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Gonorrhoea in Indonesia and the Netherlands

Diagnostics and antimicrobial resistance
Hananta, I.P.Y.

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Hananta, I. P. Y. (2018). Gonorrhoea in Indonesia and the Netherlands: Diagnostics and antimicrobial
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Download date: 08 Feb 2021

 CHAPTER 5

Characteristics of sex partners as determinants for condomless anal intercourse

among men who have sex with men and transwomen in Indonesia:
An observational study

I Putu Yuda Hananta, Henry John Christiaan de Vries, Alje Pieter van Dam, Ciptasari
Prabawanti, Adi Nugroho, Hardyanto Soebono,
Maarten Franciscus Schim van der Loeff

Submitted for publication

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 ABSTRACT K
t
Introduction

We investigated whether characteristics of sex partners are associated with

condomless anal intercourse among men who have sex with men (MSM) and
transgender women in Indonesia.

Methods
MSM and transgender women in Jakarta, Yogyakarta, and Denpasar (Indonesia)
were invited to participate in a study on sexual behaviour and sexually transmitted
infections (STIs) in 2014. These index patients completed a questionnaire regarding
sexual behaviour, and reported details of up to 4 most recent partners in the
preceding 6 months.
Results
Condomless receptive anal intercourse (CRAI) was reported in 316/1,109 (28.5%)
partnerships of 365 MSM, and was inversely associated with casual relationship (vs
steady relationship, aOR=0.45 [0.36-0.58]), partner being >3 years older than
index (vs partner of similar age as index, aOR=0.62 [0.51-0.76]), and partner of
different ethnicity (aOR=0.70 [0.54-0.92]). CRAI was reported in 68/296 (23.0%)
partnerships of 88 transgender women and was inversely associated with age of
sex partner (OR per 10 years increase =0.83 [0.73-0.94]).
Condomless penetrative anal intercourse (CPAI) was reported in 299/1,093
(27.4%) partnerships of 363 MSM and was inversely associated with casual
relationship (vs steady relationship, aOR=0.45 [0.36-0.57]), partner being >3
years older than index (vs partner of similar age as index, aOR=0.69 [0.58-0.83]).

Conclusion
In about a quarter of sexual partnerships of MSM and TG women in Indonesia, CRAI
and CPAI is practised. Casual relationships, differences in age and ethnicity
between index and partner (for MSM) and having an older partner (for transgender
women) were inversely associated with condom use in receptive anal sex.

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 Keywords: condoms – anal sex – sexual practise - men who have sex with men -
transgender women

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 INTRODUCTION B
The male latex condom remains essential for prevention against various sexually w
transmitted infections (STI).[1-3] It is estimated that up to 60% of STIs can be Y
prevented through correct and consistent condom use, including transmission of A
pathogens through anal sex.[2-3] However, various factors challenge the r
theoretical effectivity of condom use in practice. A
Men who have sex with men (MSM) and transgender women are groups that more g
frequently report anal sex. In Indonesia, the prevalence of anorectal STIs or STIs s
attributed to anal sex among MSM and transgender women is high.[4-5] Two I
studies found that consistent condom use during anal sex among Indonesian MSM r
was uncommon.[4, 6] Similar findings were also observed in other countries.[7-10] p
Several factors that contribute to the decision of condom use are related to the p
individual’s knowledge, values, and characteristics.[7-8, 11] However, many other a
factors determining condom use are related to the sex partner(s), i.e. perception of w
risk and relationship status.[11-21] S
Individuals often assess the health risk of their sex partner by observing their o
partner’s physical status (age, gender, height, weight, ethnicity).[13, 14-22] (
Relationship status is also reported as a strong predictor for condom use. [12-13, (
17-21]. r
To our knowledge, no study has investigated association between sex partner’s s
characteristics and condom use in anal sex among Indonesian MSM and I
transgender women. The aim of this study is to identify characteristics of sex r
partners that were associated with condomless anal intercourse among MSM and m
transgender women in Indonesia. Separate analyses were performed for a
condomless receptive anal intercourse (CRAI) and for condomless penetrative anal u
intercourse (CPAI). An improved understanding regarding partner factors that h
influence condom use will be useful for appropriate and contextual interventions in p
condom promotion among MSM and transgender women. a

MATERIALS AND METHODS S

Data collection and definitions A
C

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 Between January and December 2014, we invited (MSM) and transgender women,
y who were clients of sexually transmitted infection service facilities in Jakarta,
e Yogyakarta, and Denpasar, Indonesia, to participate in the study.[6]
f A participant or index was defined as MSM if he reported his gender as male and
e reported sexual contact (oral or anal) with other males in the preceding 6 months.
A participant or index was defined as a transgender woman if she reported her
e gender as “male-to-female transgender”. None of the transgender women in this
s study had underwent genital reconstructive surgery.
o Index participants completed a paper-based self-administered questionnaire and
M reported their demographics and general sexual history. They also reported
] partner-specific sexual history for up to four most recent sex partners in the
e preceding 6 months (termed “partnership” here), covering partner’s demographics
r and details of sex acts and condom use. Age difference between index and partner
f was categorized as follows: (1) Sex partner was >3 years younger than index, (2)
Sex partner had the same age as index +/- 3 years, (3) Sex partner was >3 years
r older than index. Ethnicity was categorized as indigenous Indonesian and other
] (based on Indonesian National Census). Relationship status was categorized into:
, (1) steady relationship (including marriage, boyfriend/girlfriend), (2) casual
relationship, (3) index is a sex worker; sex partner is client, (4) index is a client;
s sex partner is sex worker.
d In the first analysis, we included only index participants who reported a history of
x receptive anal intercourse with one or more male sex partner(s) in the preceding 6
d months; condomless receptive anal intercourse (CRAI) was the outcome of interest
r and was defined as any event of receptive anal intercourse in which no condom was
al used. In the second analysis we included only index participants who reported a
t history of penetrative anal intercourse with one or more male sex partner(s) in the
n preceding 6 months; condomless penetrative anal intercourse (CPAI) was defined
as any event of penetrative anal intercourse in which no condom was used.

