 2021, 21, 1839. [Google Scholar] [CrossRef]
  29. Kurniawan, D.E.; Ardiana, A. Characteristics of Socio-Demography among Male Sex Worker (MSW) Who Serve Men and Their Knowledge of HIV/AIDS in Pendalungan- Agricultural Area of Jember, Indonesia. High. Educ. 2021, 15, 275. [Google Scholar]
  30. Kusuma, M.T.P.L.; Kidd, T.; Muturi, N.; Procter, S.B.; Yarrow, L.; Hsu, W.-W. HIV Knowledge and Stigma among Dietetic Students in Indonesia: Implications for the Nutrition Education System. BMC Infect. Dis. 2020, 20, 663. [Google Scholar] [CrossRef]
  31. Nurjihan, T.F.; Rahman, T.A.; Rahman, N.A.A.; Shafri, M.A.M.; Haque, M. The Knowledge, Attitude, and Practice Regarding Pap Smear, Cervical Cancer, and Human Papillomavirus among Women Attending a Mother and Child Health Clinic in Kuantan, Malaysia. Indian J. Med. Paediatr. Oncol. 2019, 40, 193. [Google Scholar] [CrossRef]
  32. Sufiawati, I.; Rafi, M.A.; Putri, F.M. Evaluating Knowledge, Attitude, and Behavior of Dentists on HIV/AIDS in West Java, Indonesia, in the COVID-19 Era. Int. J. Dent. 2021, 2021, 1901887. [Google Scholar] [CrossRef]
  33. Virdausi, F.D.; Efendi, F.; Kusumaningrum, T.; Adnani, Q.E.S.; McKenna, L.; Ramadhan, K.; Susanti, I.A. Socio-Economic and Demographic Factors Associated with Knowledge and Attitude of HIV/AIDS among Women Aged 15–49 Years Old in Indonesia. Healthcare 2022, 10, 1545. [Google Scholar] [CrossRef]
  34. Nguyen, D.N.; Vu, H.M.; Nguyen, Q.N.; Nguyen, C.T.; Do, H.T.; Vu, T.M.T.; Tran, B.X.; Latkin, C.A.; Ho, C.S.H.; Ho, R.C.M. Gaps of Knowledge about HIV and Sexually Transmitted Infections among Industrial Workers in Northern Vietnam. AIDS Behav. 2021, 26, 188–195. [Google Scholar] [CrossRef]
  35. Inthavong, K.; Ha, L.T.H.; Anh, L.T.K.; Sychareun, V. Knowledge of Safe Sex and Sexually Transmitted Infections among High School Students, Vientiane Prefecture, Lao PDR. Glob. Health Action 2020, 13, 1785159. [Google Scholar] [CrossRef]
  36. Mansor, N.; Ahmad, N.; Rahman, H.A. Determinants of Knowledge on Sexually Transmitted Infections among Students in Public Higher Education Institutions in Melaka State, Malaysia. PLoS ONE 2020, 15, e0240842. [Google Scholar] [CrossRef]
  37. Singkun, A.; Kallawicha, K.; Yamarat, K. Risk of HIV/STIs among Muslim Army Conscripts in the Three Deep Southern Provinces of Thailand. Health Promot. Perspect. 2021, 11, 444–451. [Google Scholar] [CrossRef]
  38. Helda, H.; Muchlisa, N. Attitudes Concerning Sexual Behavior towards Risky Sexual Behavior of Sexual Transmitted Infections among Male Adolescents in Indonesia. Kesmas J. Kesehat. Masy. Nas. (Natl. Public Health J.) 2021, 16, 131–136. [Google Scholar]
  39. Efendi, F.; Pratama, E.R.; Hadisuyatmana, S.; Indarwati, R.; Lindayani, L.; Bushy, A. HIV-Related Knowledge Level among Indonesian Women between 15 Years and 49 Years of Age. Afr. Health Sci. 2020, 20, 83–90. [Google Scholar] [CrossRef]
  40. Hayee, F.; Fongkaew, W.; Chanprasit, C.; Kaewthummanukul, T.; Voss, J.G. Sexual Risk Behaviors and Influencing Factors among Muslim Adolescents on Southern Border of Thailand. Int. J. Adolesc. Med. Health 2020, 33, 469–477. [Google Scholar] [CrossRef]
