I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
2
0
2
6
,
p
p
.
6
4
0
~
6
47
I
SS
N:
2
2
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2
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8
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s
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ia
esco
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co
m
Struct
ura
l and
b
e
ha
v
io
ra
l det
ermi
na
nts
o
f
H
IV a
mo
ng
Indo
nesia
n MSM
Neila
Su
lu
ng
¹
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Adi Ca
hy
a
M
urf
i¹
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f
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HIV
p
re
v
a
len
c
e
a
m
o
n
g
m
e
n
w
h
o
h
a
v
e
se
x
with
m
e
n
(
M
S
M
)
re
m
a
in
s
d
isp
ro
p
o
rti
o
n
a
tely
h
i
g
h
i
n
I
n
d
o
n
e
sia
.
W
h
il
e
b
e
h
a
v
i
o
ra
l
r
isk
fa
c
to
rs
h
a
v
e
b
e
e
n
wid
e
l
y
stu
d
ied
,
e
v
i
d
e
n
c
e
i
n
teg
ra
ti
n
g
str
u
c
tu
ra
l
d
e
term
in
a
n
t
s
re
m
a
in
s
li
m
it
e
d
.
T
h
is
st
u
d
y
e
x
a
m
in
e
d
th
e
ro
le
o
f
str
u
c
tu
ra
l
a
n
d
b
e
h
a
v
io
ra
l
fa
c
to
rs
a
ss
o
c
iate
d
with
HIV
sta
tu
s
a
m
o
n
g
M
S
M
in
Ja
m
b
i
Cit
y
,
In
d
o
n
e
sia
.
A
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
wa
s
c
o
n
d
u
c
ted
a
m
o
n
g
6
0
M
S
M
re
c
ru
it
e
d
u
sin
g
n
o
n
-
p
ro
b
a
b
il
it
y
sa
m
p
li
n
g
d
u
e
to
t
h
e
h
id
d
e
n
n
a
tu
re
o
f
t
h
e
p
o
p
u
lati
o
n
.
Da
ta
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o
ll
e
c
ted
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g
v
a
li
d
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ted
str
u
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tu
re
d
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e
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ires
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n
d
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ly
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e
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si
n
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m
u
lt
iv
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riab
le
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g
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re
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io
n
.
F
ift
y
p
e
rc
e
n
t
o
f
re
sp
o
n
d
e
n
ts
w
e
re
HIV
-
p
o
siti
v
e
.
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w
e
d
u
c
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ti
o
n
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l
a
tt
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n
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t
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m
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d
a
s
a
n
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n
d
e
p
e
n
d
e
n
t
stru
c
tu
ra
l
de
term
in
a
n
t
o
f
HIV
sta
tu
s
(AO
R
=
5
.
5
1
;
9
5
%
CI:
1
.
1
4
–
2
6
.
4
9
)
,
wh
e
re
a
s
b
e
h
a
v
i
o
ra
l
fa
c
to
rs
sh
o
we
d
si
g
n
if
i
c
a
n
t
c
ru
d
e
a
ss
o
c
iatio
n
s b
u
t
l
o
st
si
g
n
ifi
c
a
n
c
e
a
fter
a
d
ju
stm
e
n
t.
HIV
v
u
l
n
e
ra
b
i
li
ty
a
m
o
n
g
M
S
M
is
sh
a
p
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d
b
y
stru
c
tu
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in
e
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s
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e
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o
n
d
in
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id
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a
v
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S
tru
c
t
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ra
l
-
fo
c
u
se
d
i
n
te
rv
e
n
ti
o
n
s
a
re
e
ss
e
n
ti
a
l
to
stre
n
g
t
h
e
n
HIV
p
r
e
v
e
n
ti
o
n
stra
teg
ies
i
n
In
d
o
n
e
sia
.
K
ey
w
o
r
d
s
:
B
eh
av
io
r
al
f
ac
to
r
s
E
d
u
ca
tio
n
al
attain
m
e
n
t
HI
V
in
f
ec
tio
n
I
n
d
o
n
esia
Me
n
wh
o
h
a
v
e
s
ex
with
m
en
Stru
ctu
r
al
d
eter
m
in
a
n
ts
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
C
ici
Ap
r
iza
Yan
ti
Ma
s
ter
o
f
Pu
b
lic
Hea
lth
Pro
g
r
am
,
Un
iv
er
s
itas
Prim
a
Nu
s
an
tar
a
B
u
k
itti
n
g
g
i
B
u
k
itti
n
g
g
i,
W
est Su
m
atr
a,
I
n
d
o
n
esia
E
m
ail: c
ici.
ap
r
izay
an
ti@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
HI
V/AI
DS
r
em
ain
s
a
m
ajo
r
c
h
allen
g
e
in
th
e
g
lo
b
al
p
u
b
lic
h
ea
lth
ag
en
d
a
[
1
]
,
[
2
]
.
T
h
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
r
e
p
o
r
ts
th
at
d
esp
ite
a
g
lo
b
al
d
ec
lin
e
i
n
HI
V
-
r
el
ated
m
o
r
tality
,
th
e
r
ate
o
f
n
ew
in
f
ec
tio
n
s
r
em
ain
s
r
elativ
ely
h
ig
h
a
m
o
n
g
s
p
ec
if
ic
p
o
p
u
latio
n
g
r
o
u
p
s
with
s
tr
u
ctu
r
al
an
d
s
o
cial
v
u
ln
e
r
ab
i
liti
es
[
1
]
,
[
3
]
-
[
5
]
.
I
n
eq
u
ities
in
ac
ce
s
s
to
h
ea
lth
s
er
v
ices,
s
tig
m
a,
an
d
d
is
cr
im
in
atio
n
co
n
tr
ib
u
te
to
th
e
u
n
eq
u
al
d
is
tr
ib
u
tio
n
o
f
t
h
e
HI
V
b
u
r
d
e
n
ac
r
o
s
s
p
o
p
u
latio
n
g
r
o
u
p
s
[
6
]
,
[
7
]
.
At
th
e
g
l
o
b
al
lev
el,
p
r
o
g
r
ess
to
war
d
ac
h
iev
i
n
g
th
e
Su
s
tain
ab
le
Dev
elo
p
m
en
t
Go
als
r
elate
d
to
HI
V
co
n
tr
o
l
co
n
tin
u
es
to
f
ac
e
s
er
io
u
s
o
b
s
tacle
s
,
p
ar
tic
u
lar
ly
in
lo
w
-
an
d
m
id
d
le
-
in
co
m
e
c
o
u
n
t
r
ies
[
8
]
-
[
1
0
]
.
T
h
is
s
itu
atio
n
u
n
d
er
s
co
r
e
s
th
at
HI
V/AI
DS
i
s
n
o
t
s
o
lely
a
m
ed
ical
is
s
u
e
b
u
t
also
a
s
o
cial,
b
eh
av
io
r
al,
an
d
s
tr
u
ctu
r
al
p
r
o
b
lem
s
h
a
p
ed
b
y
in
ter
r
elate
d
f
ac
to
r
s
[
1
1
]
,
[
1
2
]
.
Me
n
wh
o
h
a
v
e
s
e
x
with
m
e
n
(
MSM
)
h
av
e
l
o
n
g
b
ee
n
id
en
tifie
d
as
a
k
ey
p
o
p
u
latio
n
in
th
e
HI
V
ep
id
em
ic
ac
r
o
s
s
d
if
f
er
e
n
t
r
e
g
io
n
s
o
f
th
e
wo
r
ld
[
1
3
]
,
[
1
4
]
.
Glo
b
al
r
ep
o
r
ts
co
n
s
is
ten
tly
in
d
icate
th
at
H
I
V
p
r
ev
alen
ce
am
o
n
g
MSM
is
s
u
b
s
tan
tially
h
ig
h
er
th
an
in
th
e
g
en
er
al
p
o
p
u
latio
n
[
1
5
]
,
[
1
6
]
,
b
o
th
in
h
ig
h
-
i
n
co
m
e
co
u
n
tr
ies
an
d
in
l
o
w
-
an
d
m
i
d
d
le
-
in
co
m
e
s
ettin
g
s
[
1
7
]
.
T
h
is
h
eig
h
ten
ed
v
u
ln
e
r
ab
ilit
y
is
in
f
lu
en
ce
d
b
y
h
ig
h
ex
p
o
s
u
r
e
to
r
is
k
y
s
ex
u
al
p
r
ac
tices,
lim
ited
ac
ce
s
s
to
MS
M
-
f
r
ien
d
ly
h
ea
lth
s
er
v
ices,
an
d
p
e
r
v
asiv
e
s
tig
m
a
an
d
s
o
cial
d
i
s
cr
im
in
atio
n
[
1
8
]
-
[
2
0
]
.