Statistical analysis
All statistical analyses were performed using STATA version 13.0 (Stata Corp.
College Station, Texas, US). We described characteristics of index participants and

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 their sex partners, by risk group (i.e. MSM or transgender women). Chi-squared R
test (for categorical variables) or Kruskal-Wallis test (for continuous variables) were A
used to examine differences between MSM and transgender women. A p<0.05 was c
considered significant. We performed separate bivariable and multivariable analyses t
for index MSM and transgender women. Because the transgender women study
population for the second analysis (outcome CPAI) was too small, no risk factor C
analyses for that outcome for that group were performed. T
In logistic regression, Generalized Estimating Equations (GEE) were used to account 8
for multiple observations per index participant. Odds ratios, their 95% CI, and p a
values were provided. 1
Multivariable analyses to identify determinants of the outcome were performed e
using logistic regression via GEE, by backward selection. All variables with a p u
≤0.20 in bivariable analysis were included in the starting model. Subsequently the r
variable with the least significant contribution (if p≥0.05) was dropped from the a
model. This step was repeated until a final model resulted, i.e. a model in which all r
variables were associated with the outcome with p<0.05. 1
r
t
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d RESULTS
e Analysis 1: Association between sex partner characteristics and
s condomless receptive anal intercourse (CRAI) among MSM and
s transgender women in Indonesia
y
r Characteristics of index and partners
There were 453 index participants included in the first analysis, i.e. 365 MSM and
t 88 transgender women. Index transgender women were older than MSM (median
p age, interquartile range [IQR]) of 39 [31-49] vs 27 [24-30] years, p<0.001) (Table
1). All transgender women were Indonesian, while 18 (5.0%) of MSM reported
d ethnicities other than Indonesian. More MSM than transgender women went to
p university (27.4% vs 5.7%, p<0.001). More index MSM than transgender women
e received >200 USD monthly income (34.5% vs 8.0%, p<0.001). Most of both MSM
e and index transgender women were single (59.7% vs 62.5%). Transgender women
ll reported more sex partners in the preceding 6 months than MSM (median [IQR] of
10 [3-30] vs 5 [2-10], p<0.001). 10.1% of MSM and 9.1% of transgender women
reported giving money in exchange for sex (p=0.71). More transgender women
than MSM reported receiving money in exchange for sex (84.1% vs 35.3%,
p<0.001).
Based on index information, there were 1,405 partnerships included in the first
analysis, i.e. 1,109 partnerships of 365 MSM index and 296 partnerships of 88
transgender women index (Table 2). Most of partners of MSM and transgender
women were male (99.6% vs. 96.6%), but index transgender women reported a
higher proportion of transgender women partners compared to index MSM (3.4% vs
0.4%, p<0.001). Partners of transgender women index were estimated to be older
than partners of index MSM (median [IQR] of 35 [28-42] vs 30 [26-36] years,
p<0.001). There were more partners of index MSM who were of ethnicities other
than Indonesian than partners of transgender women (20.9% vs 3.4%, p<0.001).
Among index MSM, most partners were in casual partnership (52.8%), while this
was only 13.5% among index transgender women, p<0.001. On the other hands,
among index transgender women, most partners were clients (index were sex
workers) (69.6%), while this was the case in only 16.2% of partners of index MSM,

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 p<0.001. Partners of transgender women were mostly younger than index, A
compared to partners of MSM (proportion of partners who were >3 years younger c
than index 53.4% vs 22.5%, p<0.001). More index MSM than transgender women
reported partners of different ethnicity (23.0% vs 3.4%, p<0.001). Related to anal C
sex history, more index MSM than transgender women reported both penetrative W
and receptive anal sex with their partners (71.5% vs 16.9%, p<0.001). in
w
Factors associated with CRAI among MSM v
Out of 1,109 partnerships among index MSM, CRAI was reported in 316 I
partnerships (28.5%) (Table 3a). In bivariable analysis, CRAI was associated with (
index’ age (OR per 10 years increase 1.39 [1.06-1.83], p=0.017), index being of U
non-indigenous Indonesian ethnicity (vs index being Indonesian, OR= 3.40 [1.41- p
8.20], p=0.006), age of sex partner (per 10 years increase) (OR=0.72 [0.64-0.80], in
p<0.001), casual partnership (vs steady partnership, OR=0.48 [0.37-0.62], e
p<0.001), partner being >3 years older than index (vs partner of similar age than B
index, OR=0.62 [0.51-0.76], p<0.001), partner being of different ethnicity a
(OR=1.37 [1.04-1.80], p=0.03), number of sex partners in the preceding 6 p
months (OR per unit increase in natural log =0.80 [0.67-0.97], p=0.02), and e
history of index receiving money/goods in exchange for sex (OR=0.51 [0.32-0.81], (
p=0.004). In multivariable analysis, CRAI among MSM was associated with casual a
partnership (vs steady partnership, aOR=0.45 [0.36-0.58], p<0.001), partner m
being >3 years older than index (vs partner of similar age as index, aOR=0.62 (
[0.51-0.76], p<0.001), and partner being of different ethnicity (aOR=0.70 [0.54-
0.92], p=0.01). F
O
Factors associated with CRAI among transgender women p
Out of 296 partnerships among index transgender women, CRAI was reported in 68 w
partnerships (23.0%) (Table 3b). In bivariable analysis, CRAI was associated with s
age of sex partner (per 10 years increase) (OR=0.83 [0.73-0.94], p=0.003). In p
multivariable analysis, apart from age of sex partner, no significant associations >
were observed. [
n

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 , Analysis 2: Association between sex partner characteristics and
r condomless penetrative anal intercourse (CPAI) among MSM in Indonesia
n
al Characteristics of index and partners
e We first examined data of 380 index participants for the second analysis, i.e. 363
index MSM and 17 transgender women. Since the number of index transgender
women who reported history of penetrative anal sex in the preceding 6 months was
very small, we continued the second analyses for 363 index MSM only.(Table 4)
6 Indices had median age [IQR] of 27 [24-30] years, mostly were Indonesian
h (95.8%), mostly completed high school (54.0%), received monthly income of >200
f USD (35.3%), were mostly single (59.5%), and had a median [IQR] of 5 [2-10] sex
- partners in the preceding 6 months. 10.2% of index reported giving money/goods
, in exchange for sex, and 36.1% of index reported receiving money/goods in
, exchange for sex.
n Based on index reports, there were 1,093 partnership included in the second
y analysis.(Table 5) Most sex partners were males (99.6%), the median age [IQR] of
6 partners was 30 years [25-36], most of them were of indigenous Indonesian
d ethnicity (82.6%), and most of them were in casual partnership with the index
, (54.2%). Most partners were estimated to be >3 years older than index (50.9%)
al and of the same ethnicity as the index (81.2%). Related to history of anal sex,
r most index MSM reported both penetrative and receptive sex with their partners
2 (71.9%) (see Table 4).
-
Factors associated with CPAI among MSM
Out of 1,093 partnerships among index MSM, CPAI was reported in 299
partnerships (27.4%) (see Table 6). In bivariable analysis, CPAI was associated
8 with index’s age (per 10 years increase) (OR=1.44 [1.07-1.93], p=0.016), age of
h sex partner (per 10 years increase) (OR=0.74 [0.67-0.81], p<0.001), casual
n partnership (vs steady partnership, OR=0.48 [0.39-0.59], p<0.001), partner being
s >3 years older than index (vs partner of similar age as index +/- 3 years, OR=0.71
[0.59-0.85], p<0.001), number of sex partners in the preceding 6 months (per
natural log, OR=0.71 [0.58-0.86], p<0.001), and history of index receiving