  41. Likitdee, N.; Kietpeerakool, C.; Chumworathayi, B.; Temtanakitpaisan, A.; Aue-aungkul, A.; Nhokaew, W.; Jampathong, N. Knowledge and Attitude toward Human Papillomavirus Infection and Vaccination among Thai Women: A Nationwide Social Media Survey. Asian Pac. J. Cancer Prev. 2020, 21, 2895–2902. [Google Scholar] [CrossRef]
  42. Van Nguyen, L.; Nguyen, T.N.P.; Thach, A.N.; Lam, A.N.; Lam, D.Q.; Duong, C.X.; Pham, S.T.; Nguyen, T.H.; Perwitasari, D.A.; Taxis, K.; et al. Knowledge of Antiretroviral Treatment and Associated Factors in HIV-Infected Patients. Healthcare 2021, 9, 483. [Google Scholar] [CrossRef]
  43. Chanprasertpinyo, W.; Rerkswattavorn, C. Human Papillomavirus (HPV) Vaccine Status and Knowledge of Students at a University in Rural Thailand. Heliyon 2020, 6, e04625. [Google Scholar] [CrossRef] [PubMed]
  44. Hoang, C.D.; Tran, B.X.; Pham, M.D.; Nguyen, L.H.; Do, H.N.; Vuong, Q.H.; Ho, M.T.; Dam, V.N.; Vuong, T.T.; Nguyen, H.H.; et al. HIV- and AIDS-Related Knowledge and Attitude of Residents in Border Regions of Vietnam. Harm Reduct. J. 2019, 16, 11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  45. Nguyen, T.M.T.; Tran, B.X.; Fleming, M.; Pham, M.D.; Nguyen, L.T.; Nguyen, A.L.T.; Le, H.T.; Nguyen, T.H.; Hoang, V.H.; Le, X.T.T.; et al. HIV Knowledge and Risk Behaviors among Drug Users in Three Vietnamese Mountainous Provinces. Subst. Abus. Treat. Prev. Policy 2019, 14, 3. [Google Scholar] [CrossRef] [PubMed]
  46. Sahiratmadja, E.; Raharja, M.B.; Setiawati, E.P.; Panigoro, R. Poor Knowledge of Anemia and Sexually Transmitted Disease but Better Knowledge of HIV/AIDS among Unmarried Adolescents Aged 15–24 Years. Universa Med. 2021, 40, 110–120. [Google Scholar] [CrossRef]
  47. Taqiyuddin, N.; Mahdani, F.Y.; Ernawati, D.S.; Surboyo, M.D.C.; Rizka, A.; Azzaim, Y.A. Knowledge, Attitude, and Behavior of Clinical Dental Students in the Oral Care of HIV/AIDS Patients. J. Health Allied Sci. NU 2022, 13, 206–211. [Google Scholar] [CrossRef]
  48. Tiranda, M.; Setiyawati, N.; Rahmawati, A. Adolescents’ Attitude toward HIV/AIDS Prevention in Yogyakarta. Kesmas Natl. Public Health J. 2018, 13, 65–69. [Google Scholar] [CrossRef]
  49. Wirawan, G.B.S.; Gustina, N.L.Z.; Januraga, P.P. Open Communication about Reproductive Health Is Associated with Comprehensive HIV Knowledge and a Non-Stigmatising Attitude among Indonesian Youth: A Cross-Sectional Study. J. Prev. Med. Public Health 2022, 55, 342–350. [Google Scholar] [CrossRef]
  50. Khumaidi, K.; Yona, S.; Waluyo, A. Condom-Use Negotiation, Alcohol Consumption, and HIV-Risk Sexual Behavior among Female Sex Workers in Kupang, East Nusa Tenggara, Indonesia: A Cross-Sectional Study. J. Public Health Res. 2021, 10, 2334. [Google Scholar] [CrossRef]
  51. Saowaluck, S.; Warunee, F.; Nongkran, V.; Waraporn, B.; Voss, J.G. Competitive Sexual Risk-Taking Behaviors among Adolescents in Northern Thailand. Pac. Rim Int. J. Nurs. Res. 2019, 23, 61–73. [Google Scholar]