I
n
m
an
y
c
o
n
tex
ts
,
th
ese
s
tr
u
ctu
r
al
b
ar
r
ier
s
co
n
t
r
ib
u
te
t
o
th
e
lo
w
u
tili
za
tio
n
o
f
HI
V
p
r
ev
e
n
tio
n
,
test
in
g
,
a
n
d
tr
ea
tm
en
t
s
er
v
ices
am
o
n
g
th
is
p
o
p
u
latio
n
[
2
]
.
C
o
n
s
eq
u
en
tly
,
MSM
ar
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l a
n
d
b
eh
a
vi
o
r
a
l d
et
ermin
a
n
ts
o
f H
I
V
a
mo
n
g
I
n
d
o
n
esia
n
MS
M
(
N
eila
S
u
lu
n
g
)
641
p
o
s
itio
n
ed
as
a
p
r
io
r
ity
g
r
o
u
p
in
HI
V
c
o
n
tr
o
l
ef
f
o
r
ts
,
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
p
u
b
lic
h
ea
lth
ap
p
r
o
ac
h
es
th
at
ar
e
s
en
s
itiv
e
to
s
o
cial
an
d
cu
ltu
r
al
co
n
tex
ts
.
I
n
I
n
d
o
n
esia,
HI
V
tr
an
s
m
is
s
io
n
am
o
n
g
MSM
h
as
s
h
o
wn
an
in
cr
ea
s
in
g
tr
en
d
o
v
er
t
h
e
p
ast
d
ec
ad
e
[
21
]
.
Natio
n
al
s
u
r
v
eillan
ce
r
ep
o
r
ts
in
d
icate
th
at
MSM
r
ep
r
esen
t
o
n
e
o
f
th
e
f
astes
t
-
g
r
o
win
g
g
r
o
u
p
s
af
f
ec
ted
b
y
HI
V,
with
p
r
ev
alen
ce
s
u
b
s
tan
tially
h
ig
h
er
th
an
t
h
at
o
b
s
er
v
e
d
in
th
e
g
en
e
r
al
p
o
p
u
latio
n
[
1
5
]
,
[
22
]
.
Alth
o
u
g
h
n
atio
n
al
HI
V
p
r
o
g
r
am
s
h
av
e
ex
p
an
d
e
d
test
in
g
an
d
tr
ea
tm
e
n
t
s
er
v
ices,
s
tr
u
ctu
r
al
b
a
r
r
ier
s
in
clu
d
in
g
s
tig
m
a,
d
is
cr
im
in
atio
n
,
a
n
d
lim
ited
MSM
-
f
r
ien
d
ly
s
er
v
ices
co
n
ti
n
u
e
to
co
n
s
tr
ain
ef
f
ec
tiv
e
p
r
ev
en
tio
n
an
d
ea
r
ly
d
iag
n
o
s
is
.
T
h
ese
co
n
tex
tu
al
f
ac
to
r
s
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
c
e
o
f
e
x
am
in
in
g
HI
V
r
is
k
b
e
y
o
n
d
in
d
i
v
id
u
al
-
lev
e
l
b
eh
av
io
r
s
[
3
]
,
[
8
]
.
T
h
is
s
t
u
d
y
is
g
r
o
u
n
d
e
d
in
t
h
e
s
o
cio
-
ec
o
lo
g
ical
m
o
d
el
a
n
d
th
e
s
tr
u
ctu
r
al
v
u
ln
er
a
b
ilit
y
f
r
am
ewo
r
k
,
wh
ich
co
n
ce
p
tu
alize
HI
V
r
is
k
as
th
e
r
esu
lt
o
f
m
u
ltil
ev
el
in
ter
ac
tio
n
s
b
etwe
en
in
d
iv
i
d
u
al
b
eh
a
v
io
r
s
an
d
b
r
o
ad
e
r
s
o
cial
e
n
v
ir
o
n
m
en
ts
[
23
]
,
[
24
]
.
Fro
m
th
is
p
e
r
s
p
ec
tiv
e,
HI
V
v
u
l
n
er
ab
ilit
y
is
n
o
t
s
o
lely
a
co
n
s
eq
u
en
ce
o
f
p
e
r
s
o
n
al
d
ec
is
io
n
-
m
ak
in
g
b
u
t
is
also
s
h
a
p
ed
b
y
s
y
s
tem
ic
in
eq
u
alities
an
d
s
o
cial
p
o
s
itio
n
in
g
[
25
]
.
Un
d
er
s
tan
d
in
g
th
e
r
elativ
e
co
n
tr
ib
u
tio
n
o
f
s
tr
u
ctu
r
al
a
n
d
b
eh
av
io
r
al
f
ac
to
r
s
is
th
er
ef
o
r
e
ess
en
tial
f
o
r
d
esig
n
in
g
co
m
p
r
e
h
en
s
iv
e
an
d
co
n
tex
t
-
s
en
s
itiv
e
p
r
ev
e
n
tio
n
s
t
r
ateg
ies [
26
]
.
Alth
o
u
g
h
p
r
ev
io
u
s
s
tu
d
ies
h
av
e
ex
am
in
ed
b
eh
av
io
r
al
f
ac
to
r
s
ass
o
ciate
d
with
HI
V
r
is
k
am
o
n
g
MSM
,
in
v
esti
g
atio
n
s
th
at
s
im
u
ltan
eo
u
s
ly
co
n
s
id
er
s
tr
u
ctu
r
al
a
n
d
b
eh
av
io
r
al
f
ac
to
r
s
r
e
m
ain
lim
it
e
d
,
p
a
r
ticu
lar
ly
in
th
e
I
n
d
o
n
esian
c
o
n
tex
t.
Mo
s
t
p
r
ev
io
u
s
s
tu
d
ies
h
av
e
e
m
p
h
as
ized
k
n
o
wled
g
e
a
n
d
s
ex
u
al
p
r
ac
tices,
wh
ile
th
e
r
o
le
o
f
s
tr
u
ctu
r
al
f
ac
to
r
s
,
s
u
c
h
as
ed
u
ca
tio
n
an
d
s
o
cial
c
o
n
d
itio
n
s
,
h
as
r
ec
eiv
ed
r
elativ
ely
litt
le
atten
tio
n
.
E
m
p
ir
ical
ev
id
en
ce
d
o
c
u
m
en
ti
n
g
a
s
h
if
t
in
HI
V
r
is
k
d
eter
m
i
n
an
ts
f
r
o
m
in
d
iv
id
u
al
b
e
h
av
io
r
s
to
war
d
s
tr
u
ctu
r
al
f
ac
to
r
s
am
o
n
g
MSM
p
o
p
u
lat
io
n
s
is
also
s
ca
r
ce
.
T
h
is
s
tu
d
y
o
f
f
er
s
n
o
v
elty
b
y
h
ig
h
lig
h
tin
g
th
e
in
ter
ac
tio
n
b
etwe
en
s
tr
u
ctu
r
al
a
n
d
b
eh
a
v
io
r
al
v
u
ln
er
ab
ilit
ies
in
s
h
a
p
in
g
HI
V
r
is
k
.
T
h
e
f
in
d
i
n
g
s
ar
e
ex
p
ec
te
d
to
f
ill
ex
is
tin
g
k
n
o
wled
g
e
g
a
p
s
an
d
s
u
p
p
o
r
t
t
h
e
d
ev
el
o
p
m
en
t
o
f
m
o
r
e
c
o
n
tex
tu
alize
d
a
n
d
c
o
m
p
r
eh
en
s
iv
e
HI
V
p
r
ev
en
tio
n
s
tr
ateg
ies.
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h
d
esig
n
T
h
is
s
tu
d
y
was
d
esig
n
ed
u
s
in
g
an
an
aly
tical
o
b
s
er
v
atio
n
al
d
esig
n
with
a
cr
o
s
s
-
s
ec
tio
n
al
ap
p
r
o
ac
h
.
T
h
e
d
esig
n
was
ap
p
lied
to
e
x
am
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
e
n
s
tr
u
ctu
r
al
an
d
b
eh
a
v
io
r
al
f
a
cto
r
s
an
d
HI
V
r
is
k
am
o
n
g
MSM
.
A
q
u
an
titativ
e
a
p
p
r
o
ac
h
was
u
s
ed
to
ass
ess
th
e
ass
o
ciatio
n
s
b
etwe
en
v
ar
iab
l
es
at
a
s
in
g
le
p
o
in
t
in
tim
e.
B
iv
ar
iate
a
n
d
m
u
ltiv
a
r
iab
le
an
aly
s
es
wer
e
co
n
d
u
cte
d
to
i
d
en
tify
f
ac
to
r
s
ass
o
ciate
d
with
HI
V
s
tatu
s
.