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 money/goods in exchange for sex (OR=0.41 [0.25-0.68], p<0.001). In D
multivariable analysis, CPAI among MSM was associated with casual partnership (vs I
steady partnership, aOR=0.45 [0.36-0.57], p<0.001), partner being >3 years older 2
than index (vs partner of similar age as index +/- 3 years, aOR=0.69 [0.58-0.83], p
p<0.001) and number of sex partners in the preceding 6 months (per natural log, s
OR=0.77 [0.63-0.93], p=0.01). d
F
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n DISCUSSION
s In this study, we found that CRAI occurs in 28.5% of partnerships of MSM, and in
r 23.0% of partnerships of transgender women; CPAI occurs in 27.4% of
, partnerships of MSM. The proportion of correct and consistent condom use in our
, study population appears to be higher than other studies.[7-9] This might relate to
different definitions of “correct and consistent condom use” in the studies.
Furthermore, in Indonesia, MSM and transgender women are considered as core
groups that are often prioritized in sexual health campaigns.[23] This might
contribute to better knowledge and higher awareness about the needs to use
condoms in anal sex to prevent STI transmission.
Similar to several other studies, our study also found that the type of relationship is
associated with condom use among MSM.[11-12, 16-21] Condoms are less used in
sexual acts in steady partnerships (marriage, “boyfriends/girlfriends”). This might
relate to “trust issue” and intimacy, in which condom use is seen to cause a lack of
intimacy and to indicate lack of trust between the two partners.[18, 21] Condom
promotion should address this concern. Couples (who are engaged in steady
partnership) should still realize the possibility that his/her partner is exposed to
another sex partner, and therefore the couples should still consider to use a
condom in their sexual acts.
In addition, among MSM, we observed that both CRAI and CPAI occurred in lower
proportions in “commercial sex partnerships”, i.e. when the index received
money/goods from his/her sex partner(s) in exchange for sex services, or vice
versa, compared to steady or casual partnership. Being a sex worker, and thus
being considered to belong to a core group, provides access to more intensive
sexual health promotion, including information about condom use.[22-23]
Furthermore, it is said that a high proportion of consistent condom use might be
achieved when compulsory condom use is applied as part of regulation in sex work
business.[24]
We also observed that the age difference between index and sex partner was
associated with condom use among MSM. Among MSM, CRAI and CPAI was less
common if the partner was >3 years older than the index (vs partner of similar age
as index). Our findings were similar to a study from USA.[25] However, our findings

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 were in contrast to a study from Australia, which observed no variation in sexual a
risk behavior by age difference between MSM and their sex partners.[26] Older o
partners perhaps are seen by index as having “higher risks”, as they might have O
been exposed to more sexual partners through their life. On the other hand, older m
partners might also have better knowledge and awareness regarding the t
importance of condom use, thus the partner may contribute positively to the M
decision of using a condom. a
Difference in ethnicity was associated with lower odds of CRAI among MSM. This M
might also relate to the “trust issue”, where condom use is more likely if the in
partner had a different ethnicity than the index.[11] e
Another finding from our study was the inverse association of the number of sex M
partners in the preceding 6 months with CPAI in MSM. Our findings were in contrast I
to findings of a study from the USA.[27] A higher number of sex partners among g
sex workers may contribute to less CPAI, but in our multivariable model the in
number of sex partners was inversely associated with CPAI regardless of sex M
worker status. In our study, MSM with more sex partners perhaps have higher c
awareness of risk that leads them to use condom.
Among MSM, CRAI and CPAI occurred in similar proportions. In addition, C
determinants for CRAI and CPAI among MSM were also similar. Most of index MSM I
reported both receptive and penetrative anal sex acts in partnerships: 71.5% in the I
first analysis 1 (see Table 1) and 71.9% in the second analysis (see Table 4). Index s
MSM who practised both receptive and penetrative anal sex perhaps have similar a
decision making patterns in condom use in those sex activities. A study from s
Australia found that versatility was associated with a higher vulnerability to contract p
HIV.[28] Thus, sex roles need also to be taken into account in condom w
promotion.[29] D
Among transgender women we observed that CRAI was associated with age of sex a
partner: the older the partner, the lower the proportion of CRAI. Unfortunately, the w
number of events was too small for further analyses.
Our study has several limitations. The data regarding sex partners was limited to E
four recent partners. Several variables regarding sex partners were estimated by
the index participant (age, ethnicity), and therefore might not be precise. As we

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al asked for sexual behaviour over the preceding 6 months, recall bias might have
r occurred.
e Our study has several strengths. We collected data from participants in several
r major cities in Indonesia. We performed separate analyses for MSM and
e transgender women. Transgender women are frequently grouped together with
e MSM in other studies. However, we observed differences in various demographics
and behaviors between MSM and transgender women in Indonesia. Compared to
s MSM, transgender women tended to be older, have lower education, receive smaller
e incomes, have more sex partners, and more often report receiving money/goods in
exchange for sex. These were similar to the findings from a study on HIV-positive
x MSM and transgender women in Indonesia by Nugroho et al.[30]
t In Indonesia, both MSM and transgender women groups are considered as core
g groups.[23] Both groups are prioritized in various sexual health care programs,
e including condom promotion, especially through outreach services. Therefore, many
x MSM and transgender women might have received more information regarding
r condom use that improves their knowledge and awareness in sexual health.

, CONCLUSION
M In about a quarter of sexual partnerhips of MSM and transgender women in
e Indonesia condomless anal sex is practised. The type of relationship (casual vs
x steady relationship), having older sex partners and a difference in ethnicity were
r associated with lower odds of CRAI in MSM. The type of relationship (casual vs
m steady relationship), having older sex partners, and a higher number of sex
t partners were associated with lower odds of CPAI in MSM. Among transgender
m women, having older sex partners was associated with lower odds of CRAI.
Despite the fact that both MSM and transgender women are considered core groups
x and are targets for intensive sexual health interventions, MSM and transgender
e women in Indonesia have different socio-demographic characteristics.

o ETHICS APPROVAL
y
e

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 This study was approved by the Medical and Health Research Ethics Committee
(MHREC), Faculty of Medicine Universitas Gadjah Mada (Letter Number: C
KE/FK/38/EC).

CONFLICTS OF INTEREST
HJC de Vries and MF Schim van der Loeff served on a vaccine advisory board of
GSK. Other authors: nothing to declare.

ACKNOWLEDGEMENT
The study was funded by the Indonesian government through the Excellence
Scholarship Program (Program Beasiswa Unggulan) Ministry of Research, M
Technology, and Higher Education, Republic of Indonesia and Public Health Service r

(GGD) of Amsterdam, the Netherlands. A

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e Table
Table
1.1.Characteristics
Characteristicsof
ofIndex
Index Participants
Participants in
in the
the Study
Studyon
onthe
theDeterminants
Determinantsof of
: Condomless
CondomlessReceptive
ReceptiveAnal
AnalIntercourse
Intercourse (CRAI) amongMen
(CRAI) among Menwho
whoHave
HaveSex
Sexwith
with Men
Men
(MSM)
(MSM)and
andTransgender
Transgender Women
Women in Indonesia, Overalland
Indonesia, Overall andby
byRisk
RiskGroup
Group

f By
Byrisk
riskgroup
group
All
All
Transgender
Transgender
participants
participants MSM
MSM
Variables
Variables Women
Women
N=453
N=453 n=365
n=365 p1p1
n=88
n=88

e nn % n
n %
% nn %%

, Median
Medianage
age(interquartile
(interquartile
27
27 (24-34)
(24-34) 27 (24-30)
27 (24-30) 39(31-49)
39 <0.001
(31-49) <0.001
e range [IQR]),
range [IQR]),ininyears
years
Age
Agegroups,
groups,ininyears
years <0.001
<0.001
16-24
16-24 141
141 31.1 130 35.6
130 35.6 11
11 12.5
12.5
25-34
25-34 205
205 45.3 187 51.2
187 51.2 18
18 20.5
20.5
35-44
35-44 55
55 12.1 29
29 8.0
8.0 26
26 29.6
29.6
≥45
≥45 52
52 11.5 19
19 5.2
5.2 33
33 37.5
37.5
Ethnicity
Ethnicity
2 2
0.033
0.033
Indigenous
IndigenousIndonesian
Indonesian 33
432
432 96.0 344 95.0
344 95.0 88
88 100.0
100.0
Other ethnicities
Other ethnicities44
18
18 4.0 18
18 5.0
5.0 00 0.0
0.0
Educational
Educationallevel
level <0.001
<0.001
Junior high
Junior highschool
schoolororlower
lower 83
83 18.3 53
53 14.5
14.5 30
30 34.1
34.1
Senior
Seniorhigh
highschool
school 246
246 54.3 193 52.9
193 52.9 53
53 60.2
60.2
University
University 124
124 27.4 119 32.6
119 32.6 55 5.7
5.7
Monthly
Monthlyincome
income <0.001
<0.001
NoNo
regular
regularincome
income 110
110 24.3 87
87 23.8
23.8 23
23 26.1
26.1
<100
<100USD
USD 91
91 20.1 47
47 12.9
12.9 44
44 50.0
50.0
100-200
100-200USD
USD 119
119 26.3 105 28.8
105 28.8 14
14 15.9
15.9
>200
>200USD
USD 133
133 29.4 126 34.5
126 34.5 77 8.0
8.0
Marital
Maritalstatus
status 0.03
0.03
Single
Single 273
273 60.3 218
218 59.7
59.7 55
55 62.5
62.5

3 124
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 Married/partnered
Married/partnered 170
170 37.5 142
142 38.9
38.9 28
28 31.8
31.8 a
Divorced/widowed
Divorced/widowed 10
10 2.2 55 1.4
1.4 55 5.7
5.7 J
Median
Mediannumber
numberof
ofsex
sex I
partners
partnersininthe
thepreceding
preceding 55 (2-15)
(2-15) 55 (2-10)
(2-10) 10(3-30)
10 (3-30) <0.001
<0.001
6 6months
months(IQR)
(IQR)
Number
Numberofofsex
sexpartners
partners in
in
<0.001
<0.001
the
thepreceding
preceding66months
months
11 64
64 14.1 53
53 14.5
14.5 11
11 12.5
12.5
2-9
2-9 203
203 44.8 180
180 49.3
49.3 23
23 26.1
26.1
10-49
10-49 148
148 32.7 111
111 30.4
30.4 37
37 42.1
42.1
≥50
≥50 38
38 8.4 21
21 5.8
5.8 17
17 19.3
19.3
History
Historyofofgiving
giving
money/goods
money/goodsin
inexchange
exchange 0.71
0.71
for
forsex
sex
No
No 408
408 90.1 328
328 89.9
89.9 80
80 90.9
90.9
Yes
Yes 45
45 9.9 37
37 10.1
10.1 88 9.1
9.1
History
Historyofofreceiving
receiving
money/goods
money/goodsin
inexchange
exchange <0.001
<0.001
for
forsex
sex
No
No 250
250 55.2 236
236 64.7
64.7 14
14 15.9
15.9
Yes
Yes 203
203 44.8 129
129 35.3
35.3 74
74 84.1
84.1
Role
Roleininanal
analsex
sexwith
withup
up to
to
four
fourmost
mostrecent
recentsex
sex
<0.001
<0.001
partners
partnersininthe
thepreceding
preceding
6 6months
months

Receptive
Receptiveonly
only 177
177 39.1 104
104 28.5
28.5 73
73 83.0
83.0
Both
Bothreceptive
receptiveand
and
276
276 60.9 261
261 71.5
71.5 15
15 17.1
17.1
penetrative
penetrative

p pvalues
1 1
valueswere
werecalculated
calculated using
using Chi-squared test for
Chi-squared test for categorical
categoricalvariables
variablesand
andusing
using
Kruskal-Wallis
Kruskal-Wallis test
test for
for continuous
continuous variables; For
For 450
22
450 index
index participants
participants with
with

125
125

134

15994-dVries_BNW.indd 134 22-10-18 11:46

 available data; 3Ethnicities as defined in Indonesian census as “indigenous”, e.g
Javanese, Malay, Balinese, Sundanese, Papuan; 4Ethnicities other than indigenous
Indonesian, e.g Chinese, Arabic, Indian, Caucasian.
1

g
h

5 126

135

15994-dVries_BNW.indd 135 22-10-18 11:46

 Table
Table2.2.Characteristics
Characteristics of
of Sex
Sex Partners
Partners in the
the Study
Study on
onthe
theDeterminants
Determinantsofof
Condomless
CondomlessReceptive
ReceptiveAnal
Anal Intercourse
Intercourse (CRAI) among
among Men
Men who
whoHave
HaveSex
Sexwith
withMen
Men
(MSM)
(MSM) and
and Transgender Women in
Transgender Women in Indonesia
Indonesia

By
By risk
risk group
groupof
ofindex
indexparticipant
participant
All
All sex Partnersof
Partners of
Partners
Partners
partners
partners Transgender
Transgender
Variables
Variables of MSM
of MSM
N=1,405
N=1,405 Women
Women p1p1
n=1,109
n=1,109
n=296
n=296
N
N % n
n %
% nn %
%
A.A.Demographics
Demographicsof
ofsex
sex
partner
partner
Gender
Gender <0.001
<0.001
Male
Male 1,391
1,391 99.0 1,105
1,105 99.6
99.6 286
286 96.6
96.6
Transgender
Transgenderwomen
women 14
14 1.0 44 0.4
0.4 10
10 3.4
3.4
Median
Medianestimated
estimatedage
age
(interquartile
(interquartilerange
range 32
32 (26-37)
(26-37) 30 (26-36)
30 (26-36) 35(28-42)
35 (28-42) <0.001
<0.001
[IQR]),
[IQR]),ininyears
years22
Age
Agegroups,
groups,in
inyears
years22 <0.001
<0.001
16-24
16-24 245
245 17.4 201
201 18.1
18.1 44
44 14.9
14.9
25-34
25-34 612
612 43.6 534
534 48.2
48.2 78
78 26.4
26.4
35-44
35-44 426
426 30.3 309
309 27.9 117
27.9 117 39.5
39.5
≥45
≥45 122
122 8.7 65
65 5.9
5.9 57
57 19.3
19.3
Ethnicity
Ethnicity33
<0.001
<0.001
Indigenous
IndigenousIndonesian
Indonesian44 1,156
1,156 82.8 871
871 79.1 285
79.1 285 96.6
96.6
Other
Otherethnicities
ethnicities 55
240
240 17.2 230
230 20.9
20.9 10
10 3.4
3.4
Relationship
Relationshipof
ofsex
sex
<0.001
<0.001
partner
partnerwith
withindex
index
Steady
Steadyrelationship
relationship 171
171 12.2 146
146 13.2
13.2 25
25 8.5
8.5
Casual
Casualrelationship
relationship 625
625 44.5 585
585 52.8
52.8 40
40 13.5
13.5

127
127

136

15994-dVries_BNW.indd 136 22-10-18 11:46

 Index is a sex worker;
386 27.5 180 16.2 206 69.6
n sex partner is client
Index is a client; sex
75 5.3 61 5.5 14 4.7
partner is sex worker
Not specified 148 10.5 137 12.4 11 3.7
t
B. Comparison of
demographics of index
and sex partner
Comparison of age
<0.001
index and sex partner2
Sex partner was >3
years younger than 407 29.0 249 22.5 158 53.4
index
1 Sex partner had the
same age as index +/- 341 24.3 293 26.4 48 16.2
3 years
Sex partner was >3
657 46.8 567 51.1 90 30.4
1 years older than index
Comparison of ethnicity
1 between index and sex <0.001
partner2,6
Same ethnicity 1,130 81.2 845 77.0 285 96.6
Different ethnicity 262 18.8 252 23.0 10 3.4
C. Details on sexual
1 contact
Reported anal sex <0.001
Receptive only 562 40.0 316 28.5 246 83.1
Both penetrative and
1 843 60.0 793 71.5 50 16.9
receptive
Used a condom in
0.06
receptive anal sex

7 128

137

15994-dVries_BNW.indd 137 22-10-18 11:46

 No 384 27.3 316 28.5 68 23.0
Yes 1,021 72.7 793 71.5 228 77.0

1
p values calculated using Chi-squared test for categorical variables and using
Kruskal-Wallis test for continuous variables; 2as estimated by index participant; 3for
1,396 partnerships with available data; 4Ethnicities defined in Indonesian census as
“indigenous”, e.g. Javanese, Malay, Balinese, Sundanese, Papuan; 5Ethnicities other
than indigenous Indonesian, e.g. Chinese, Arabic, Indian, Caucasian; 6
for 1,392
partnerships with available data.

129

138

15994-dVries_BNW.indd 138 22-10-18 11:46

 s
g

r
2
r

9
Table 3a. Bivariable and Multivariable Analysis of Determinants of Condomless Receptive Anal Intercourse (CRAI)
among Men who Have Sex with Men (MSM) in Indonesia

15994-dVries_BNW.indd 139
No. of No. of Bivariable Analysis Multivariable Analysis
partnerships partnerships
in which in which
index had index had aOR
Variables ORa 95% CI pb 95% CI pd
receptive CRAI c

anal sex n=316

N=1,109 (28.5%)
N n %
A. Demographics of index
Age of index (per 10 year increase) 1109 - - 1.39 1.06-1.83 0.017
Age groups of index, in years 0.03
16-24 372 83 22.3 1 -
17
25-34 604 29.6 1.43 0.89-2.29
9
≥35 133 54 40.6 2.41 1.26-4.63
1
Ethnicity of index 0.006
28
Indigenous Indonesian2 1046 26.9 1 -
1
Other ethnicities3 57 32 56.1 3.40 1.41-8.20
Educational level of index 0.07
Junior high school or lower 167 31 18.6 1 -
16
Senior high school 602 27.9 1.60 0.80-3.17
8

139
130

22-10-18 11:46
 11

140
University 340 34.4 2.24 1.10-4.57
7

15994-dVries_BNW.indd 140
Monthly income of index 0.33
No regular income 293 71 24.2 1 -
<100 USD 153 36 23.5 1.00 0.47-2.14
100-200 USD 288 98 34.0 1.63 0.91-2.93
11
>200 USD 375 29.6 1.35 0.76-2.39
1
Marital status of index 0.25
18
Single 682 27.3 1 -
6
13
Partnered/married/divorced/widowed 427 30.4 1.28 0.84-1.96
0
B. Demographics of sex partner
Risk groups of sex partner
31
MSM 1105 28.6 -
6
Transgender women 4 0 0.0 -
Age of sex partner (per 10 year <0.00
1109 - - 0.72 0.64-0.80
increase) 1
<0.00
Age group of sex partner, in years4
1
16-24 201 71 35.3 1 -
17
25-34 534 32.4 0.83 0.67-1.02
3

131

22-10-18 11:46
 ≥35 374 72 19.3 0.58 0.45-0.73
4, 5
Ethnicity of sex partner 0.08

15994-dVries_BNW.indd 141
23
Indigenous Indonesian2 871 27.0 1 -
5
Other ethnicities3 230 79 34.4 1.28 0.97-1.69
<0.00 <0.001
Relationship of sex partner with index
1
Steady relationship 146 61 41.8 1 - 1 -
18 0.45 0.35-0.58
Casual relationship 585 31.3 0.48 0.37-0.62
3
Index is a sex worker; sex partner is 0.41 0.26-0.63
180 27 15.0 0.38 0.25-0.59
client
Index is a client; sex partner is sex 0.11 0.04-0.30
61 11 18.0 0.14 0.06-0.36
worker
Not specified 137 34 24.8 0.44 0.28-0.70 0.50 0.32-0.79
C. Comparison between demographics of
index and sex partner
Comparison of age of index and sex <0.00
<0.001
4
partner 1
Sex partner was >3 years younger
249 97 39.0 1.02 0.81-1.30 1.12 0.89-1.41
than index participant
Sex partner had the same age as the
293 96 32.8 1 - 1 -
participant +/- 3 years
Sex partner was >3 years older than 12
567 21.7 0.62 0.51-0.76 0.62 0.51-0.76
index participant 3

141
132

22-10-18 11:46
 Ethnicity of index and sex partner4,6 0.03 0.01

142
22 1 -
Same ethnicity 845 26.2 1 -

15994-dVries_BNW.indd 142
1
Different ethnicity 252 92 36.5 1.37 1.04-1.80 0.70 0.54-0.92
D. General Sexual History of Index
Number of sex partners in the
1109 - 0.98 0.97-1.00 0.04
preceding 6 months of index
Number of sex partners in the
preceding 6 months of index (per 1109 - 0.80 0.67-0.97 0.02
natural log increase)
Number of sex partners in the
0.04
preceding 6 months of index
1 53 18 34.0 1 -
19
2-9 545 34.9 0.98 0.52-1.85
0
10-49 432 99 22.9 0.58 0.29-1.16
≥50 79 9 11.4 0.27 0.07-0.99
History of index giving money/goods
0.56
in exchange for sex
28
No 983 28.7 1 -
2
Yes 126 34 27.0 0.81 0.40-1.65
History of index receiving
0.004
money/goods in exchange for sex
No 657 22 33.6 1 -

133

22-10-18 11:46
 1
Yes 452 95 21.0 0.51 0.32-0.81

15994-dVries_BNW.indd 143
a
OR=odds ratio calculated using generalized estimating equation (GEE); CI=confidence interval; bp values calculated using
GEE; caOR=adjusted odds ratio calculated using “test”, see Methods; dp values calculated using likelihood ratio test, see
1 2
Methods; For 1,103 partnerships with available data; Ethnicities as defined in Indonesian census as “indigenous”, e.g
Javanese, Malay, Balinese, Sundanese, Papuan; 3Ethnicities other than indigenous Indonesian, e.g Chinese, Arabic, Indian,
4 5 6
Caucasian; as estimated by index participant; For 1,101 partnerships with available data; For 1,097 partnerships with
available data.

143
134

22-10-18 11:46
 Table 3b. Bivariable Analysis of Determinants of Condomless Receptive Anal Intercourse (CRAI)

144
among Transgender Women in Indonesia

15994-dVries_BNW.indd 144
No. of No. of Bivariable Analysis
partnerships partnerships
in which in which
index had index had 95%
Variables ORa pb
receptive anal CRAI CI
sex n=68
N=296 (23.0%)
N n %
A. Demographics of index
0.58-
Age of index (per 10 year increase) 296 - - 0.90 0.63
1.39
Age groups of index, in years 0.88
16-34 98 20 20.4 1 -
0.40-
35-44 87 25 28.7 1.28
4.11
0.32-
≥45 111 23 20.7 1.00
3.09
Ethnicity of index
Indigenous Indonesian1 296 68 23.0 - - -
2
Other ethnicities - - - - -

135

22-10-18 11:46
 Educational level of index 0.93
Junior high school or lower 112 27 24.1 1 -

15994-dVries_BNW.indd 145
0.39-
Senior high school 167 36 21.6 1.06
2.94
0.14-
University 17 5 29.4 1.46
15.21
Monthly income of index 0.14
No regular income 72 18 25.0 1 -
0.27-
<100 USD 149 44 29.5 0.76
2.13
0.03-
≥100 USD 75 6 8.0 0.19
0.99
Marital status of index 0.63
Single 195 50 25.6 1 -
0.30-
Partnered/married/divorced/widowed 101 18 17.8 0.79
2.10
B. Demographics of sex partner
Risk groups of sex partner 0.71
MSM 286 64 22.4 1 -
0.34-
Transgender women 10 4 40.0 1.28
4.91
Age of sex partner (per 10 year 296 - - 0.83 0.73- 0.003

145
136

22-10-18 11:46
 increase) 0.94

146
Age group of sex partner, in years3 0.03

15994-dVries_BNW.indd 146
≤34 122 34 27.9 1 -
0.63-
35-44 117 24 20.5 0.82
1.08
0.43-
≥45 57 10 17.5 0.62
0.88
3
Ethnicity of sex partner 0.93
1
Indigenous Indonesian 285 67 23.5 1 -
0.39-
Other ethnicities2 10 1 10.0 0.96
2.36
Relationship of sex partner with
0.05
index
Steady relationship 25 6 24.0 1 -
0.24-
Casual relationship 40 5 12.5 0.50
1.07
Index is a sex worker; sex partner is 0.29-
206 44 21.4 0.51
client 0.91
Index is a client; sex partner is sex 0.50-
14 9 64.3 3.11
worker 19.49
0.18-
Not specified 11 4 36.4 0.60
1.99

137

22-10-18 11:46
 C. Comparison between demographics
of index and sex partner

15994-dVries_BNW.indd 147
Comparison of age of index and sex
0.17
partner3
Sex partner was >3 years younger 0.80-
158 40 25.3 1.18
than index participant 1.73
Sex partner had the same age as
48 8 16.7 1 -
the participant +/- 3 years
Sex partner was >3 years older than 0.55-
90 20 22.2 0.83
index participant 1.25
4
Ethnicity of index and sex partner 0.93
Same ethnicity 285 67 23.5 1 -
0.39-
Different ethnicity 10 1 10.0 0.96
2.36
D. General Sexual History of Index
Number of sex partners in the 0.98-
296 - 0.99 0.36
preceding 6 months of index 1.01

Number of sex partners in the

0.60-
preceding 6 months of index (per 296 - 0.83 0.25
1.14
natural log increase)
Number of sex partners in the
0.52
preceding 6 months of index

147
138

22-10-18 11:46
 1 11 4 36.4 1 -

148
0.17-

15994-dVries_BNW.indd 148
2-9 69 23 33.3 0.75
3.34
0.09-
10-49 148 27 18.2 0.39
1.68
0.09-
≥50 68 14 20.6 0.45
2.38
History of index giving
0.15
money/goods in exchange for sex
No 273 57 20.9 1 -
0.68-
Yes 23 11 47.8 2.84
11.89
History of index receiving
0.24
money/goods in exchange for sex
No 30 12 40.0 1 -
0.15-
Yes 266 56 21.1 0.49
1.60

a b
OR=odds ratio calculated using generalized estimating equation (GEE); CI=confidence interval; p values
c d
calculated using GEE; aOR=adjusted odds ratio calculated using “test”, see Methods; p values calculated using
likelihood ratio test, see Methods; 1Ethnicities as defined in Indonesian census as “indigenous”, e.g Javanese, Malay,
2
Balinese, Sundanese, Papuan; Ethnicities other than indigenous Indonesian, e.g Chinese, Arabic, Indian,
3
Caucasian; as estimated by index participant.

139

22-10-18 11:46
E
E
A

M
M
M
M

m
 Table
Table4.
4.Characteristics
Characteristics of
of Index
Index Participants in the
the Study
Study on
on the
theDeterminants
Determinantsofof
Condomless
Condomless Penetrative Intercourse (CPAI)
Penetrative Anal Intercourse (CPAI)
among
among Men
Men who
who Have
Have Sex with Men (MSM)
(MSM) in
in Indonesia
Indonesia

AllMSM
All MSM
Variables
Variables N=363
N=363
nn %
%
Median
Medianage
age(interquartile
(interquartile range
range [IQR]), in years
years 27
27(24-30)
(24-30)
Age
Agegroups,
groups,in
inyears
years
16-24
16-24 134
134 36.9
36.9
25-34
25-34 181
181 49.9
49.9
35-44
35-44 33
33 9.1
9.1
≥45
≥45 15
15 4.1
4.1
Ethnicity
Ethnicity 11

Indigenous
IndigenousIndonesian
Indonesian22 345
345 95.8
95.8
Other
Otherethnicities
ethnicities 33
15
15 4.2
4.2
Educational
Educationallevel
level
Junior
Juniorhigh
highschool
school or
or lower
lower 55
55 15.2
15.2
Senior
Seniorhigh
highschool
school 196
196 54.0
54.0
University
University 112
112 30.9
30.9
Monthly
Monthlyincome
income
No
Noregular
regularincome
income 82
82 22.6
22.6
<100
<100USD
USD 49
49 13.5
13.5
100-200
100-200USD
USD 104
104 28.7
28.7
>200
>200USD
USD 128
128 35.3
35.3
Marital
Maritalstatus
status
Single
Single 216
216 59.5
59.5
Married/partnered
Married/partnered 143
143 39.4
39.4
Divorced/widowed
Divorced/widowed 44 1.1
1.1
Median
Mediannumber
number of
of sex
sex partners
partners in the preceding
preceding 6
6
55(2-10)
(2-10)
months
months(IQR)
(IQR)

140
140

149

15994-dVries_BNW.indd 149 22-10-18 11:46

 Number
Numberof
ofsex
sexpartners
partners in
in the
the preceding 6 months
months
11 55
55 15.2
15.2
2-9
2-9 178
178 49.0
49.0
10-49
10-49 105
105 28.9
28.9
≥50
≥50 25
25 6.9
6.9
History
Historyof
ofgiving
giving money/goods
money/goods in exchange for
for sex
sex
No
No 326
326 89.8
89.8
Yes
Yes 37
37 10.2
10.2
History
Historyof
ofreceiving
receiving money/goods
money/goods in exchange for
exchange for
sex
sex
No
No 232
232 63.9
63.9
Yes
Yes 131
131 36.1
36.1
Role
Rolein
inanal
analsex
sex with
with up
up to
to four
four most recent sex
sex
partners
partnersin
inthe
thepreceding
preceding 6
6 months
months

Penetrative
Penetrativeonly
only 102
102 28.1
28.1
Both
Bothreceptive
receptive and
and penetrative
penetrative 261
261 71.9
71.9

For
11
For360
360index
indexparticipants
participants with
with available
available data; 22Ethnicities
Ethnicities as
as defined
definedin
inIndonesian
Indonesian
census
census as
as “indigenous”,
“indigenous”, e.g
e.g Javanese,
Javanese, Malay,
Malay, Balinese,
Balinese, Sundanese,
Sundanese, Papuan;
Papuan;
Ethnicities
33
Ethnicities other
other than
than indigenous
indigenous Indonesian, e.g Chinese,
Indonesian, e.g Chinese, Arabic,
Arabic, Indian,
Indian,
Caucasian.
Caucasian.

141
141

150

15994-dVries_BNW.indd 150 22-10-18 11:46

 Table
Table 5.
5. Characteristics
Characteristics of Sex Partners in the Study on
on the
the Determinants
Determinants of
of
Condomless
Condomless Penetrative Anal Intercourse
Intercourse (CPAI)
(CPAI)
among
among Men
Men who Have Sex with Men (MSM) in
in Indonesia
Indonesia

All sex
All sex partners
partners
Variables
Variables
N=1,093
N=1,093
n
n %
%
A.
A. Demographics
Demographics of
of sex
sex partner
Gender
Gender
Male
Male 1089
1089 99.6
99.6
Transgender
Transgender women
women 44 0.4
0.4
Median
Median estimated
estimated age
age (interquartile range
30 (25-36)
30 (25-36)
[IQR]),
[IQR]), in
in years
years11
Age
Age groups,
groups, in
in years
years
16-24
16-24 212
212 19.4
19.4
25-34
25-34 508
508 46.5
46.5
35-44
35-44 317
317 29.0
29.0

n ≥45
≥45 56
56 5.1
5.1
; Ethnicity
Ethnicity22
, Indigenous
Indigenous Indonesian
Indonesian33 895
895 82.6
82.6
Other
Other ethnicities
ethnicities 44
189
189 17.4
17.4
Relationship
Relationship of
of sex
sex partner with index
Steady
Steady relationship
relationship 142
142 13.0
13.0
Casual
Casual relationship
relationship 592
592 54.2
54.2
Index
Index is
is aa sex
sex worker;
worker; sex partner is client 174
174 15.9
15.9
Index
Index is
is aa client;
client; sex
sex partner is sex worker 64
64 5.9
5.9
Not
Not specified
specified 121
121 11.1
11.1
B.
B. Comparison
Comparison of
of demographics
demographics of index and sex
partner
partner
Comparison
Comparison of
of age
age of
of index and sex partner22
Sex
Sex partner
partner was
was >3
>3 years younger than index 243
243 22.3
22.3

1 142
142

151

15994-dVries_BNW.indd 151 22-10-18 11:46

 Sex
Sex partner
partner had
had the
the same age as index +/- 3 years
years 294
294 26.9
26.9
Sex
Sex partner
partner was
was >3
>3 years older than index 556
556 50.9
50.9
Comparison
Comparison of
of ethnicity
ethnicity between index and sex
partner
partner55
Same
Same ethnicity
ethnicity 877
877 81.2
81.2
Different
Different ethnicity
ethnicity 203
203 18.8
18.8
C.
C. Detail
Detail history
history of
of sex
sex contact
Reported
Reported anal
anal sex
sex
Penetrative
Penetrative only
only 300
300 27.5
27.5
Both
Both penetrative
penetrative and
and receptive 793
793 72.6
72.6
Used
Used aa condom
condom in
in penetrative
penetrative anal sex
Yes
Yes 794
794 72.6
72.6
No
No 299
299 27.4
27.4

as
as estimated
11
estimated by
by index
index participant;
participant; 2for 1,084 partnerships
partnerships with
with available
available data;
data;
Ethnicities
Ethnicities defined
33
defined in
in Indonesian
Indonesian census as “indigenous”,
“indigenous”, e.g.
e.g. Javanese,
Javanese, Malay,
Malay,
Balinese,
Balinese, Sundanese,
Sundanese, Papuan;
Papuan; 4Ethnicities other than indigenous
indigenous Indonesian,
Indonesian, e.g.
e.g.
Chinese,
Chinese, Arabic,
Arabic, Indian,
Indian, Caucasian;
Caucasian; 5for 1,080 partnerships
partnerships with
with available
available data.
data.

143
143

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15994-dVries_BNW.indd 152 22-10-18 11:46

 ,,
..
;;

33
Table 6. Bivariable and Multivariable Analysis of Determinants of Condomless Penetrative Anal Intercourse (CPAI)

among Men who Have Sex with Men (MSM) in Indonesia

15994-dVries_BNW.indd 153
No. of No. of Bivariable analysis Multivariable analysis
partnerships partnership
in which s in which
index had index had 95%
Variables ORa pb aORc 95% CI pd
penetrative CPAI CI
anal sex n=299
N=1,093 (27.4%)
n n %
A. Demographics of index
Age of index (per 10 year 1.07-
1093 - - 1.44 0.016
increase) 1.93
Age groups of index, in years 0.13
16-24 394 84 21.3 1 -
0.79-
25-34 573 163 28.5 1.28
2.08
1.02-
≥35 126 52 41.3 1.99
3.87
1
Ethnicity of index 0.25
2
Indigenous Indonesian 1044 279 26.7 1 -
3
Other ethnicities 43 17 39.5 1.83 0.66-

153
144

22-10-18 11:46
 4.90

154
Educational level of index 0.22

15994-dVries_BNW.indd 154
Junior high school or lower 172 31 18.0 1 -
0.90-
Senior high school 599 174 29.1 1.81
3.63
0.89-
University 322 94 29.2 1.86
3.90
Monthly income of index 0.83
No regular income 278 68 24.5 1 -
0.64-
<100 USD 152 48 31.6 1.35
2.82
0.70-
100-200 USD 291 81 27.8 1.30
2.40
0.64-
>200 USD 372 102 27.4 1.17
2.12
Marital status of index 0.16
Single 671 175 26.1 1 -
Partnered/married/divorced/wid 0.88-
422 124 29.4 1.37
owed 2.12
B. Demographics of sex partner
Risk groups of sex partner -
MSM 1089 299 27.5 - -

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22-10-18 11:46
 Transgender women 4 0 0.0 - -
Age of sex partner (per 10 year 0.67-
1093 - - 0.74 <0.001

15994-dVries_BNW.indd 155
4
increase) 0.81
Age groups of sex partner, in
<0.001
years4
16-24 212 70 33.0 1 -
0.70-
25-34 508 163 32.1 0.83
1.00
0.47-
≥35 373 66 17.7 0.58
0.71
4,5
Ethnicity of sex partner 0.44
2
Indigenous Indonesian 895 241 26.9 1 -
0.68-
Other ethnicities3 189 54 28.6 0.90
1.18
Relationship of sex partner <0.00
<0.001
with index 1
Steady relationship 142 62 43.7 1 - 1 -
0.39- 0.37-
Casual relationship 592 169 28.6 0.48 0.46
0.59 0.57
Index is a sex worker; sex 0.29- 0.29-
174 27 15.5 0.42 0.44
partner is client 0.61 0.66
Index is a client; sex partner is 64 16 25.0 0.14 0.06- 0.11 0.04-

155
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22-10-18 11:46
 sex worker 0.33 0.33

156
0.25- 0.26-
Not specified 121 25 20.7 0.38 0.39

15994-dVries_BNW.indd 156
0.58 0.60
C. Comparison between
demographics of index and sex
partner
Comparison of age of index and <0.00
<0.001
4
sex partner 1
Sex partner was >3 years 0.96- 0.99-
243 94 38.7 1.19 1.20
younger than index 1.47 1.45
Sex partner had the same age
294 91 31.0 1 - 1 -
with index +/- 3 years
Sex partner was >3 years older 0.59- 0.59-
556 114 20.5 0.71 0.70
than index 0.85 0.82
Comparison of ethnicity of
index participant and sex 0.78
4,6
partner
Same ethnicity 877 237 27.0 1 -
0.73-
Different ethnicity 203 57 28.1 0.96
1.26
D. General Sexual History of
Index
Number of sex partners in the 1093 - 0.97 0.95- 0.01

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22-10-18 11:46
 preceding 6 months of index 0.99

Number of sex partners in the

15994-dVries_BNW.indd 157
0.58- 0.63-
preceding 6 months of index 1093 - 0.71 <0.001 0.77 0.01
0.86 0.93
(per natural log increase)
Number of sex partners in the
<0.001
preceding 6 months of index
1 58 23 39.7 1 -
0.50-
2-9 542 199 36.7 0.93
1.72
0.17-
10-49 398 67 16.8 0.35
0.72
0.06-
≥50 95 10 10.5 0.22
0.78
History of index giving
money/goods in exchange for 0.41
sex
No 966 268 27.7 1 -
0.34-
Yes 127 31 24.4 0.73
1.55
History of index receiving
money/goods in exchange for <0.001
sex

157
148

22-10-18 11:46
 No 640 216 33.8 1 -

158
0.25-
Yes 453 83 18.3 0.41

15994-dVries_BNW.indd 158
0.68

a b
OR=odds ratio calculated using generalized estimating equation (GEE); CI=confidence interval; p values
c d
calculated using GEE; aOR=adjusted odds ratio calculated using likelihood ratio test, see Methods; p values
1 2
calculated using “test”, see Methods; For 1,087 partnerships with available data; Ethnicities as defined in
Indonesian census as “indigenous”, e.g Javanese, Malay, Balinese, Sundanese, Papuan; 3Ethnicities other than
indigenous Indonesian, e.g Chinese, Arabic, Indian, Caucasian; 4as estimated by index participant; 5For 1,084
partnerships with available data; 6For 1,080 partnerships with available data.

149

22-10-18 11:46
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