  52. Thepthien, B.; Celyn. Risky Sexual Behavior and Associated Factors among Sexually-Experienced Adolescents in Bangkok, Thailand: Findings from a School Web-Based Survey. Reprod. Health 2022, 19, 127. [Google Scholar] [CrossRef]
  53. Khawcharoenporn, T.; Mongkolkaewsub, S.; Naijitra, C.; Khonphiern, W.; Apisarnthanarak, A.; Phanuphak, N. HIV Risk, Risk Perception and Uptake of HIV Testing and Counseling among Youth Men Who Have Sex with Men Attending a Gay Sauna. AIDS Res. Ther. 2019, 16, 13. [Google Scholar] [CrossRef]
  54. Wansom, T.; Muangnoicharoen, S.; Nitayaphan, S.; Kitsiripornchai, S.; Crowell, T.A.; Francisco, L.; Gilbert, P.; Rwakasyaguri, D.; Dhitavat, J.; Li, Q.; et al. Risk Factors for HIV Sero-Conversion in a High Incidence Cohort of Men Who Have Sex with Men and Transgender Women in Bangkok, Thailand. EClinicalMedicine 2021, 38, 101033. [Google Scholar] [CrossRef]
  55. Yu, J.; Nehl, E.J.; Dinh, V.P.; Liang, B.; Son, N.V.; Meng, D.; Zhang, Y.; Jiang, J.; Huang, J.; Ning, C.; et al. Vietnamese Female Sex Workers in Rural Cross-Border Areas of Guangxi, China: Migration and HIV/STI Risk Behaviors. AIDS Care 2020, 32, 1515–1523. [Google Scholar] [CrossRef]
  56. Mwanri, L.; Fauk, N.K.; Kustanti, C.Y.; Ambarwati, A.; Merry, M.S. HIV Susceptibility among Clients of Female Sex Workers in Indonesia: A Qualitative Inquiry. Sex. Health 2018, 15, 246. [Google Scholar] [CrossRef]
  57. Nguyen, P.T.; Gilmour, S.; Le, P.M.; Nguyen, T.T.; Tanuma, J.; Nguyen, H.V. Factors Associated with High-Risk Behaviors of People Newly Diagnosed with HIV/AIDS: Results from a Cross-Sectional Study in Vietnam. AIDS Care 2020, 33, 607–615. [Google Scholar] [CrossRef]
  58. Vu, T.; Boggiano, V.; Tran, B.; Nguyen, L.; Tran, T.; Latkin, C.; Ho, C.; Ho, R. Sexual Risk Behaviors of Patients with HIV/AIDS over the Course of Antiretroviral Treatment in Northern Vietnam. Int. J. Environ. Res. Public Health 2018, 15, 1106. [Google Scholar] [CrossRef] [Green Version]
  59. Rueanrudipirom, K.; Fongkaew, W.; Viseskul, N.; Fongkaew, K. Lifestyle of Young Men Who Have Sex with Men Living with HIV: A Qualitative Descriptive Study. Pac. Rim Int. J. Nurs. Res. 2021, 25, 312–326. [Google Scholar]
  60. Ross, J.L.; Teeraananchai, S.; Lumbiganon, P.; Hansudewechakul, R.; Chokephaibulkit, K.; Khanh, T.H.; Van Nguyen, L.; Mohamed, T.A.J.; Yusoff, N.K.N.; Fong, M.S.; et al. A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living with HIV in Asia. JAIDS J. Acquir. Immune Defic. Syndr. 2019, 81, e28–e38. [Google Scholar] [CrossRef]
  61. Sopheab, H.; Chhea, C.; Tuot, S.; Muir, J.A. HIV Prevalence, Related Risk Behaviors, and Correlates of HIV Infection among People Who Use Drugs in Cambodia. BMC Infect. Dis. 2018, 18, 562. [Google Scholar] [CrossRef] [Green Version]
Healthcare 11 01093 g001 550
Figure 1. PRISMA-ScR flowchart.
Figure 1. PRISMA-ScR flowchart.
Healthcare 11 01093 g001
Table
Table 1. Inclusion and exclusion criteria.
Table 1. Inclusion and exclusion criteria.
