Behavioral and Structural Predictors of Adolescents' Attitudes Towards Voluntary Counseling and Testing (VCT) for HIV in East Java, Indonesia
Abstract
Introduction: HIV remains a significant global public health issue, with East Java, Indonesia, contributing 15–20% of the national HIV cases. Voluntary Counseling and Testing (VCT) is a critical strategy for early detection and prevention, yet its uptake among adolescents is influenced by multifaceted factors. This study aimed to identify the determinants of adolescents' attitudes towards VCT for HIV in East Java.
Methods: An observational analytic cross-sectional study was conducted from July to December 2024, involving 329 adolescents aged 18–24 years selected through random sampling. Data were collected via a validated online questionnaire assessing demographic, socio-economic, knowledge, psychosocial, and institutional factors. Binary logistic regression analysis was employed to determine significant predictors of VCT attitudes.
Results: Nine factors were significantly associated with positive attitudes toward VCT: younger age (OR = 0.81), male gender (OR = 2.34), higher parental income (OR = 1.86), higher HIV-related knowledge (OR = 2.18), better VCT knowledge (OR = 1.72), low-risk sexual activity (OR = 1.95), service availability (OR = 2.48), family support (OR = 1.77), and institutional support (OR = 1.63). Conversely, stigma remained a significant barrier (OR = 0.49).
Conclusion: Addressing stigma, enhancing institutional and family support, and improving access to VCT services are crucial for increasing VCT uptake among adolescents. Targeted interventions, including family-based approaches and comprehensive sexual education, are recommended to foster positive attitudes and reduce HIV transmission in East Java.
References
Ministry of Health of the Republic of Indonesia. Report on the Development of HIV-AIDS & Sexually Transmitted Infections Quarter I [Internet]. 2024 [cited 2025 Jun 18]. Available from: https://www.kemkes.go.id
Ministry of Health of the Republic of Indonesia. HIV-AIDS Infodatin 2023 [Internet]. Jakarta: Directorate General of Disease Prevention and Control, Ministry of Health. (2023).; 2024 [cited 2025 Jun 18]. Available from: https://www.kemkes.go.id
East Java Provincial Health Office. Annual Report on HIV-AIDS Cases in East Java 2023 [Internet]. 2023 [cited 2025 Jun 18]. Available from: https://dinkes.jatimprov.go.id
Sub-Directorate of HIV-AIDS & PIMS M of H. Statistics of HIV-AIDS Cases in Indonesia. 2024.
Ministry of Health of the Republic of Indonesia. HIV-AIDS Information System (SIHA) – Latest data on cases per province.
GAYa Nusantara. Report on Access to HIV Services for Key Populations in East Java. 2023.
East Java AIDS Community. Challenges and Achievements of HIV Handling in Surabaya and Malang.UNAIDS Indonesia. Country Factsheet; 2023.
WHO. Global HIV Programme: Indonesia. [Internet]. 2023 [cited 2025 Jun 18]. Available from: https://www.who.int/countries/idn
Myers JJ, Maiorana A, Chaturvedi SD, Guilin V, Buisker T, Khumalo-Sakutukwa G, et al. Uptake and Outcomes Associated with Implementation of a Community-Based Voluntary HIV Counseling and Testing Program in Antigua and Barbuda. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2016 Sep 9;15(5):385–91.
Akhigbe R, Bamidele J. Prevalence and pattern of utilization of voluntary counseling and testing services and HIV infection in Ogbomoso, southwestern Nigeria. J Nat Sci Biol Med. 2013;4(1):163.
Abdalla AM, Abusalih HH. Factors Affecting HIV Voluntary Counseling and Testing Uptake among Usndergraduate Students of Khartoum, Sudan. Open AIDS J. 2021 Mar 22;15(1):21–7.
Conserve D, Sevilla L, Mbwambo J, King G. Determinants of Previous HIV Testing and Knowledge of Partner’s HIV Status Among Men Attending a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania. Am J Mens Health. 2013 Nov 4;7(6):450–60.
Samayoa B, Anderson M, O’Sullivan L, Pacheco K, Matos A, Reyes D, et al. Does HIV VCT Reduce Risk Behaviors? An Observational Study in Guatemala City. Curr HIV Res. 2010 Mar 1;8(2):121–6.
Worthington CA, Calzavara LM, White SJ, Allman D, Tyndall MW. Individual and jurisdictional factors associated with voluntary HIV testing in Canada: Results of a national survey, 2011. Canadian Journal of Public Health. 2015 Jan 1;106(2):e4–9.
Addis Z, Yalew A, Shiferaw Y, Alemu A, Birhan W, Mathewose B, et al. Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study. BMC Public Health. 2013 Dec 2;13(1):714.
Sanga Z, Kapanda G, Msuya S, Mwangi R. Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: a cross sectional study. BMC Public Health. 2015 Dec 2;15(1):452.
MacPhail CL, Pettifor A, Coates T, Rees H. “You Must Do the Test to Know Your Status”: Attitudes to HIV Voluntary Counseling and Testing for Adolescents Among South African Youth and Parents. Health Education & Behavior. 2008 Feb 31;35(1):87–104.
Fako TT. Social and psychological factors associated with willingness to test for HIV infection among young people in Botswana. AIDS Care. 2006 Apr 19;18(3):201–7.
Karim QA, Meyer-Weitz A, Mboyi L, Carrara H, Mahlase G, Frohlich JA, et al. The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa. Glob Public Health. 2008 Oct 15;3(4):351–65.
Satyanarayana VA, Chandra PS, Vaddiparti K, Benegal V, Cottler LB. Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India. AIDS Care. 2009 May 14;21(5):615–21.
He N, Zhang J, Yao J, Tian X, Zhao G, Jiang Q, et al. Knowledge, Attitudes, and Practices of Voluntary HIV Counseling and Testing among Rural Migrants in Shanghai, China. AIDS Education and Prevention. 2009 Dec;21(6):570–81.
Avedissian T, Alayan N. Adolescent well?being: A concept analysis. Int J Ment Health Nurs. 2021 Apr 4;30(2):357–67.
E. Ngozi, A. Oguzie, A. Aigbokhaode, E. Ezunu. Socio-Demographic Determinants of Attitude Towards Voluntary Counselling and Testing (VCT) in Delta State, Nigeria. 2020;4(1):44–60.
Kusumaningrum TAI, Kusumawati Y, Indriawan T, Saputri MW, Pebrianti S, Liswanti AL. Formation of Peer Educators in Efforts to Disseminate Information on Preventing HIV Risk Behavior in Adolescents. Warta LPM. 2021;24(4):677–86.
Rachmawati L. The Relationship between Parental and Friend Motivations on Reproductive Health and LGBT Behavior in Adolescents. Pertiwi Health Journal. 2023;5(1):32–43.
Erena AN, Shen G, Lei P. Factors affecting HIV counselling and testing among Ethiopian women aged 15–49. BMC Infect Dis. 2019 Dec 21;19(1):1076.
Zhang Q, Fu YS, Liu XM, Ding ZQ, Li MQ, Fan YG. HIV Prevalence and Factors Influencing the Uptake of Voluntary HIV Counseling and Testing among Older Clients of Female Sex Workers in Liuzhou and Fuyang Cities, China, 2016?2017: A Cross?Sectional Study. Biomed Res Int. 2020 Jan 24;2020(1).
Blake H, Yildirim M, Lax SJ, Evans C. Voluntary HIV Testing and Counselling Initiatives in Occupational Settings: A Scoping Review. Int J Environ Res Public Health. 2025 Feb 12;22(2):263.
Pulerwitz J, Gottert A, Kahn K, Haberland N, Julien A, Selin A, et al. Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa. AIDS Behav. 2019 Sep 29;23(S2):162–71.
Igiribambe R, Rutayisire E, Habtu M. Uptake of HIV Voluntary Counseling and Testing and Associated Factors among Students in the Higher Institutions of Learning in Kigali, Rwanda: A Cross-Sectional Study. Rwanda Journal of Medicine and Health Sciences. 2023 Jul 31;6(2):104–12.
Joint United Nations Programme on HIV/AIDS. Global HIV & AIDS statistics— Fact sheet. 2023 [cited 2025 Jun 18]; Available from: https://www.unaids.org/en/resources/factsheet. 2022
Institute of Statistics of Rwanda (NISR) [Rwanda] M of H (MOH) [Rwanda], and I. Rwanda Demographic and Health Survey 2019-20 Final Report. Kigali, Rwanda, and Rockville, Maryland, USA; 2021.
Onyemachi PEN, Awa MJ, Ejikem MEC, Enukeme JU. Prevalence and Predictors of Non-Uptake of HIV Voluntary Counseling and Testing among Undergraduates of Tertiary Institution in Abia State, Nigeria. Open J Stat. 2021;11(01):19–35.
Alem AT, Sisay MM, Alemayehu AM. Factors Affecting Voluntary HIV/AIDS Counseling and Testing Service Utilization Among Youth in Gondar City, Northwest Ethiopia. HIV/AIDS - Research and Palliative Care. 2020 Nov;Volume 12:667–73.
UNAIDS. Global aids update: Geneva, Switzerland [Internet]. 2016 [cited 2025 Jun 18]. Available from: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf
Oppong Asante K. HIV/AIDS knowledge and uptake of HIV counselling and testing among undergraduate private university students in Accra, Ghana. Reprod Health. 2013 Dec 28;10(1):17.
Kholis M, Pranoto YKS. Literature review: Effectiveness of implementing sex education in formal schools for early childhood. In: In Proceedings of the National Postgraduate Seminar . 2022. p. 635–40.
Wajdi F, Arif A. The importance of sex education for children as an effort to understand and avoid preventing violence and sexual crimes. Jurnal Abdimas Indonesia. 2021;1(3):129–37.
Hubaybah H, Wisudariani E, Lanita U. Evaluation of the Implementation of Voluntary Counseling and Testing (VCT) Services in the HIV/AIDS Prevention Program at the Pakuan Baru Health Center, Jambi City. Jurnal Kesmas Jambi. 2021;5(1):61–71.
Mousavi M, Esmaeili R, Karimy M, Azaripour A. Family-based interventions in youth to prevent HIV/AIDS: A systematic review. J Educ Health Promot. 2023;
Perrino T, Gonzales M, Pantin H, Brincks A, Prado G. Efficacy of a family-based intervention for HIV prevention with Hispanic adolescents with same-gender sexual behaviors. Prevention Science. 2021;22(4):508–18.
Polk JB, Campbell J, Drilon AE, Keating P, Cambrosio A. Organizing precision medicine: A case study of Memorial Sloan Kettering Cancer Center’s engagement in/with genomics. Soc Sci Med. 2023 May;324:115789.
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