All r
esear
ch
p
r
o
ce
d
u
r
es we
r
e
i
m
p
lem
en
ted
in
ac
co
r
d
an
ce
wit
h
estab
lis
h
ed
p
u
b
lic
h
ea
lth
r
es
ea
r
ch
p
r
i
n
cip
les.
2
.
2
.
P
o
pu
la
t
io
n a
nd
s
a
m
ples
T
h
e
s
tu
d
y
p
o
p
u
latio
n
was
d
ef
in
ed
as
MSM
r
es
id
in
g
in
J
am
b
i
C
ity
.
A
to
tal
o
f
6
0
r
esp
o
n
d
en
ts
wh
o
m
et
th
e
in
clu
s
io
n
cr
iter
ia
we
r
e
in
clu
d
ed
i
n
th
e
s
tu
d
y
.
Par
ticip
an
ts
wer
e
s
elec
ted
u
s
in
g
a
n
o
n
-
p
r
o
b
ab
ilit
y
s
am
p
lin
g
tech
n
iq
u
e
co
n
s
is
ten
t
with
th
e
ch
ar
ac
ter
is
tics
o
f
a
k
ey
p
o
p
u
latio
n
.
R
esp
o
n
d
e
n
ts
w
er
e
en
r
o
lled
b
ased
o
n
th
eir
willin
g
n
ess
to
p
ar
t
icip
ate
an
d
th
eir
a
b
ilit
y
to
p
r
o
v
id
e
t
h
e
r
e
q
u
ir
ed
in
f
o
r
m
atio
n
.
Par
ticip
an
t
co
n
f
id
en
tiality
was
en
s
u
r
ed
th
r
o
u
g
h
th
e
u
s
e
o
f
a
n
o
n
y
m
o
u
s
i
d
en
tific
atio
n
c
o
d
es
d
u
r
in
g
d
ata
co
llectio
n
.
Giv
en
th
e
h
id
d
en
a
n
d
s
tig
m
atize
d
n
atu
r
e
o
f
MSM
p
o
p
u
latio
n
s
,
n
o
n
-
p
r
o
b
ab
ilit
y
s
am
p
lin
g
w
as
em
p
lo
y
ed
as
a
p
r
ag
m
atic
s
tr
ateg
y
to
en
s
u
r
e
p
ar
ticip
an
t
ac
ce
s
s
.
W
h
ile
th
is
ap
p
r
o
ac
h
m
ay
lim
it
g
e
n
er
aliz
ab
ilit
y
,
it
r
em
ain
s
a
co
m
m
o
n
l
y
ac
ce
p
ted
m
eth
o
d
in
r
esear
ch
in
v
o
l
v
in
g
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
.
2
.
3
.
I
ns
t
rum
ent
s
T
h
e
r
esear
ch
in
s
tr
u
m
e
n
t
co
n
s
is
ted
o
f
a
s
tr
u
ctu
r
e
d
q
u
esti
o
n
n
air
e
ad
ap
ted
f
r
o
m
p
r
ev
i
o
u
s
ly
p
u
b
lis
h
ed
HI
V
-
r
elate
d
in
s
tr
u
m
en
ts
.
T
h
e
q
u
esti
o
n
n
air
e
was
r
ev
iewe
d
b
y
th
r
ee
p
u
b
lic
h
ea
lth
ex
p
er
t
s
to
en
s
u
r
e
co
n
ten
t
va
lid
ity
an
d
r
elev
an
ce
to
th
e
MSM
p
o
p
u
latio
n
in
th
e
I
n
d
o
n
esian
co
n
tex
t.
Pil
o
t
test
in
g
was
co
n
d
u
cted
a
m
o
n
g
1
0
MSM
p
r
io
r
t
o
d
ata
co
l
lectio
n
,
an
d
th
e
in
s
tr
u
m
en
t
d
em
o
n
s
tr
ated
ac
ce
p
tab
le
i
n
ter
n
al
co
n
s
is
ten
cy
(
C
r
o
n
b
ac
h
’
s
α
=
0
.
8
1
)
.
HI
V
s
tatu
s
was
v
er
if
ied
u
s
in
g
d
o
cu
m
en
ted
test
r
ec
o
r
d
s
wh
en
e
v
er
av
ailab
le.
I
n
ca
s
es
wh
er
e
d
o
cu
m
en
tatio
n
was
u
n
av
ailab
le,
s
elf
-
r
ep
o
r
ted
HI
V
s
tatu
s
was
ac
ce
p
ted
a
n
d
r
ec
o
r
d
ed
c
o
n
f
id
e
n
tially
;
h
o
wev
er
,
r
elian
ce
o
n
s
elf
-
r
ep
o
r
t m
ay
h
a
v
e
in
tr
o
d
u
ce
d
in
f
o
r
m
atio
n
b
ias.
2
.
4
.
P
r
o
ce
du
re
s
Data
co
llect
io
n
was
co
n
d
u
ct
ed
u
s
in
g
a
v
alid
ate
d
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
ad
ap
ted
f
r
o
m
s
tan
d
ar
d
in
s
tr
u
m
en
ts
co
m
m
o
n
ly
em
p
l
o
y
ed
in
HI
V
r
esear
ch
an
d
s
tu
d
ies
in
v
o
lv
in
g
MSM
p
o
p
u
latio
n
s
.
Data
wer
e
co
llected
th
r
o
u
g
h
in
ter
v
iewe
r
-
ad
m
in
is
ter
ed
in
ter
v
iews
b
y
tr
a
in
ed
p
er
s
o
n
n
el.
T
h
e
co
llected
d
ata
wer
e
ch
ec
k
ed
f
o
r
co
m
p
leten
ess
an
d
co
n
s
is
t
en
cy
p
r
i
o
r
to
s
tatis
tical
an
aly
s
is
.
Data
an
aly
s
is
wa
s
p
er
f
o
r
m
ed
u
s
in
g
b
iv
ar
iate
an
aly
s
is
an
d
m
u
ltiv
ar
iab
le
lo
g
is
tic
r
eg
r
ess
io
n
to
id
en
tify
in
d
ep
en
d
en
t
d
eter
m
i
n
an
ts
o
f
HI
V
r
is
k
.
E
th
ical
ap
p
r
o
v
al
f
o
r
th
e
s
tu
d
y
was
o
b
tain
ed
f
r
o
m
th
e
R
esear
ch
E
th
i
cs
C
o
m
m
ittee
o
f
Un
iv
er
s
itas
Fo
r
t
d
e
Ko
ck
(
No
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
6
4
0
-
647
642
4
0
6
/KE
PK.U
FDK/I
I
I
/2
0
2
3
)
.
T
h
e
s
tu
d
y
was c
o
n
d
u
cte
d
in
a
cc
o
r
d
an
ce
with
th
e
p
r
in
cip
les o
f
th
e
Dec
lar
atio
n
o
f
Helsin
k
i
an
d
th
e
I
n
ter
n
atio
n
al
C
o
n
f
er
en
ce
o
n
Har
m
o
n
is
atio
n
–
G
o
o
d
C
lin
ical
Pra
ctice
(
I
C
H
-
GC
P)
g
u
id
elin
es.
Par
ticip
atio
n
was
v
o
lu
n
ta
r
y
f
o
llo
win
g
th
e
p
r
o
v
is
io
n
o
f
i
n
f
o
r
m
atio
n
r
e
g
ar
d
in
g
th
e
s
tu
d
y
o
b
jectiv
es
an
d
p
r
o
ce
d
u
r
es.
Giv
en
t
h
e
s
en
s
itiv
e
an
d
s
tig
m
atize
d
n
atu
r
e
o
f
th
e
MSM
p
o
p
u
latio
n
,
n
o
p
e
r
s
o
n
ally
id
en
tifia
b
le
in
f
o
r
m
atio
n
was
co
llected
,
an
d
all
in
ter
v
iews
wer
e
co
n
d
u
cted
in
p
r
i
v
ate
s
ettin
g
s
to
p
r
o
tect
p
ar
ticip
an
t
co
n
f
id
en
tiality
a
n
d
p
r
iv
ac
y
.
T
h
e
s
af
ety
,
co
m
f
o
r
t,
an
d
co
n
f
id
en
tiality
o
f
r
esp
o
n
d
en
t
s
wer
e
m
ain
tain
ed
th
r
o
u
g
h
o
u
t a
ll st
ag
es o
f
th
e
s
tu
d
y
,
a
n
d
n
o
in
ter
v
en
tio
n
s
p
o
s
in
g
s
er
io
u
s
r
is
k
to
p
ar
ticip
an
ts
wer
e
in
v
o
lv
e
d
.
3.
RE
SU
L
T
S
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
t
he
r
esp
o
nd
ent
s
T
h
e
ch
ar
ac
ter
is
tics
o
f
th
e
r
esp
o
n
d
en
ts
ar
e
s
u
m
m
ar
ized
in
T
a
b
le
1
.
A
to
tal
o
f
6
0
MSM
wer
e
in
clu
d
ed
in
th
e
an
al
y
s
is
,
with
5
0
.
0
%
i
d
en
tifie
d
as
HI
V
-
p
o
s
itiv
e.
Mo
s
t
p
ar
ticip
an
ts
wer
e
y
o
u
n
g
er
th
a
n
3
0
y
ea
r
s
(
5
8
.
3
%)
an
d
h
ad
attain
ed
a
h
ig
h
lev
el
o
f
ed
u
ca
tio
n
(
7
5
.
0
%).
T
h
e
m
ajo
r
ity
r
ep
o
r
te
d
n
o
h
is
to
r
y
o
f
d
r
u
g
u
s
e
(
8
5
.
0
%).
R
eg
ar
d
in
g
p
s
y
ch
o
s
o
cial
f
ac
t
o
r
s
,
m
o
s
t
r
esp
o
n
d
en
ts
d
em
o
n
s
tr
ated
h
ig
h
HI
V
-
r
elate
d
k
n
o
wled
g
e
(
8
3
.
3
%),
p
o
s
itiv
e
attitu
d
es (
5
8
.
3
%),
g
o
o
d
m
o
tiv
atio
n
(
6
5
.
0
%),
a
n
d
g
o
o
d
p
ar
e
n
tin
g
p
atter
n
s
(
5
3
.
3
%).
T
ab
le
1
.
C
h
ar
ac
ter
is
tic
o
f
r
esp
o
n
d
en
ts
(
n
=
6
0
)
V
a
r
i
a
b
l
e
N
u
mb
e
r
P
e
r
c
e
n
t
a
g
e
(
%)
A
g
e
<
3
0
y
e
a
r
s
35
5
8
.
3
≥
3
0
y
e
a
r
s
25
4
1
.
7
Ed
u
c
a
t
i
o
n
Lo
w
15
2
5
.
0
H
i
g
h
45
7
5
.
0
H
I
V
/
A
I
D
S
P
o
si
t
i
v
e
30
5
0
.
0
N
e
g
a
t
i
v
e
30
5
0
.
0
D
r
u
g
s
u
se
U
se
9
1
5
.
0
No
51
8
5
.
0
S
e
x
u
a
l
b
e
h
a
v
i
o
r
S
a
me
s
e
x
se
x
u
a
l
b
e
h
a
v
i
o
r
22
3
6
.
7
Lo
w
e
r
-
r
i
s
k
s
e
x
u
a
l
b
e
h
a
v
i
o
r
38
6
3
.
3
K
n
o
w
l
e
d
g
e
Lo
w
10
1
5
.
7
H
i
g
h
50
8
3
.
3
A
t
t
i
t
u
d
e
N
e
g
a
t
i
v
e
25
4
1
.
7
P
o
si
t
i
v
e
35
5
8
.
3
M
o
t
i
v
a
t
i
o
n
P
o
o
r
21
3
5
.
0
G
o
o
d
39
6
5
.
0
P
a
r
e
n
t
i
n
g
p
a
t
t
e
r
n
s
P
o
o
r
28
4
6
.
7
G
o
o
d
32
5
3
.
3
3
.
2
.
B
iv
a
ria
t
e
a
nd
m
ultiv
a
ri
a
ble a
s
s
o
cia
t
io
ns
wit
h H
I
V
s
t
a
t
us
T
ab
le
2
p
r
esen
ts
th
e
b
iv
ar
iate
ass
o
ciatio
n
s
b
etwe
en
s
elec
ted
v
ar
iab
les
an
d
HI
V
s
tatu
s
am
o
n
g
MSM
.
E
d
u
ca
tio
n
al
lev
el
an
d
s
ex
u
al
b
eh
av
io
r
wer
e
s
ig
n
if
ican
tly
a
s
s
o
ciate
d
with
HI
V
in
f
ec
tio
n
.
R
esp
o
n
d
e
n
ts
with
lo
w
ed
u
ca
tio
n
al
attain
m
en
t
h
a
d
a
h
ig
h
er
lik
elih
o
o
d
o
f
b
ein
g
HI
V
-
p
o
s
itiv
e
c
o
m
p
ar
e
d
with
th
o
s
e
with
h
ig
h
e
r
ed
u
ca
tio
n
(
C
OR
=
6
.
0
0
;
9
5
%
C
I
:
1
.
4
8
–
2
4
.
2
9
;
p
=
0
.
0
1
7
)
.
Similar
ly
,
MSM
r
ep
o
r
tin
g
s
am
e
-
s
ex
s
ex
u
al
b
eh
av
io
r
h
a
d
a
s
ig
n
i
f
ican
tly
h
ig
h
er
r
is
k
o
f
HI
V
in
f
ec
tio
n
th
a
n
th
o
s
e
r
ep
o
r
tin
g
n
o
n
-
r
is
k
s
ex
u
al
b
eh
a
v
io
r
(
C
OR
=
4
.
5
7
;
9
5
%
C
I
:
1
.
4
5
–
1
4
.
3
8
;
p
=
0
.
0
1
6
)
.
Oth
er
v
a
r
iab
les,
in
clu
d
in
g
ag
e,
d
r
u
g
u
s
e,
k
n
o
wled
g
e,
attitu
d
e
,
m
o
tiv
atio
n
,
an
d
p
ar
en
tin
g
p
a
tter
n
s
,
wer
e
n
o
t
s
ig
n
if
ican
tly
ass
o
ciate
d
with
HI
V
in
f
ec
ti
o
n
i
n
th
e
b
iv
a
r
iate
an
aly
s
is
(
p
>
0
.
0
5
)
.
I
n
th
e
m
u
ltiv
ar
iab
le
lo
g
is
tic
r
eg
r
ess
io
n
m
o
d
el,
lo
w
e
d
u
ca
ti
o
n
al
attain
m
en
t
r
em
ain
ed
in
d
ep
en
d
en
tly
ass
o
ciate
d
with
HI
V
in
f
ec
tio
n
am
o
n
g
MSM
af
te
r
co
n
tr
o
lli
n
g
f
o
r
p
o
ten
tial
co
n
f
o
u
n
d
e
r
s
(
AOR
=
5
.
5
1
;
9
5
%
C
I
:
1
.
1
4
–
2
6
.
4
9
;
p
=
0
.
0
3
3
)
.
T
h
is
f
in
d
in
g
in
d
icate
s
th
at
r
esp
o
n
d
en
ts
with
lo
wer
e
d
u
ca
tio
n
h
ad
m
o
r
e
th
an
f
iv
e
tim
es
h
ig
h
er
o
d
d
s
o
f
HI
V
i
n
f
ec
tio
n
co
m
p
ar
ed
with
th
o
s
e
with
h
ig
h
er
ed
u
ca
tio
n
.
Alth
o
u
g
h
s
am
e
-
s
ex
s
ex
u
al
b
eh
av
io
r
s
h
o
wed
a
s
tr
o
n
g
ass
o
ciatio
n
in
th
e
cr
u
d
e
an
aly
s
is
,
th
is
ass
o
ciatio
n
was
atten
u
a
ted
an
d
n
o
lo
n
g
e
r
s
tatis
t
ically
s
ig
n
if
ican
t
af
ter
ad
ju
s
tm
en
t
(
AOR
=
4
.
4
8
;
9
5
%
C
I
:
0
.
6
9
–
2
8
.
8
6
;
p
=
0
.
1
1
4
)
.
K
n
o
wled
g
e,
attitu
d
e,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l a
n
d
b
eh
a
vi
o
r
a
l d
et
ermin
a
n
ts
o
f H
I
V
a
mo
n
g
I
n
d
o
n
esia
n
MS
M
(
N
eila
S
u
lu
n
g
)
643
m
o
tiv
atio
n
,
d
r
u
g
u
s
e,
ag
e,
an
d
p
ar
en
tin
g
p
atter
n
s
wer
e
also
n
o
t
in
d
ep
e
n
d
en
tly
ass
o
ciate
d
with
HI
V
in
f
ec
tio
n
in
th
e
ad
ju
s
ted
m
o
d
el.
T
ab
le
2
.
B
iv
ar
iate
an
d
m
u
ltiv
a
r
iab
le
ass
o
ciatio
n
s
b
etwe
en
in
d
ep
en
d
e
n
t v
ar
iab
les an
d
HI
V
s
tatu
s
am
o
n
g
MSM
V
a
r
i
a
b
l
e
s
H
I
V
/
A
I
D
S
C
O
R
(
9
5
%
C
I
)
p
-
v
a
l
u
e
AOR
(
9
5
%
C
I
)
p
-
v
a
l
u
e
Y
e
s
No
n
%
n
%
A
g
e
<
3
0
y
e
a
r
s
17
4
8
.
6
18
5
1
.
4
0
.
8
7
1
.
0
0
0
0
.
9
7
0
.
5
8
3
≥
3
0
y
e
a
r
s
13
5
2
.
0
12
4
8
.
0
(
0
.
3
1
–
2
.
4
3
)
(
0
.
8
8
–
1
.
0
7
)
Ed
u
c
a
t
i
o
n
Lo
w
12
8
0
.
0
3
7
.
5
6
.
0
0
0
.
0
1
7
5
.
5
1
0
.
0
3
3
H
i
g
h
18
4
0
.
0
27
6
0
.
0
(
1
.
4
8
–
2
4
.
2
9
)
(
1
.
1
4
–
2
6
.
4
9
)
D
r
u
g
s
u
se
U
se
4
4
4
.
4
5
5
6
.
6
0
.
7
6
1
.
0
0
0
0
.
8
6
0
.
8
6
3
No
26
5
1
.
0
25
2
5
.
5
(
0
.
1
8
–
3
.
1
9
)
(
0
.
1
6
–
4
.
5
5
)
S
e
x
u
a
l
b
e
h
a
v
i
o
r
S
a
me
-
se
x
s
e
x
u
a
l
b
e
h
a
v
i
o
r
16
7
2
.
7
6
2
7
.
3
4
.
5
7
0
.
0
1
6
4
.
4
8
0
.
1
1
4
Lo
w
e
r
-
r
i
s
k
s
e
x
u
a
l
b
e
h
a
v
i
o
r
14
3
6
.
8
24
6
3
.
2
(
1
.
4
5
–
1
4
.
3
8
)
(
0
.
6
9
–
2
8
.
8
6
)
K
n
o
w
l
e
d
g
e
Lo
w
8
8
0
.
0
2
2
0
.
0
5
.
0
9
0
.
0
8
3
3
.
0
1
0
.
2
8
0
H
i
g
h
22
4
4
.
0
28
5
6
.
0
(
0
.
9
8
–
2
6
.
4
3
)
(
0
.
4
0
–
2
2
.
1
1
)
A
t
t
i
t
u
d
e
N
e
g
a
t
i
v
e
1
5
6
0
.
0
10
4
0
.
0
2
.
0
0
0
.
2
9
5
1
.
3
5
0
.
6
6
3
P
o
si
t
i
v
e
15
4
2
.
9
20
5
7
.
1
(
0
.
7
0
–
5
.
6
7
)
(
0
.
3
4
–
5
.
2
3
)
M
o
t
i
v
a
t
i
o
n
P
o
o
r
10
4
7
.
6
11
5
2
.
4
0
.
8
6
1
.
0
0
0
0
.
4
3
0
.
3
5
6
G
o
o
d
20
5
1
.
3
19
4
8
.
7
(
0
.
2
9
–
2
.
4
9
)
(
0
.
0
7
–
2
.
5
6
)
P
a
r
e
n
t
i
n
g
p
a
t
t
e
r
n
s
P
o
o
r
16
5
7
.
1
12
4
2
.
9
1
.
7
1
0
.
4
3
8
0
.
9
1
0
.
8
8
9
G
o
o
d
14
4
3
.
8
18
5
6
.
3
(
0
.
1
6
–
4
.
7
7
)
(
0
.
2
4
–
3
.
3
6
)
a
C
h
i
-
s
q
u
a
re
p
<
0
.
0
5
st
a
t
i
st
i
c
a
l
l
y
si
g
n
i
f
i
c
a
n
t
a
t
a
l
p
h
a
(
α)
0
.
0
5
;
b
L
o
g
i
s
t
i
c
re
g
r
e
ssi
o
n
,
p
<
0
.
0
5
i
s s
t
a
t
i
s
t
i
c
a
l
l
y
s
i
g
n
i
f
i
c
a
n
t
a
t
a
l
p
h
a
(
α)
0
.
0
5
,
OR
=
O
d
d
s
Ra
t
i
o
;
C
I
=
C
o
n
f
i
d
e
n
c
e
i
n
t
e
rv
a
l
;
P
=
Pro
b
a
b
i
l
i
t
y
v
a
l
u
e
.
4
.
DIS
CU
SS
I
O
N
4
.
1
.
H
I
V
bu
rden
a
m
o
ng
M
SM
in lo
ca
l
co
nte
x
t
T
h
e
h
ig
h
p
r
o
p
o
r
tio
n
o
f
HI
V
-
p
o
s
itiv
e
ca
s
es
o
b
s
er
v
ed
am
o
n
g
MSM
u
n
d
er
s
co
r
es
th
at
th
e
H
I
V
b
u
r
d
en
r
em
ain
s
co
n
ce
n
tr
ated
with
in
s
p
ec
if
ic
p
o
p
u
latio
n
g
r
o
u
p
s
,
co
n
s
is
ten
t
with
g
lo
b
al
ep
id
em
io
lo
g
ical
p
atter
n
s
d
em
o
n
s
tr
atin
g
u
n
eq
u
al
r
is
k
d
i
s
tr
ib
u
tio
n
[
27
]
.
T
h
is
p
atter
n
s
u
p
p
o
r
ts
th
e
v
iew
th
at
HI
V
is
n
o
t d
eter
m
in
ed
s
o
lely
b
y
clin
ical
f
ac
to
r
s
b
u
t
is
also
s
h
ap
ed
b
y
s
o
cial
c
o
n
tex
ts
th
at
in
f
lu
en
ce
ex
p
o
s
u
r
e
a
n
d
ac
ce
s
s
to
h
ea
lth
s
er
v
ices
[
2
0
]
.
W
ith
in
th
e
f
r
am
ewo
r
k
o
f
th
e
s
o
cial
d
eter
m
i
n
an
ts
o
f
h
ea
lth
,
s
o
cial
s
tatu
s
,
in
cl
u
d
in
g
ed
u
ca
tio
n
al
attain
m
en
t
s
er
v
es
as
an
in
d
icato
r
o
f
in
d
iv
id
u
al
an
d
co
m
m
u
n
ity
ca
p
ac
ity
to
ac
ce
s
s
ac
tio
n
ab
le
in
f
o
r
m
atio
n
,
MSM
-
f
r
ien
d
ly
s
er
v
ices,
an
d
s
o
cial
p
r
o
tectio
n
m
ec
h
an
is
m
s
[
28
]
.
Acc
o
r
d
i
n
g
ly
,
th
ese
f
i
n
d
in
g
s
r
ein
f
o
r
ce
th
e
ar
g
u
m
en
t
th
at
HI
V
co
n
tr
o
l
s
tr
ateg
ies
s
h
o
u
ld
p
r
io
r
itize
k
ey
p
o
p
u
latio
n
s
r
ath
er
th
a
n
r
ely
i
n
g
o
n
g
e
n
er
alize
d
ap
p
r
o
ac
h
es
f
o
r
th
e
b
r
o
a
d
er
p
o
p
u
latio
n
.
T
h
is
em
p
ir
ical
ev
id
e
n
ce
also
h
ig
h
lig
h
ts
th
e
r
elev
a
n
ce
o
f
HI
V
-
r
elate
d
Su
s
tain
ab
le
Dev
elo
p
m
en
t G
o
a
ls
,
wh
ich
ca
ll f
o
r
m
o
r
e
tar
g
ete
d
in
ter
v
en
tio
n
s
am
o
n
g
v
u
ln
er
a
b
le
g
r
o
u
p
s
.
4
.
2
.
Str
uct
ura
l det
er
m
ina
nts o
f
H
I
V
risk
T
h
e
an
aly
s
is
f
u
r
th
er
in
d
icate
s
th
at
HI
V
r
is
k
d
y
n
am
ics
am
o
n
g
MSM
ex
h
ib
it
d
is
tin
ct
ch
ar
ac
ter
is
tics
,
th
er
eb
y
s
tr
en
g
th
e
n
in
g
th
e
r
atio
n
ale
f
o
r
d
e
f
in
in
g
MSM
as
a
k
ey
p
o
p
u
latio
n
.
T
h
e
f
in
d
in
g
t
h
at
s
ex
u
al
b
eh
av
io
r
s
h
o
wed
a
s
tr
o
n
g
ass
o
ciatio
n
i
n
b
iv
ar
iate
an
aly
s
is
b
u
t
was
atten
u
ated
af
ter
ad
j
u
s
tm
en
t
s
u
g
g
ests
th
at
HI
V
r
is
k
am
o
n
g
MSM
d
o
es
n
o
t
ex
is
t
s
o
lely
as
a
n
“i
n
d
iv
id
u
al
b
e
h
av
io
r
”
is
s
u
e
b
u
t
is
em
b
e
d
d
ed
with
in
a
b
r
o
a
d
er
n
etwo
r
k
o
f
d
eter
m
in
a
n
ts
.
T
h
i
s
o
b
s
er
v
atio
n
alig
n
s
with
th
e
s
o
cio
-
ec
o
lo
g
ical
m
o
d
el,
wh
ich
c
o
n
ce
p
tu
alize
s
HI
V
r
is
k
as
b
ein
g
in
f
lu
e
n
ce
d
b
y
m
u
ltip
le
lev
els,
in
clu
d
in
g
in
d
iv
id
u
al,
r
elatio
n
al,
c
o
m
m
u
n
ity
,
an
d
s
tr
u
ct
u
r
al
o
r
p
o
licy
c
o
n
tex
ts
[
29
]
.
I
n
th
is
r
e
g
ar
d
,
HI
V
p
r
ev
en
tio
n
p
r
o
g
r
a
m
s
f
o
r
MSM
s
h
o
u
ld
s
h
if
t
f
r
o
m
an
ex
clu
s
iv
e
f
o
cu
s
o
n
b
eh
av
io
r
ch
an
g
e
to
war
d
s
tr
en
g
th
en
in
g
s
u
p
p
o
r
tiv
e
en
v
ir
o
n
m
en
ts
,
s
u
c
h
as
s
tig
m
a
-
f
r
ee
h
ea
lth
s
er
v
ices,
ac
ce
s
s
ib
le
r
o
u
tin
e
HI
V
test
in
g
,
an
d
s
af
e
r
ef
e
r
r
al
s
y
s
tem
s
[
1
8
]
,
[
25
]
.
T
h
ese
f
in
d
in
g
s
p
r
o
v
id
e
d
ata
-
d
r
iv
en
ju
s
tific
ati
o
n
th
at
p
o
p
u
latio
n
-
s
p
ec
if
ic
in
ter
v
e
n
tio
n
s
r
em
ai
n
n
ec
ess
ar
y
,
ev
en
wh
en
in
d
icat
o
r
s
o
f
HI
V
-
r
elate
d
k
n
o
wled
g
e
am
o
n
g
r
esp
o
n
d
en
t
s
ap
p
ea
r
r
elativ
ely
a
d
eq
u
ate.
4
.
3
.
K
no
wledg
e
beha
v
io
r
g
a
p a
nd
ps
y
cho
s
o
cia
l c
o
nte
x
t
L
o
w
ed
u
ca
tio
n
al
attain
m
e
n
t
em
er
g
ed
as
a
s
ig
n
if
ic
an
t
i
n
d
ep
en
d
en
t
d
eter
m
in
an
t
o
f
HI
V
s
tatu
s
,
th
er
eb
y
p
r
o
v
i
d
in
g
s
tr
o
n
g
e
m
p
ir
ical
s
u
p
p
o
r
t
f
o
r
th
e
r
o
l
e
o
f
s
tr
u
ctu
r
al
v
u
ln
er
ab
ilit
y
.
E
d
u
ca
tio
n
ca
n
b
e
u
n
d
er
s
to
o
d
as
a
“f
u
n
d
am
en
ta
l
ca
u
s
e”
th
at
s
h
ap
es
ac
ce
s
s
t
o
h
ea
lth
-
r
elate
d
r
eso
u
r
ce
s
,
ca
p
ac
ity
to
n
av
i
g
ate
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
6
4
0
-
647
644
h
ea
lth
s
er
v
ices,
an
d
o
p
p
o
r
tu
n
ities
to
av
o
id
r
is
k
e
x
p
o
s
u
r
e
[
4
]
.
E
d
u
ca
tio
n
al
attain
m
e
n
t
m
ay
also
s
er
v
e
as
a
p
r
o
x
y
in
d
icato
r
o
f
ac
ce
s
s
to
h
ea
lth
in
f
o
r
m
atio
n
,
h
ea
lth
ca
r
e
s
er
v
ices,
an
d
s
o
cial
r
eso
u
r
ce
s
th
at
s
u
p
p
o
r
t
HI
V
p
r
ev
en
tio
n
,
test
in
g
,
an
d
ea
r
ly
d
iag
n
o
s
is
am
o
n
g
M
SM.
T
h
i
s
f
in
d
in
g
is
also
co
n
s
is
ten
t
with
th
e
co
n
ce
p
t
o
f
s
tr
u
ctu
r
al
v
u
ln
er
a
b
ilit
y
,
wh
ich
p
o
s
its
th
at
h
ea
lth
r
is
k
s
ar
e
p
r
o
d
u
ce
d
b
y
s
o
cial
p
o
s
itio
n
an
d
s
y
s
tem
ic
b
ar
r
ier
s
r
ath
er
th
an
s
o
lely
b
y
in
d
i
v
id
u
al
ch
o
ices
[
30
]
,
[
31
]
.
T
h
e
p
r
e
s
en
t
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t
w
ith
ev
id
en
ce
f
r
o
m
o
th
er
lo
w
-
an
d
m
id
d
le
-
i
n
co
m
e
co
u
n
tr
ies.
Stu
d
ies
c
o
n
d
u
cted
am
o
n
g
MSM
in
C
h
in
a,
B
r
az
il,
an
d
Vietn
am
h
av
e
s
im
ilar
ly
d
em
o
n
s
tr
ated
th
at
s
tr
u
ctu
r
al
d
is
ad
v
a
n
tag
es,
in
clu
d
in
g
lo
wer
ed
u
ca
tio
n
al
attain
m
en
t
an
d
b
ar
r
ier
s
to
h
ea
lth
ca
r
e
ac
c
ess
,
co
n
tr
i
b
u
te
s
u
b
s
tan
tially
to
HI
V
v
u
ln
er
a
b
ilit
y
.
T
h
is
co
n
s
is
ten
cy
ac
r
o
s
s
s
ettin
g
s
s
u
g
g
ests
th
at
th
e
in
f
lu
en
ce
o
f
s
tr
u
ctu
r
al
d
et
er
m
in
an
ts
o
n
HI
V
r
is
k
ex
ten
d
s
b
ey
o
n
d
lo
ca
l
c
o
n
tex
ts
an
d
r
ep
r
esen
ts
a
b
r
o
ad
er
p
u
b
lic
h
ea
lth
ch
allen
g
e
am
o
n
g
MSM
p
o
p
u
latio
n
s
.
Am
o
n
g
MSM
,
s
tr
u
ctu
r
al
b
ar
r
ier
s
o
f
ten
in
ter
ac
t
with
p
s
y
ch
o
s
o
cial
p
r
ess
u
r
es,
s
u
ch
as
f
ea
r
o
f
s
tig
m
a
an
d
d
is
cr
im
in
atio
n
,
wh
ich
m
a
y
u
ltima
tely
r
ed
u
ce
th
e
u
tili
za
tio
n
o
f
HI
V
p
r
ev
en
tio
n
an
d
tr
ea
tm
en
t
s
er
v
ices
[
32
]
,
[
33
]
.
T
h
u
s
,
th
ese
f
in
d
in
g
s
ch
allen
g
e
o
v
er
ly
s
im
p
l
if
ied
n
ar
r
ativ
es
th
at
f
r
am
e
HI
V
am
o
n
g
MSM
p
r
im
ar
ily
as
a
b
eh
av
io
r
al
is
s
u
e,
as
s
tr
u
ctu
r
al
d
eter
m
in
an
ts
r
em
ain
ed
d
o
m
in
an
t e
v
en
a
f
ter
co
n
tr
o
llin
g
f
o
r
o
th
er
f
ac
to
r
s
.
T
h
e
lack
o
f
s
ig
n
if
ican
t
ass
o
ci
atio
n
s
f
o
r
k
n
o
wled
g
e,
attitu
d
es,
an
d
m
o
tiv
atio
n
in
t
h
e
m
u
ltiv
ar
i
ab
le
m
o
d
el
in
d
icate
s
th
at
h
ig
h
er
l
ev
els
o
f
k
n
o
wled
g
e
d
o
n
o
t
a
u
to
m
atica
lly
tr
an
s
late
in
to
co
n
s
is
ten
t
p
r
ev
en
tiv
e
p
r
ac
tices.
T
h
is
p
h
en
o
m
en
o
n
alig
n
s
with
h
ea
lth
p
r
o
m
o
t
io
n
liter
atu
r
e
em
p
h
asizin
g
t
h
e
p
r
esen
ce
o
f
a
k
n
o
wled
g
e
–
b
eh
a
v
io
r
g
ap
,
in
wh
ich
k
n
o
wled
g
e
f
ails
to
c
o
n
v
er
t
in
to
ac
tio
n
d
u
e
to
r
elatio
n
al
b
ar
r
ier
s
,
s
o
cial
n
o
r
m
s
,
o
r
p
e
r
v
asiv
e
r
is
k
co
n
tex
ts
[
34
]
,
[
35
]
.
W
ith
in
th
e
f
r
am
ewo
r
k
s
o
f
th
e
Hea
lth
B
elief
Mo
d
el
a
n
d
t
h
e
T
h
eo
r
y
o
f
Plan
n
ed
B
eh
av
io
r
,
p
r
ev
en
tiv
e
b
eh
a
v
io
r
s
ar
e
in
f
l
u
en
ce
d
b
y
r
is
k
p
er
ce
p
tio
n
,
s
u
b
j
ec
tiv
e
n
o
r
m
s
,
s
elf
-
ef
f
icac
y
,
a
n
d
p
er
ce
iv
e
d
b
e
h
av
i
o
r
al
co
n
tr
o
l;
th
ese
f
ac
to
r
s
m
a
y
b
e
c
o
n
s
tr
ain
ed
am
o
n
g
MSM
b
y
s
tig
m
a,
u
n
eq
u
al
s
ex
u
al
p
o
wer
r
elatio
n
s
,
o
r
lim
ited
ca
p
ac
ity
to
n
eg
o
tiate
co
n
d
o
m
u
s
e
[
30
]
,
[
36
]
.
T
h
ese
f
in
d
in
g
s
ex
te
n
d
cu
r
r
e
n
t
u
n
d
er
s
tan
d
i
n
g
b
y
d
em
o
n
s
tr
a
t
in
g
th
at
h
ea
lth
e
d
u
ca
tio
n
alo
n
e
is
in
s
u
f
f
icien
t
with
o
u
t
co
m
p
lem
e
n
tar
y
in
ter
v
en
tio
n
s
th
at
s
tr
en
g
th
en
n
eg
o
tiatio
n
s
k
ills
,
p
ee
r
s
u
p
p
o
r
t,
an
d
ac
ce
s
s
to
s
af
e
h
ea
lt
h
s
er
v
ices
[
33
]
,
[
37]
.
C
o
n
s
eq
u
en
tly
,
th
e
p
r
in
ci
p
al
co
n
tr
ib
u
tio
n
o
f
th
is
s
tu
d
y
lies
in
p
o
s
itio
n
in
g
k
n
o
wled
g
e
as
a
n
ec
ess
ar
y
b
u
t
in
s
u
f
f
icien
t
co
m
p
o
n
en
t,
u
n
d
e
r
s
co
r
in
g
th
e
n
ee
d
f
o
r
in
ter
v
en
tio
n
s
th
at
ar
e
m
o
r
e
r
esp
o
n
s
iv
e
to
th
e
s
o
cial
r
ea
liti
es o
f
MSM
.
T
h
e
co
m
b
in
atio
n
o
f
f
in
d
in
g
s
n
am
ely
th
e
h
ig
h
p
r
o
p
o
r
tio
n
o
f
HI
V
-
p
o
s
itiv
e
ca
s
es,
th
e
p
r
ed
o
m
in
an
ce
o
f
ed
u
ca
ti
o
n
al
attain
m
en
t
as
a
d
eter
m
in
an
t,
an
d
t
h
e
atten
u
atio
n
o
f
b
e
h
av
io
r
al
ef
f
ec
ts
af
ter
ad
ju
s
tm
en
t
s
u
p
p
o
r
ts
th
e
n
ee
d
f
o
r
co
m
p
r
eh
en
s
iv
e
a
n
d
co
n
tex
t
-
s
en
s
itiv
e
p
r
ev
e
n
tio
n
ap
p
r
o
ac
h
es.
Sy
n
d
em
ic
th
e
o
r
y
ex
p
lain
s
th
at
c
o
-
o
cc
u
r
r
in
g
co
n
d
itio
n
s
,
in
clu
d
i
n
g
s
tig
m
a,
p
s
y
ch
o
s
o
c
ial
s
tr
ess
o
r
s
[
32
]
,
[
37
]
,
an
d
s
o
cial
v
u
ln
er
ab
ilit
y
,
m
a
y
s
im
u
ltan
eo
u
s
ly
am
p
lify
HI
V
r
is
k
,
r
en
d
er
in
g
s
in
g
le
-
f
o
cu
s
i
n
ter
v
en
tio
n
s
in
ad
e
q
u
ate
[
2
0
]
,
[
33
]
,
[
38
]
.
I
n
th
is
co
n
tex
t,
s
tr
en
g
t
h
en
in
g
MSM
-
f
r
ien
d
ly
h
ea
lth
s
er
v
ices,
r
e
d
u
cin
g
s
tig
m
a
with
in
h
ea
lth
ca
r
e
s
ettin
g
s
,
an
d
im
p
lem
en
tin
g
s
tr
u
ctu
r
al
in
ter
v
en
tio
n
s
ce
n
ter
ed
o
n
ed
u
ca
tio
n
an
d
s
o
cial
em
p
o
wer
m
e
n
t
b
ec
o
m
e
in
cr
ea
s
in
g
ly
r
elev
an
t.
T
h
ese
f
in
d
in
g
s
also
o
f
f
er
p
r
ac
tical
d
i
r
ec
tio
n
b
y
i
n
d
icatin
g
th
at
p
r
o
g
r
am
s
s
h
o
u
ld
tar
g
et
s
tr
u
ctu
r
al
d
eter
m
in
an
ts
as
k
e
y
en
tr
y
p
o
in
ts
wh
i
le
m
ain
tain
in
g
co
m
m
u
n
ity
-
b
ased
b
eh
a
v
io
r
al
i
n
ter
v
en
tio
n
s
a
n
d
p
ee
r
s
u
p
p
o
r
t.
Acc
o
r
d
in
g
l
y
,
th
is
s
tu
d
y
f
ills
a
lo
ca
l
ev
id
en
ce
g
ap
an
d
o
f
f
er
s
s
h
ar
p
er
p
o
lic
y
im
p
licatio
n
s
b
y
ad
v
o
ca
tin
g
a
s
h
if
t
in
f
o
cu
s
f
r
o
m
“c
h
a
n
g
in
g
in
d
iv
id
u
als”
to
“im
p
r
o
v
in
g
th
e
r
is
k
c
o
n
tex
t
”
t
h
at
s
h
a
p
es
HI
V
v
u
ln
er
ab
ilit
y
am
o
n
g
MSM
.
Fro
m
th
e
p
er
s
p
ec
tiv
e
o
f
f
u
n
d
am
en
tal
ca
u
s
e
th
eo
r
y
(
L
in
k
a
n
d
Ph
elan
)
,
ed
u
ca
tio
n
ca
n
b
e
u
n
d
er
s
to
o
d
as
a
“f
u
n
d
am
en
tal
ca
u
s
e”
th
at
s
h
ap
es
ac
ce
s
s
to
h
ea
lth
-
r
elate
d
r
eso
u
r
ce
s
,
ca
p
ac
ity
to
n
a
v
ig
ate
h
ea
lth
s
er
v
ices,
an
d
o
p
p
o
r
tu
n
ities
to
av
o
id
r
is
k
ex
p
o
s
u
r
e
[
39
]
,
[
40
]
.
E
d
u
ca
tio
n
al
attain
m
en
t
m
ay
also
s
er
v
e
as
a
p
r
o
x
y
in
d
icato
r
o
f
ac
ce
s
s
to
h
ea
lt
h
in
f
o
r
m
atio
n
,
h
ea
lth
ca
r
e
s
e
r
v
ices,
an
d
s
o
cial
r
eso
u
r
ce
s
th
at
s
u
p
p
o
r
t
HI
V
p
r
ev
en
tio
n
,
test
in
g
,
an
d
ea
r
l
y
d
iag
n
o
s
is
am
o
n
g
MSM
.
T
h
ese
co
-
o
cc
u
r
r
in
g
co
n
d
itio
n
s
d
o
n
o
t
o
p
er
ate
in
d
ep
en
d
en
tly
b
u
t
m
ay
s
y
n
e
r
g
is
tically
in
cr
ea
s
e
s
u
s
ce
p
tib
ilit
y
to
HI
V
in
f
ec
tio
n
.
E
d
u
ca
ti
o
n
al
d
is
ad
v
an
tag
e,
lim
ited
ac
ce
s
s
to
s
u
p
p
o
r
tiv
e
s
er
v
ices,
an
d
s
o
cial
m
ar
g
in
aliza
tio
n
m
ay
co
llectiv
ely
cr
ea
te
a
r
is
k
en
v
ir
o
n
m
en
t
th
at
r
ein
f
o
r
ce
s
ex
p
o
s
u
r
e
wh
il
e
co
n
s
tr
ain
in
g
p
r
o
tectiv
e
b
eh
av
io
r
s
.
Ad
d
r
ess
in
g
HI
V
am
o
n
g
MSM
t
h
er
ef
o
r
e
r
eq
u
ir
es
in
te
g
r
ated
s
tr
ateg
ies
th
at
m
o
v
e
b
ey
o
n
d
is
o
lated
b
eh
av
io
r
al
in
ter
v
en
tio
n
s
.
T
h
ese
f
i
n
d
in
g
s
a
r
e
r
ele
v
an
t
to
I
n
d
o
n
esia’
s
o
n
g
o
i
n
g
HI
V
co
n
tr
o
l
ef
f
o
r
ts
,
wh
ich
em
p
h
a
s
ize
ex
p
an
d
ed
HI
V
test
in
g
,
e
ar
ly
d
iag
n
o
s
is
,
an
d
im
p
r
o
v
e
d
ac
ce
s
s
to
s
er
v
ices
f
o
r
k
ey
p
o
p
u
latio
n
s
.
Ad
d
r
ess
in
g
ed
u
ca
tio
n
al
in
e
q
u
alities
an
d
s
tig
m
a
-
r
elate
d
b
ar
r
ier
s
m
ay
s
tr
en
g
th
en
t
h
e
ef
f
ec
tiv
en
ess
o
f
th
ese
n
atio
n
al
HI
V
p
r
ev
en
tio
n
s
tr
ateg
ies.
4
.
4
.
Study
lim
it
a
t
io
ns
T
h
is
s
tu
d
y
h
as
s
ev
er
al
lim
itatio
n
s
.
First,
th
e
r
elativ
ely
s
m
all
s
am
p
le
s
ize
(
n
=
6
0
)
m
ay
r
ed
u
ce
s
tatis
t
ical
p
o
wer
an
d
wid
en
c
o
n
f
id
en
ce
i
n
ter
v
als,
th
er
eb
y
af
f
ec
tin
g
esti
m
ate
p
r
ec
is
io
n
.
Seco
n
d
,
th
e
u
s
e
o
f
non
-
p
r
o
b
a
b
ilit
y
s
am
p
lin
g
m
ay
in
tr
o
d
u
ce
s
elec
tio
n
b
ias
an
d
lim
it
th
e
g
en
er
aliza
b
ilit
y
o
f
f
i
n
d
in
g
s
b
e
y
o
n
d
th
e
s
tu
d
y
s
ettin
g
.
T
h
ir
d
,
alth
o
u
g
h
HI
V
s
tatu
s
was
p
r
im
ar
ily
b
as
ed
o
n
d
o
cu
m
en
te
d
test
r
esu
lts
,
p
ar
tial
r
elian
ce
o
n
s
elf
-
r
ep
o
r
t
co
u
ld
lead
to
p
o
ten
tial
m
is
clas
s
if
icatio
n
.
Fin
al
ly
,
th
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
p
r
ec
lu
d
es
ca
u
s
al
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l a
n
d
b
eh
a
vi
o
r
a
l d
et
ermin
a
n
ts
o
f H
I
V
a
mo
n
g
I
n
d
o
n
esia
n
MS
M
(
N
eila
S
u
lu
n
g
)
645
in
f
er
en
ce
.
T
h
ese
lim
itatio
n
s
s
h
o
u
ld
b
e
co
n
s
id
er
e
d
wh
en
in
t
er
p
r
etin
g
th
e
f
in
d
in
g
s
an
d
h
ig
h
lig
h
t
th
e
n
ee
d
f
o
r
lar
g
er
,
p
r
o
b
a
b
ilit
y
-
b
ased
lo
n
g
i
tu
d
in
al
s
tu
d
ies.
5
.
CO
NCLU
SI
O
N
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
n
ee
d
f
o
r
p
o
licy
r
esp
o
n
s
es
t
h
at
ex
ten
d
b
e
y
o
n
d
in
d
iv
id
u
al
b
eh
a
v
io
r
ch
an
g
e.
Po
licy
m
ak
er
s
s
h
o
u
ld
p
r
io
r
itize
im
p
r
o
v
in
g
ac
ce
s
s
to
ed
u
ca
tio
n
,
e
x
p
an
d
in
g
MSM
-
f
r
ien
d
ly
HI
V
test
in
g
s
er
v
ices,
im
p
lem
en
tin
g
s
tig
m
a
-
r
ed
u
ctio
n
p
r
o
g
r
am
s
with
in
h
ea
lth
ca
r
e
s
ettin
g
s
,
an
d
s
tr
en
g
th
en
in
g
p
ee
r
-
le
d
co
m
m
u
n
ity
o
u
tr
ea
ch
.
I
n
te
g
r
at
in
g
s
tr
u
ctu
r
al
in
ter
v
en
tio
n
s
w
ith
b
eh
a
v
io
r
al
p
r
ev
e
n
tio
n
s
tr
ateg
ies
m
ay
o
f
f
er
a
m
o
r
e
s
u
s
tain
ab
le
p
ath
way
to
w
ar
d
r
ed
u
cin
g
HI
V
d
is
p
ar
ities
am
o
n
g
MSM
in
I
n
d
o
n
esia
.
RE
F
E
R
E
NC
E
S
[
1
]
W
H
O
,
“
W
o
r
l
d
h
e
a
l
t
h
s
t
a
t
i
s
t
i
c
s:
m
o
n
i
t
o
r
i
n
g
h
e
a
l
t
h
f
o
r
t
h
e
s
u
st
a
i
n
a
b
l
e
d
e
v
e
l
o
p
me
n
t
g
o
a
l
s
(
S
D
G
s)
,
”
M
i
l
b
a
n
k
Me
m
.
F
u
n
d
Q
.
,
v
o
l
.
2
7
,
p
p
.
1
7
9
–
1
8
7
,
2
0
2
3
.
[
2
]
P
.
X
i
a
n
w
u
e
t
a
l
.
,
“
D
i
s
t
i
n
c
t
r
a
t
e
s
a
n
d
t
r
a
n
smiss
i
o
n
p
a
t
t
e
r
n
s
o
f
m
a
j
o
r
H
I
V
-
1
su
b
t
y
p
e
s
a
m
o
n
g
m
e
n
w
h
o
h
a
v
e
s
e
x
w
i
t
h
me
n
i
n
G
u
a
n
g
x
i
,
C
h
i
n
a
,
”
Fr
o
n
t
i
e
rs i
n
Mi
c
r
o
b
i
o
l
o
g
y
,
v
o
l
.
1
4
,
p
p
.
1
–
1
2
,
2
0
2
4
,
d
o
i
:
1
0
.
3
3
8
9
/
f
m
i
c
b
.
2
0
2
3
.
1
3
3
9
2
4
0
.
[
3
]
Y
,
R
o
n
g
y
i
e
t
a
l
.
,
“
F
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
p
a
s
t
H
I
V
t
e
st
i
n
g
a
m
o
n
g
m
e
n
w
h
o
h
a
v
e
s
e
x
w
i
t
h
me
n
a
t
t
e
n
d
i
n
g
u
n
i
v
e
r
si
t
y
i
n
C
h
i
n
a
:
a
c
r
o
ss
-
se
c
t
i
o
n
a
l
s
t
u
d
y
,
”
S
e
x
u
a
l
H
e
a
l
t
h
,
v
o
l
.
1
8
,
n
o
.
1
,
p
p
.
5
8
–
6
3
,
2
0
2
4
,
d
o
i
:
1
0
.
1
0
7
1
/
S
H
2
0
0
8
8
.
F
a
c
t
o
r
s
.
[
4
]
E.
S
i
n
u
l
i
n
g
g
a
,
A
.
W
a
l
u
y
o
,
a
n
d
S
.
Y
o
n
a
,
“
Th
e
r
o
l
e
o
f
c
h
u
r
c
h
c
o
m
mu
n
i
t
y
i
n
i
n
c
r
e
a
s
i
n
g
se
l
f
a
w
a
r
e
n
e
ss
t
o
p
r
e
v
e
n
t
a
n
i
n
c
r
e
a
se
i
n
H
I
V
/
A
I
D
S
:
Li
t
e
r
a
t
u
r
e
R
e
v
i
e
w
,
”
N
u
rs
i
n
g
C
u
rre
n
t
:
J
u
rn
a
l
K
e
p
e
r
a
w
a
t
a
n
,
v
o
l
.
9
,
n
o
.
2
,
p
p
.
1
4
–
2
9
,
2
0
2
1
.
[
5
]
S
.
A
G
u
n
a
w
a
r
d
e
n
a
,
“
T
h
e
e
f
f
e
c
t
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[
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E.
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1
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[
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;
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[
1
6
]
R
.
L
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,
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[
1
7
]
A
.
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[
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[
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Evaluation Warning : The document was created with Spire.PDF for Python.
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p
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.
Evaluation Warning : The document was created with Spire.PDF for Python.