InclusionExclusion
Published articles, including those in pressPre-prints, along with book chapters, conference proceedings, letters to editors, viewpoints etc.
Focus on knowledge, awareness, perception, attitude, or risky behavior (at least one)Focus on stigmatization, prevalence, coping strategies and effect of intervention strategies on these aspects
Any STIsNon-STIs such as cervical cancer, and vaccines
Valid research methodology (i.e., empirical, experiments, content analysis etc.)Clinical biological trials that did not investigate participants’ knowledge, awareness, perceptions, or attitudes
Articles in English
Location of study is Southeast Asia
Table
Table 2. Descriptive statistics.
Table 2. Descriptive statistics.
CharacteristicsN (%)
Year
(n = 70)		201811 (15.7)
201920 (28.6)
202013 (18.6)
202119 (27.1)
20227 (10.0)
Country
(n = 83) *		Vietnam17 (20.5)
Indonesia24 (28.9)
Thailand21 (25.3)
Malaysia10 (12.0)
Philippines2 (0.02)
Laos1 (0.01)
Cambodia5 (0.06)
Myanmar1 (0.01)
Singapore2 (0.02)
Aspect
(n = 79) *		HIV/AIDS53 (67.1)
HPV11 (13.9)
STD/STI15 (19.0)
Focus
(n = 87) *		Knowledge43 (49.4)
Risky behavior17 (19.5)
Attitude20 (23.0)
Awareness2 (0.02)
Perception5 (0.06)
Methodology
(n = 74) *		Survey40 (54.1)
Interview29 (39.1)
Dataset3 (0.04)
Focus group2 (0.03)
Scale
(n = 84) *		Own44 (52.4)
Database4 (0.05)
IDHS 20174 (0.05)
IDHS 20122 (0.02)
Others: Full list given at the end the table16 (0.19)
Cohort
(n = 72) *		University students9 (12.5)
Prisoners/migrants/sex workers9 (12.5)
General population7 (0.10)
HCW6 (0.08)
(Y)MSM/Trans.6 (0.08)
High-school students/adolescents10 (13.9)
Women7 (0.10)
Others: HIV patients, parents, teachers, people living with HIV patients etc.18 (25.0)
Sociodemographic/behavioral
(n = 125) *		Education level28 (22.40)
Age21 (16.80)
Income level19 (15.20)
Marital status11 (8.80)
Gender9 (7.20)
Occupation9 (7.20)
Social behavioral risk6 (4.80)
Sexual behavioral risk5 (4.00)
Ethnicity5 (4.00)
Place of birth5 (4.00)
Place of residence4 (3.20)
Religion3 (2.40)
Underlying conditions3 (2.40)
Infected living partner3 (2.40)
Note: “n”—the frequency that an item was described in the included articles. *—Numbers do not total 70 due to multiple points of focus, countries etc. Others:—refer to instances with fewer than 3 studies; Only points of focus related to the review are shown. HIV—human immunodeficiency virus; HPV—human papillomavirus; AIDS—acquired immunodeficiency syndrome; STD—sexually transmitted disease; IHCW—Healthcare Worker; DHS—Indonesia Demographic Health and Survey; Scale for Others: (1) The Sensitivity to Punishment and Sensitivity to Reward Questionnaire; The Drug Abuse Screening Test; & The Sexual Risk Behavior; Vietnam Administrative of HIV/AIDS Control (VAAC); Safe Sexual Behavior Questionnaire; Condom Influence Strategy Questionnaire (CISQ); Asian Value Scale (AVS) and the Beliefs and Values Scales; Integrated Biological and Behavioral Surveillance (IBBS) 2012 questionnaire; Questionnaire based on guidelines from the Vietnam Ministry of Health and relevant references from the National Institute of Hygiene and Epidemiology; US NIH Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol; National Youth Risk Behavior Survey questionnaire; Model Questionnaires of the DHS Program; EuroQol five-dimension five-level (EQ-5D-5L).
Table
Table 3. Level of knowledge, awareness, attitude, or perception.
Table 3. Level of knowledge, awareness, attitude, or perception.
