Perilaku Pencarian Pelayanan Kesehatan Dalam Konsep Perawatan Mandiri Terkait HIV AIDS dan IMS Pada Kalangan Lelaki Berhubungan Seksual Dengan Lelaki.
HEALTH SERVICES SEEKING BEHAVIOR ON SELF
CARE CONCEPT RELATED HIV AIDS AND STIs AMONG
MEN WHO HAVE SEX WITH MEN
Phenomenology Qualitative Study in Denpasar City
Ns. Nyoman Agus Jagat Raya, S.Kep
Nursing Program, Faculty of Medicine,
Udayana University
Bali, Indonesia
Email: jagatraya.bali@gmail.com
Abstract─The transmission of HIV AIDS and STIs dominated
through unprotected sexual intercourse. Men who has sex with
men (MSM) had a high risk of contracting and transmitting
HIV AIDS and STIs. Thus, it increases some cases of HIV
AIDS and STIs. The actions were taken to care for themselves
independently deemed not optimal without visiting and
utilizing health services. This study aims to describing,
exploring, and uncovering the health seeking behavior on self
care concept related to HIV AIDS and STIs among MSM in
the city of Denpasar. In addition, the driving and inhibiting
factors MSM seek health care are analyzed. This study uses a
qualitative design with a phenomenological approach. The
participants were taken from 7 people who selected using
purposive sampling methods and data collection techniques
with in-depth interviews. Interviews were recorded and
analyzed using thematic analysis. Afterwards, the data and
test of the data validity were analyzed. Results of this study
indicated to the search behavior of MSM to health care
services is quite good, merely it was required to give
assistances for understanding and mentoring continually so
that, the process in independently caring for themselves can be
well understood. Views on health cared by the MSM to be are
quite good, including health workers, facilities, data storage,
and the clinic. MSM motivating factor to seek health care
were namely desire, awareness, and call a friend. The
inhibiting factors were the lack of information, less activeness,
difficulties in obtaining health care, no friends, cost, and fear
of test results. One suggestion was given to the nursing
community is to be able to reach out to the existence of MSM
who have a high risk of HIV AIDS and STIs.
Keywords─ HIV AIDS; STIs; MSM; health services
I.
INTRODUCTION
HIV AIDS is an emerging infectious diseases around
the world and included on sixth goal in the Millennium
Development Goals (MDGs). According to the United
Nations Programme on HIV AIDS (UNAIDS) World
Health Organization (WHO) regarding the increase in
people living with HIV from 2008 to 2010 was as follows:
2008: 32.3 million 2009: 32.9 million, and 2010 : 34
million people [26].
In Indonesia, the number of cumulative to June 2011
recorded cases of AIDS reported cases reached 26,483 and
is spread in 33 provinces [9]. Bali as having high
susceptibility to HIV AIDS data obtained from KPA Bali
with incident cases from January 2012 until August 2012
those as many as 374 cases of HIV and AIDS as many as
432 cases with total mortality by 15 cases. The cumulative
data from 1987 to August 2012 reached a total of as many
as 3,378 cases of HIV and AIDS cases as many as 3,126
with a total of 490 death cases. Total reached 6,504 cases
[14].
Increased HIV AIDS cases are caused by key
populations. Men who have sex with men (MSM) entered
in the population as key to the spread of HIV AIDS related
sexual behavior without using a condom. Frequency of
condom use in the past month with regular partners is never
amounted to 12%, sometimes 25%, often 26% and always
36%. Meanwhile, last month the frequency of condom use
with casual partners or customers those do not have 9%,
sometimes 17%, often 27% and always 47% [13].
HIV AIDS is not only a threat to the MSM, but STIs is
also a thing that should be wary. This is related to STIs
caused by more than 25 pathogenic organisms and viruses
that can attack the immune system [11]. STIs will increase
due to the high risk of HIV viral entry activity if it remains
unprotected sexual intercourse [8]. Although STIs can be
treated and in contrast to AIDS has no cure, but STIs will
also make a person feel uncomfortable and impact on daily
life.
The concept of self care among MSM importantly
enforced in order to know the state of health at risk for HIV
AIDS as an early prevention. If STIs is happening, it is
done for his treatment measures. One of the things that can
be done by the MSM in order to care for him independently
is to seek health care.
Access to health care in the city of Denpasar dominates
other districts in Bali and equally accessible in 4 districts,
one of which contained PHC (Public Health Center)
facilities through VCT. Denpasar city has HIV AIDS and
STIs among MSM is higher than other districts in Bali.
Recorded from January to September 2012 cases of STIs
among MSM in Denpasar on by 120 cases [30], while 96
were HIV reactive after VCT in Denpasar area [29]. Based
on this, it is necessary to look at the real research on the
health seeking behavior related to the concept of self care
among MSM in Denpasar as one of the prevention of HIV
AIDS and STIs.
II.
RESEARCH METHODOLOGY
A. Design Study
The design in this study used a qualitative research
with approach phenomenology approach.
B. Population and Sample
The population in this study was the MSM who live in
the city of Denpasar. The sample in this study was called
participants and taken from 7 people. The ages of
participants were between 15-40 years old with sexual
orientation; heterosexual, bisexual, or homosexual.
Retrieval method of participant was purposive sampling.
C. Data Collection Procedure
Preparation phase was developed to guidelines for
interviews, field notes, and do license with related parties.
Implementation phase was done by the introduction of
participants and followed by in-depth interviews.
Termination phase was done after all the participants
validated the results of the interview transcripts.
D. Analysis and Test Data Validity
Analysis of the data was using an inductive process
starting point the findings conclusions on the data collected,
then concluded in general. Processing data were using
thematic analysis, further verified and presented in
descriptive form. Stages of data analysis were: 1) the period
of data collection, 2) data reduction; 3) presentation of data;
4) conclusion/verification data. Theme selection was
determined based on the topics that appear in research, and
then the similar topics are grouped in a single theme.
Validity of the study was divided into two, namely
internal validity and external validity. Internal validation
would be done by implementing the principle researcher
credibility, dependability, and conformability for the
validity of the data. Transferability was often called
external validity. External validity was indicated the degree
of accuracy or applicability of research results to the
population in which the sample could be drawn [18].
III.
FINDINGS
Based on the study, the results showed 10 themes with 33
sub-themes. Response MSM’s knowledge about HIV AIDS
and STIs quite good, but not deep. This study was reflected to
the theme in the cognitive response to the statement of HIV
attacked the immune system, IMS is a genital disease that can
be cured; explain media transmission, prevention, treatment,
and HIV AIDS connection with STIs.
"HIV AIDS disease that's
…transmitted by sex." (P4)
included
in
the
STIs.
Risk sexual behavior perceived of MSM reflected in the
sexual behavior theme composed of anal sex and oral sex.
Theme inconvenience obtained due to the impact of unsafe
sex, perceived pain, and uncomfortable.
"...uncomfortable, while working. When I work, I want to
piss or while serving my customer or whatever it is, genital
pain was fixed and all. It's also interfere as well, disrupting
the work. " (P5)
It affects the attitudes and perceptions of the MSM in
performing self care which was reflected in the theme of how
to care for them, such as taking care of the cleanliness of the
body, keeping away from sexual relations, drug consumption,
and routine control. Sources of support were obtained through
a friend in the form of advice and motivation.
"…support as possible told to change, only he knows my
true character. Could only push him to be on the right
path." (P1)
MSM view of the existence of health care services was
reflected in the theme of health services consisting of health
workers, facilities, data storage, and the clinic. Psychosocial
response to the theme in the MSM response when he first visit
or utilize health services and it was the perceived fear,
depression, and resignation.
"Afraid! Very pounding. Very panic and my face is pale."
(P2)
MSM theme motivating factor in seek health care were
namely desire, awareness, and call a friend.
"...I want to know the problem. Want to know if I have
HIV or not, and for the prevention in the future. Secondly,
want to know the health status of myself." (P6)
The inhibiting factors are the lack of information, less
activeness, difficulties in obtaining health care, no friends,
cost, and fear of test results.
“Only myself have less aggressive, it’s right? …It maybe I
find very busy or lazy or whatever to go utilizing health
services.” (P3)
“Well, I’m afraid, if I go to public health center, so the
result is positive, I afraid if my friends know about the
result, so I do not want that to happen!” (P7)
IV.
DISCUSSION
Theme cognitive responses illustrate how far the MSM
knowledge about HIV AIDS and STIs. Cognitive responses
are part of the structural components of attitude. According
to Mann (1969) in Sunaryo revealed that the contents of the
cognitive component are the perception, beliefs, and
stereotypes of individuals [24]. According Brotosaputro in
Supriyanto explained that the education level of the
individual is an important factor influencing knowledge.
That is, more higher education status of someone, it is more
easily to absorb the knowledge and practice in accordance
with the knowledge gained [25].
Sexual behavior both anal sex and oral sex is not safe,
such as not using condoms would cause a high risk of
contracting STIs and even HIV. The data results of research
conducted in Atlanta, Georgia gained as much as 73% of
MSM do not practice safe sex [16] and in Hanoi, Vietnam
30% did not use condoms of male sex workers [10]. It will
have an impact on the sense of discomfort, such as pain and
uncomfortable on the genitals and anus. This is consistent
with the results of the study in Nairobi, Kenya with the data
obtained for 12% of genital pain, 14% burning during
urination, 11% of itching in the genital and/or anal [21].
Hygiene care for the body to support self care and self
supporting activity daily living (ADL) is optimal. Orem
(1985) in Michael Becker believes that his theory is the
basis for the health and well being, it is because the client
requires more knowledge to maintain the health of yourself
and pay attention to each client independently (Becker,
2012). The process of taking care of themselves needs the
support of people nearby, like a good friend in the form of
advice or motivation. Community involvement can increase
feelings of calm and positive self identity among MSM and
transgender people, as well as the strengthening of peer
norms in the practice of safe sex [7]. In addition to the gay
and bisexual more support from friends than family itself
[17].
Health services play an important role related of MSM
wishes in utilizing health services, including health
workers, facilities, data storage, and the clinic. Reason
MSM who suffer pain in genital to utilize health care
facilities in Kenya by 18% can be reached, the quality of
service 15%, 12% recommended by a friend, 10%
recommended by health professionals, and the location is
close to 2%. By 37% MSM feel comfortable and
confidential [21]. VCT and STI clinics can not be separated
from the MSM. VCT clinic is a clinic as a process of pretesting counseling, post-testing counseling and voluntary
HIV testing is confidential and even earlier to help people
know their HIV status [2]. While the STI clinic is a clinic
that provides clinical and laboratory examinations in cases
of genital disorders [22].
Fear, depression, and resignation are psychosocial
responses at the first time that felt while visiting or utilizing
health services. The first time visit to the health services
has a lot of stressors that trigger fear in participants [24].
Physiological responses experienced in case of coping
responses that fear is poorly controlled, so that the resulting
impact on organs such as heart palpitations, facial tension,
general weakness, rapid and shallow breathing, anxiety, and
discomfort in the abdominal area and urination [23].
Prolonged depression can cause a person to become
discouraged by the desire to end his life and the impact of
depression is the inability to deal with stress is more severe
[27]. Resignation is the process of adjustment to face
demands of the state with conscious, realistic, objective,
and rational. Adjustment process according Suharto
Heerdjan (1987) in Sunaryo that business admission or
behavior that aims to overcome difficulties and obstacles
[24].
MSM motivating factor to seek health care are namely
desire, awareness, and call a friend. Snehandu B. Karr
theory stated that the intention or a person's desire to act in
relation to objects or stimulus beyond itself into a
predisposing determinant of behavior. In addition, the
autonomy or personal freedom (personal autonomy) to take
decisions also predisposes one determinant of behavior
[19]. According to the theory of Sigmund Freud (18561939) explains that consciousness is just a small part of the
whole psychic life that illustrate the things that exist in the
consciousness and the unconscious. According to Freud the
unconscious is contained in the basic forces that drive to do
something. According to Kaplan H. et al. explained that the
unconscious is limited to seeking the fulfillment of
expectations that lead to motivation [24]. MSM tend to be
more comfortable talking the status and the problem to
friends than parents and friends support a factor that has a
relationship to HIV risk [12, 15], so it has an influence on
health seeking. Results of research in Kenya on of MSM
who experienced genital pain STIs examination obtained
12% of the 137 respondents constitute an invitation from a
friend [21].
The inhibiting factors are the lack of information, less
activeness, difficulties in obtaining health care, no friends,
cost, and fear of test results. In Vietnam is only obtained
11% MSM who use health services and the remaining
states are not aware of information about the health care
system with a variety of reasons [20]. According to the
theory Snehandu B. Karr that the accessibility of
information is the availability of information related to
actions to be taken by a person and a determinant of
behavior [19].
Less active is one of the inhibiting factors included in
the endogen factor, namely the personality of the idler.
According Maramis, personality traits is the overall pattern
of thoughts, feelings, and behaviors that is often used by a
person in a continuous adaptation effort against his life
[24]. Difficulty in obtaining health services is also
described by the WHO that was the location of health
services is a part that is often complained MSM, so it needs
a focused approach to public health, as well as respond
according to the location and the magnitude and trends of
the HIV epidemic. This should be based on the WHO
program uses a comprehensive service management for
MSM, including STI testing and counseling [28].
No friend become the inhibit thing because friends are
an important source of support and friends to be a source of
information about HIV AIDS and STIs in the form of peer
educators [1, 21]. Health costs are considered to be a
bottleneck for pricey health care. Therefore, does not little
MSM claim to feel satisfactory income from a job as a male
sex worker [6]. Fear of test results is an obstacle that is
often experienced by MSM. Fear of test results is also
described in the research of Magaly M. Blas et al. statement
in 2011 regarding the MSM respondents, i.e., "I fear the
Consequences of a positive test result" which amounted to
34.4% or 55 of 105 MSM respondents. This research was
continued in 2012 in order to fear the results of the test can
be done a campaign of support for MSM of stigma and
discrimination [5, 6].
V.
CONCLUSION AND SUGGESTION
Knowledge of MSM to HIV AIDS and STIs can be
quite good, it's just still a general nature and not
comprehensive. Attitude and outlook towards self care
related to MSM sexual behavior. Unsafe sexual behavior
would lead to the occurrence of STIs or even HIV AIDS.
When the symptoms STIs, the MSM will be a tendency to
feel discomfort on him. This discomfort will affect ADL of
MSM. This is what will affect the way of doing self care.
To support the process of self treatment MSM needs the
support of a friend in the form of advice and motivation.
ACKNOWLEDGMENT
Researcher would like to thank the University of
Udayana and NGO of GAYa Dewata Foundation is focused
on preventing the spread of HIV AIDS and STIs and has
supported the implementation of this study.
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[11]
[12]
View of the MSM to health care, including health
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response when he first time to visit or utilize health services
there is a sense of fear, depression, and resignation. MSM
motivating factor to seek health care are namely desire,
awareness, and call a friend. The inhibiting factors are the
lack of information, less activeness, difficulties in obtaining
health care, no friends, cost, and fear of test results.
Researcher suggests the community nursing team to be
able to do outreach to the MSM who have a high risk of
transmission of HIV AIDS and STIs through PHN
program. In addition, to policy makers, such as the National
AIDS Commission (KPA), NGOs, and governments. For
nursing education can be used as the application of the
latest scientific foundation in evidence-based nursing and
the development of future similar studies.
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CARE CONCEPT RELATED HIV AIDS AND STIs AMONG
MEN WHO HAVE SEX WITH MEN
Phenomenology Qualitative Study in Denpasar City
Ns. Nyoman Agus Jagat Raya, S.Kep
Nursing Program, Faculty of Medicine,
Udayana University
Bali, Indonesia
Email: jagatraya.bali@gmail.com
Abstract─The transmission of HIV AIDS and STIs dominated
through unprotected sexual intercourse. Men who has sex with
men (MSM) had a high risk of contracting and transmitting
HIV AIDS and STIs. Thus, it increases some cases of HIV
AIDS and STIs. The actions were taken to care for themselves
independently deemed not optimal without visiting and
utilizing health services. This study aims to describing,
exploring, and uncovering the health seeking behavior on self
care concept related to HIV AIDS and STIs among MSM in
the city of Denpasar. In addition, the driving and inhibiting
factors MSM seek health care are analyzed. This study uses a
qualitative design with a phenomenological approach. The
participants were taken from 7 people who selected using
purposive sampling methods and data collection techniques
with in-depth interviews. Interviews were recorded and
analyzed using thematic analysis. Afterwards, the data and
test of the data validity were analyzed. Results of this study
indicated to the search behavior of MSM to health care
services is quite good, merely it was required to give
assistances for understanding and mentoring continually so
that, the process in independently caring for themselves can be
well understood. Views on health cared by the MSM to be are
quite good, including health workers, facilities, data storage,
and the clinic. MSM motivating factor to seek health care
were namely desire, awareness, and call a friend. The
inhibiting factors were the lack of information, less activeness,
difficulties in obtaining health care, no friends, cost, and fear
of test results. One suggestion was given to the nursing
community is to be able to reach out to the existence of MSM
who have a high risk of HIV AIDS and STIs.
Keywords─ HIV AIDS; STIs; MSM; health services
I.
INTRODUCTION
HIV AIDS is an emerging infectious diseases around
the world and included on sixth goal in the Millennium
Development Goals (MDGs). According to the United
Nations Programme on HIV AIDS (UNAIDS) World
Health Organization (WHO) regarding the increase in
people living with HIV from 2008 to 2010 was as follows:
2008: 32.3 million 2009: 32.9 million, and 2010 : 34
million people [26].
In Indonesia, the number of cumulative to June 2011
recorded cases of AIDS reported cases reached 26,483 and
is spread in 33 provinces [9]. Bali as having high
susceptibility to HIV AIDS data obtained from KPA Bali
with incident cases from January 2012 until August 2012
those as many as 374 cases of HIV and AIDS as many as
432 cases with total mortality by 15 cases. The cumulative
data from 1987 to August 2012 reached a total of as many
as 3,378 cases of HIV and AIDS cases as many as 3,126
with a total of 490 death cases. Total reached 6,504 cases
[14].
Increased HIV AIDS cases are caused by key
populations. Men who have sex with men (MSM) entered
in the population as key to the spread of HIV AIDS related
sexual behavior without using a condom. Frequency of
condom use in the past month with regular partners is never
amounted to 12%, sometimes 25%, often 26% and always
36%. Meanwhile, last month the frequency of condom use
with casual partners or customers those do not have 9%,
sometimes 17%, often 27% and always 47% [13].
HIV AIDS is not only a threat to the MSM, but STIs is
also a thing that should be wary. This is related to STIs
caused by more than 25 pathogenic organisms and viruses
that can attack the immune system [11]. STIs will increase
due to the high risk of HIV viral entry activity if it remains
unprotected sexual intercourse [8]. Although STIs can be
treated and in contrast to AIDS has no cure, but STIs will
also make a person feel uncomfortable and impact on daily
life.
The concept of self care among MSM importantly
enforced in order to know the state of health at risk for HIV
AIDS as an early prevention. If STIs is happening, it is
done for his treatment measures. One of the things that can
be done by the MSM in order to care for him independently
is to seek health care.
Access to health care in the city of Denpasar dominates
other districts in Bali and equally accessible in 4 districts,
one of which contained PHC (Public Health Center)
facilities through VCT. Denpasar city has HIV AIDS and
STIs among MSM is higher than other districts in Bali.
Recorded from January to September 2012 cases of STIs
among MSM in Denpasar on by 120 cases [30], while 96
were HIV reactive after VCT in Denpasar area [29]. Based
on this, it is necessary to look at the real research on the
health seeking behavior related to the concept of self care
among MSM in Denpasar as one of the prevention of HIV
AIDS and STIs.
II.
RESEARCH METHODOLOGY
A. Design Study
The design in this study used a qualitative research
with approach phenomenology approach.
B. Population and Sample
The population in this study was the MSM who live in
the city of Denpasar. The sample in this study was called
participants and taken from 7 people. The ages of
participants were between 15-40 years old with sexual
orientation; heterosexual, bisexual, or homosexual.
Retrieval method of participant was purposive sampling.
C. Data Collection Procedure
Preparation phase was developed to guidelines for
interviews, field notes, and do license with related parties.
Implementation phase was done by the introduction of
participants and followed by in-depth interviews.
Termination phase was done after all the participants
validated the results of the interview transcripts.
D. Analysis and Test Data Validity
Analysis of the data was using an inductive process
starting point the findings conclusions on the data collected,
then concluded in general. Processing data were using
thematic analysis, further verified and presented in
descriptive form. Stages of data analysis were: 1) the period
of data collection, 2) data reduction; 3) presentation of data;
4) conclusion/verification data. Theme selection was
determined based on the topics that appear in research, and
then the similar topics are grouped in a single theme.
Validity of the study was divided into two, namely
internal validity and external validity. Internal validation
would be done by implementing the principle researcher
credibility, dependability, and conformability for the
validity of the data. Transferability was often called
external validity. External validity was indicated the degree
of accuracy or applicability of research results to the
population in which the sample could be drawn [18].
III.
FINDINGS
Based on the study, the results showed 10 themes with 33
sub-themes. Response MSM’s knowledge about HIV AIDS
and STIs quite good, but not deep. This study was reflected to
the theme in the cognitive response to the statement of HIV
attacked the immune system, IMS is a genital disease that can
be cured; explain media transmission, prevention, treatment,
and HIV AIDS connection with STIs.
"HIV AIDS disease that's
…transmitted by sex." (P4)
included
in
the
STIs.
Risk sexual behavior perceived of MSM reflected in the
sexual behavior theme composed of anal sex and oral sex.
Theme inconvenience obtained due to the impact of unsafe
sex, perceived pain, and uncomfortable.
"...uncomfortable, while working. When I work, I want to
piss or while serving my customer or whatever it is, genital
pain was fixed and all. It's also interfere as well, disrupting
the work. " (P5)
It affects the attitudes and perceptions of the MSM in
performing self care which was reflected in the theme of how
to care for them, such as taking care of the cleanliness of the
body, keeping away from sexual relations, drug consumption,
and routine control. Sources of support were obtained through
a friend in the form of advice and motivation.
"…support as possible told to change, only he knows my
true character. Could only push him to be on the right
path." (P1)
MSM view of the existence of health care services was
reflected in the theme of health services consisting of health
workers, facilities, data storage, and the clinic. Psychosocial
response to the theme in the MSM response when he first visit
or utilize health services and it was the perceived fear,
depression, and resignation.
"Afraid! Very pounding. Very panic and my face is pale."
(P2)
MSM theme motivating factor in seek health care were
namely desire, awareness, and call a friend.
"...I want to know the problem. Want to know if I have
HIV or not, and for the prevention in the future. Secondly,
want to know the health status of myself." (P6)
The inhibiting factors are the lack of information, less
activeness, difficulties in obtaining health care, no friends,
cost, and fear of test results.
“Only myself have less aggressive, it’s right? …It maybe I
find very busy or lazy or whatever to go utilizing health
services.” (P3)
“Well, I’m afraid, if I go to public health center, so the
result is positive, I afraid if my friends know about the
result, so I do not want that to happen!” (P7)
IV.
DISCUSSION
Theme cognitive responses illustrate how far the MSM
knowledge about HIV AIDS and STIs. Cognitive responses
are part of the structural components of attitude. According
to Mann (1969) in Sunaryo revealed that the contents of the
cognitive component are the perception, beliefs, and
stereotypes of individuals [24]. According Brotosaputro in
Supriyanto explained that the education level of the
individual is an important factor influencing knowledge.
That is, more higher education status of someone, it is more
easily to absorb the knowledge and practice in accordance
with the knowledge gained [25].
Sexual behavior both anal sex and oral sex is not safe,
such as not using condoms would cause a high risk of
contracting STIs and even HIV. The data results of research
conducted in Atlanta, Georgia gained as much as 73% of
MSM do not practice safe sex [16] and in Hanoi, Vietnam
30% did not use condoms of male sex workers [10]. It will
have an impact on the sense of discomfort, such as pain and
uncomfortable on the genitals and anus. This is consistent
with the results of the study in Nairobi, Kenya with the data
obtained for 12% of genital pain, 14% burning during
urination, 11% of itching in the genital and/or anal [21].
Hygiene care for the body to support self care and self
supporting activity daily living (ADL) is optimal. Orem
(1985) in Michael Becker believes that his theory is the
basis for the health and well being, it is because the client
requires more knowledge to maintain the health of yourself
and pay attention to each client independently (Becker,
2012). The process of taking care of themselves needs the
support of people nearby, like a good friend in the form of
advice or motivation. Community involvement can increase
feelings of calm and positive self identity among MSM and
transgender people, as well as the strengthening of peer
norms in the practice of safe sex [7]. In addition to the gay
and bisexual more support from friends than family itself
[17].
Health services play an important role related of MSM
wishes in utilizing health services, including health
workers, facilities, data storage, and the clinic. Reason
MSM who suffer pain in genital to utilize health care
facilities in Kenya by 18% can be reached, the quality of
service 15%, 12% recommended by a friend, 10%
recommended by health professionals, and the location is
close to 2%. By 37% MSM feel comfortable and
confidential [21]. VCT and STI clinics can not be separated
from the MSM. VCT clinic is a clinic as a process of pretesting counseling, post-testing counseling and voluntary
HIV testing is confidential and even earlier to help people
know their HIV status [2]. While the STI clinic is a clinic
that provides clinical and laboratory examinations in cases
of genital disorders [22].
Fear, depression, and resignation are psychosocial
responses at the first time that felt while visiting or utilizing
health services. The first time visit to the health services
has a lot of stressors that trigger fear in participants [24].
Physiological responses experienced in case of coping
responses that fear is poorly controlled, so that the resulting
impact on organs such as heart palpitations, facial tension,
general weakness, rapid and shallow breathing, anxiety, and
discomfort in the abdominal area and urination [23].
Prolonged depression can cause a person to become
discouraged by the desire to end his life and the impact of
depression is the inability to deal with stress is more severe
[27]. Resignation is the process of adjustment to face
demands of the state with conscious, realistic, objective,
and rational. Adjustment process according Suharto
Heerdjan (1987) in Sunaryo that business admission or
behavior that aims to overcome difficulties and obstacles
[24].
MSM motivating factor to seek health care are namely
desire, awareness, and call a friend. Snehandu B. Karr
theory stated that the intention or a person's desire to act in
relation to objects or stimulus beyond itself into a
predisposing determinant of behavior. In addition, the
autonomy or personal freedom (personal autonomy) to take
decisions also predisposes one determinant of behavior
[19]. According to the theory of Sigmund Freud (18561939) explains that consciousness is just a small part of the
whole psychic life that illustrate the things that exist in the
consciousness and the unconscious. According to Freud the
unconscious is contained in the basic forces that drive to do
something. According to Kaplan H. et al. explained that the
unconscious is limited to seeking the fulfillment of
expectations that lead to motivation [24]. MSM tend to be
more comfortable talking the status and the problem to
friends than parents and friends support a factor that has a
relationship to HIV risk [12, 15], so it has an influence on
health seeking. Results of research in Kenya on of MSM
who experienced genital pain STIs examination obtained
12% of the 137 respondents constitute an invitation from a
friend [21].
The inhibiting factors are the lack of information, less
activeness, difficulties in obtaining health care, no friends,
cost, and fear of test results. In Vietnam is only obtained
11% MSM who use health services and the remaining
states are not aware of information about the health care
system with a variety of reasons [20]. According to the
theory Snehandu B. Karr that the accessibility of
information is the availability of information related to
actions to be taken by a person and a determinant of
behavior [19].
Less active is one of the inhibiting factors included in
the endogen factor, namely the personality of the idler.
According Maramis, personality traits is the overall pattern
of thoughts, feelings, and behaviors that is often used by a
person in a continuous adaptation effort against his life
[24]. Difficulty in obtaining health services is also
described by the WHO that was the location of health
services is a part that is often complained MSM, so it needs
a focused approach to public health, as well as respond
according to the location and the magnitude and trends of
the HIV epidemic. This should be based on the WHO
program uses a comprehensive service management for
MSM, including STI testing and counseling [28].
No friend become the inhibit thing because friends are
an important source of support and friends to be a source of
information about HIV AIDS and STIs in the form of peer
educators [1, 21]. Health costs are considered to be a
bottleneck for pricey health care. Therefore, does not little
MSM claim to feel satisfactory income from a job as a male
sex worker [6]. Fear of test results is an obstacle that is
often experienced by MSM. Fear of test results is also
described in the research of Magaly M. Blas et al. statement
in 2011 regarding the MSM respondents, i.e., "I fear the
Consequences of a positive test result" which amounted to
34.4% or 55 of 105 MSM respondents. This research was
continued in 2012 in order to fear the results of the test can
be done a campaign of support for MSM of stigma and
discrimination [5, 6].
V.
CONCLUSION AND SUGGESTION
Knowledge of MSM to HIV AIDS and STIs can be
quite good, it's just still a general nature and not
comprehensive. Attitude and outlook towards self care
related to MSM sexual behavior. Unsafe sexual behavior
would lead to the occurrence of STIs or even HIV AIDS.
When the symptoms STIs, the MSM will be a tendency to
feel discomfort on him. This discomfort will affect ADL of
MSM. This is what will affect the way of doing self care.
To support the process of self treatment MSM needs the
support of a friend in the form of advice and motivation.
ACKNOWLEDGMENT
Researcher would like to thank the University of
Udayana and NGO of GAYa Dewata Foundation is focused
on preventing the spread of HIV AIDS and STIs and has
supported the implementation of this study.
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