TopicStudyCohort, SizeKnowledge *AwarenessPositive Attitude/Perception
Level (%)Scale (Mean/Max)Level (%)ScaleLevel (%)Scale
HPV[1]Rural women, n = 338 6.40/15
[14]University students, n = 425 5.26/1359.8
[27]Urbanites, n = 40050.8 82.0
HIV/AIDS[28]Highlanders/natives, n = 8039 3.10/6
[29]MSW, n = 10024.0
[16]Housewives, n = 10035.0
[30]School students, n = 516 19.90/35
[31]School students, n = 32096.0
[32]Dentists, 20944.0 53.0
[33]Women, n = 25,89588.7 39.7
[34]Industrial workers, n = 289 7.50/11
[17]Pharmacy students, n = 1013 14.14/21
Pharmacists, n = 250 15.39/21
[15]Adults, n = 403 14.0
STD/STI[35]School students, n = 33751.9
[36]University students, n = 600 24.09/38
[37]Muslim army conscripts, n = 36021.3
[18]Inmates of women shelter n = 6033.0 23.1/25
[38]Boys, n = 10,547 29.8
Note: Only studies that reported these figures are included in this table; Scales are not mentioned as most studies assessed using their own scales. *—Indicate possession of knowledge based on population (x/sample).
Table
Table 4. Summary of sociodemographic profiles affecting the levels of knowledge, awareness, attitude, or perception.
Table 4. Summary of sociodemographic profiles affecting the levels of knowledge, awareness, attitude, or perception.
Sociodemographic ProfilesLevels of Knowledge, Awareness, Attitude, or Perception
HighLow
Studies
SexFemale[10,14,27,39,40,41,42][1,43]
Education levelHigh[1,2,9,27,28,33,34,35,44,45,46,47]
Low [15,16,39,41,42]
Socioeconomic statusHigh[2]
Low [41]
Living areaRural [39]
Urban[2,27]
ReligionMuslim/Christian [20,41]
Open[35]
Accessibility to medical device or informationHigh[25,44,46,48,49]
Low [39,42]
OccupationSex workers/Industrial [29,42,50]
Healthcare professionals/Medical students[11,14,17,32]
Note: Only sociodemographic profiles with more than two studies are included in this table; significant results are only as determined and reported in the respective studies (p < 0.05); a higher level of attitude/perception refers to more positive attitude/perception.
Table
Table 5. Top STD/STI risky behaviors.
Table 5. Top STD/STI risky behaviors.
TypeRisky BehaviorCohort
SexualNo/infrequent use of protective and/or preventive measuresRural (women)[1]
Migrant workers[3]
Adolescents[40,51,52]
(Y)MSM/Transgender[26,53,54]
FSW and clients, inmates[18,50,55,56]
HIV patients[57,58]
University students[8]
Multiple sex partners(Y)MSM/Transgender[53,54,59]
FSW and clients[55,56]
HIV patients[57,58]
University students[8]
Adolescents[13,40,51]
Adolescents (living with HIV)[60]
Married community [12]
SocialRejection, discrimination, and stigmatizationHIV (Female migrant workers)[19]
University students/youth[20,49]
FSW clients[56]
Lacking awareness and knowledge(Y)MSM/Transgender[26,53]
Industry workers[42]
FSW and clients[55,56]
University students/Youth[20,49]
Adolescents[51]
Married community [12]
OthersInjecting drugs, being sexually active, partner/childhood sex abuse, difficulty in condom procurement, substance/alcohol abuse, sharing needles [20,22,23,37,40,50,52,55,57,61]
Only risky behaviors with a minimum of three studies were reported.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Balakrishnan, V.; Yong, K.K.; Tiong, C.K.; Ng, N.J.S.; Ni, Z. A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia. Healthcare 2023, 11, 1093. https://doi.org/10.3390/healthcare11081093

AMA Style

Balakrishnan V, Yong KK, Tiong CK, Ng NJS, Ni Z. A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia. Healthcare. 2023; 11(8):1093. https://doi.org/10.3390/healthcare11081093

Chicago/Turabian Style

Balakrishnan, Vimala, Kok Khuen Yong, Chiong Kian Tiong, Nicholas Jian Shen Ng, and Zhao Ni. 2023. "A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia" Healthcare 11, no. 8: 1093. https://doi.org/10.3390/healthcare11081093

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop