Knowledge, Attitudes, and HIV/AIDS Preventive Behaviors Among Tattooed Papuan Adolescents in Eastern Indonesia: A Cross-Sectional Study of Cultural Risk Factors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Yowel Kambu
Abstract
HIV/AIDS remains a significant global health challenge, with a 2.3% prevalence in Papua and an estimated 12,050 cases in West Papua by 2024. The prevalent practice of tattooing among Papuan adolescents potentially increases the risk of HIV transmission. This study aimed to analyze the levels of knowledge, attitudes, and preventive behaviours regarding HIV/AIDS among tattooed Papuan ethnic secondary school students in Sorong City. A cross-sectional study was conducted in March 2024 at a secondary school in Sorong City. The sample comprised 150 Papuan ethnic students in Years XI-XII, aged 15-18 years, with tattoo history, selected through purposive sampling. Data were collected using validated questionnaires (Cronbach's alpha >0.7) measuring knowledge (10 items), attitudes (12 items), and preventive behaviours (8 items). Analyses employed descriptive statistics and chi-square tests using SPSS version 25.0. The study received ethical approval (approval number DM.03.05/8/138/2024, dated 17 January 2024). Many respondents (53.3%) demonstrated moderate knowledge levels, 43.3% exhibited neutral attitudes, and 46.7% showed adequate preventive behaviours. Significant positive correlations were found between knowledge and attitudes (r=0.65; p<0.01) and preventive behaviours (r=0.72; p<0.01). Sociodemographic analysis revealed a predominance of respondents aged 17-18 years (46.7%) from middle-income backgrounds. The findings indicate the necessity for culturally sensitive educational interventions to enhance knowledge and promote positive attitudes towards HIV/AIDS prevention among tattooed Papuan ethnic adolescents.
Downloads
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Yowel Kambu
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Alyafei, A., & Easton-Carr, R. (2025). The Health Belief Model of Behavior Change. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK606120/
Balaskas, S., Panagiotarou, A., & Rigou, M. (2023). Impact of Environmental Concern, Emotional Appeals, and Attitude toward the Advertisement on the Intention to Buy Green Products: The Case of Younger Consumer Audiences. Sustainability, 15(17), Article 17. https://doi.org/10.3390/su151713204
CDC. (2024, December 19). HIV Testing and Youth. Adolescent and School Health. https://www.cdc.gov/healthy-youth/nyhaad/hiv-testing-and-youth.html
Chooniedass, R., Reekie, M., Denison, J., Mercuri, A., Nawara, R., Purcell, N., Oelke, M., & Janke, R. (2025). Embedding cultural safety in nursing education: A scoping review of strategies and approaches. Journal of Professional Nursing, 56, 113–129. https://doi.org/10.1016/j.profnurs.2024.11.005
Cohen, P. R. (2021). Tattoo-Associated Viral Infections: A Review. Clinical, Cosmetic and Investigational Dermatology, 14, 1529–1540. https://doi.org/10.2147/CCID.S284796
Dzinamarira, T., & Moyo, E. (2024). Adolescents and young people in sub-Saharan Africa: Overcoming challenges and seizing opportunities to achieve HIV epidemic control. Frontiers in Public Health, 12, 1321068. https://doi.org/10.3389/fpubh.2024.1321068
F. Alves, R. (2024). The relationship between health-related knowledge and attitudes and health risk behaviours among Portuguese university students. Global Health Promotion, 31(1), 36–44. https://doi.org/10.1177/17579759231195561
Hardisman, H. (2009). HIV/AIDS di Indonesia: Fenomena Gunung Es dan Peranan Pelayanan Kesehatan Primer. Kesmas, 3(5), 236–243. https://doi.org/10.21109/kesmas.v3i3.228
Hasnia, H., Handayani, E. P., Astutik, E. D. W., Lestari, T. F., & Nasrianti, N. (2024). Perbedaan pengetahuan dan sikap pada siswa siswi melalui edukasi berbasis video dan leaflet tentang HIV/AIDS. Holistik Jurnal Kesehatan, 18(3), Article 3. https://doi.org/10.33024/hjk.v18i3.134
Jocelyn, Nasution, F. M., Nasution, N. A., Asshiddiqi, M. H., Kimura, N. H., Siburian, M. H. T., Rusdi, Z. Y. N., Munthe, A. R., Chairenza, I., Ginting Munthe, M. C. F. Br., Sianipar, P., Gultom, S. P., Simamora, D., Uswanas, I. R., Salim, E., Khairunnisa, K., & Syahputra, R. A. (2024). HIV/AIDS in Indonesia: Current treatment landscape, future therapeutic horizons, and herbal approaches. Frontiers in Public Health, 12, 1298297. https://doi.org/10.3389/fpubh.2024.1298297
K, R., R, L. K., J, W., K, G., S, E., & T, P. (2024). Systematic review of cash plus or bundled interventions targeting adolescents in Africa to reduce HIV risk. PubMed. https://pubmed.ncbi.nlm.nih.gov/38245689/
Karagözoğlu, M., & İlhan, N. (2024). The effect of health literacy on health behaviors in a sample of Turkish adolescents. Journal of Pediatric Nursing, 77, e187–e194. https://doi.org/10.1016/j.pedn.2024.04.028
Karman, Ardiyanti, H., Laksmono, B. S., Mudjiyanto, B., & Walujo, D. (2024). Shifting biculturality to monoculturality: The acculturation among Chinese Peranakans in Serui Regency of Papua, Indonesia. Cogent Social Sciences, 10(1), 2359012. https://doi.org/10.1080/23311886.2024.2359012
Khairunisa, S. Q., Indriati, D. W., Megasari, N. L. A., Ueda, S., Kotaki, T., Fahmi, M., Ito, M., Rachman, B. E., Hidayati, A. N., Nasronudin, & Kameoka, M. (2024). Spatial–temporal transmission dynamics of HIV-1 CRF01_AE in Indonesia. Scientific Reports, 14(1), 9917. https://doi.org/10.1038/s41598-024-59820-y
Khan, N. H., Beg, M. M., Sarwar, M. Z., Kyzy, G. Z., Zhetkinbekova, T., Mamatov, A., Kyzy, A. Z., Osmonaliev, K., Nurlanbek, M. U., Faisal, S. S., Ahmad, H., Khanam, S., & Rehman, S. U. (2024). Assessment of Knowledge and Attitudes Related to HIV/AIDS Among the Population With Increasing Incidence Rate. Cureus, 16(2), e53451. https://doi.org/10.7759/cureus.53451
Koch, J. R., Roberts, A. E., Cannon, J. H., Armstrong, M. L., & Owen, D. C. (2005). College Students, Tattooing, And The Health Belief Model: Extending Social Psychological Perspectives On Youth Culture And Deviance. Sociological Spectrum, 25(1), 79–102. https://doi.org/10.1080/027321790500121
Mela, M., Maulana, M. A., & Rahmah, R. G. N. (2024). Overview of Adolescent Knowledge About HIV/AIDS. ProNers, 9(2), Article 2. https://doi.org/10.26418/jpn.v9i2.78773
Mosleh, S. M., Khraisat, A., Shoqirat, N., & Obeidat, R. (2024). Using the Health Belief Model to Predict Self-Care Behaviors Among Patients With Cardiovascular Disease Post COVID-19 Pandemic: A Perspective From the United Arab Emirates. SAGE Open Nursing, 10, 23779608241293667. https://doi.org/10.1177/23779608241293667
Mudazkir, A. K., & Puspitasari, Y. (2024). Prevention of HIV/AIDS Transmission in Key Communities in Surabaya | Journal of Community Engagement in Health. https://jceh.org/index.php/JCEH/article/view/543
Naully, P. G., & Romlah, S. (2018). Prevalensi HIV dan HBV pada Kalangan Remaja. Jurnal Kesehatan, 9(2), Article 2. https://doi.org/10.26630/jk.v9i2.908
NIH’s Office of AIDS Research. (2024). HIV and Children | HIVinfo.NIH.gov. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-children
Nyoko, Y. O., & Hara, M. K. (2020). Knowledge and Attitudes with HIV/AIDS on Adolescent Behavior in Senior High School. Jurnal Kesehatan Masyarakat, 16(1), Article 1. https://doi.org/10.15294/kemas.v16i1.19928
Perkins, C. J., Schiff, S., Steger, K. A., & Craven, D. E. (1997). Tattoos in Persons Infected with Human Immunodeficiency...: Infectious Diseases in Clinical Practice. 6(8). https://journals.lww.com/infectdis/abstract/1997/06080/tattoos_in_persons_infected_with_human.10.aspx
Permatasari, D., Mulyadi, E., Pratiwi, I. G. D., Indriyani, R., & Puspitasari, D. I. (2025). Model of Risk Behavior for Prevention of HIV/AIDS Transmission Based on Self-Efficacy in Adolescents. Journal of Applied Nursing and Health, 6(2), Article 2. https://doi.org/10.55018/janh.v6i2.241
Qashqari, F. S., Alsafi, R. T., Kabrah, S. M., AlGary, R. A., Naeem, S. A., Alsulami, M. S., & Makhdoom, H. (2022). Knowledge of HIV/AIDS transmission modes and attitudes toward HIV/AIDS infected people and the level of HIV/AIDS awareness among the general population in the kingdom of Saudi Arabia: A cross-sectional study. Frontiers in Public Health, 10, 955458. https://doi.org/10.3389/fpubh.2022.955458
Ramdan, R. H., & Setiadi, D. (2024). Gambaran Karakteristik Penderita HIV/AIDS Berbasis Data di Kota Tasikmalaya Tahun 2023: Gambaran Karakteristik Penderita HIV/AIDS Berbasis Data di Kota Tasikmalaya Tahun 2023. Jurnal Rekam Medis Dan Informasi Kesehatan, 3(2), 1–9.
Ratnawati, D., Huda, M. H., Mukminin, M. A., Widyatuti, W., & Setiawan, A. (2024). Meta-analysis of the effectiveness of educational programs about HIV prevention on knowledge, attitude, and behavior among adolescents. Narra J, 4(2), e870. https://doi.org/10.52225/narra.v4i2.870
Ratnawati, D., Setiawan, A., Sahar, J., Widyatuti, Nursasi, A. Y., & Siregar, T. (2024a). Improving adolescents’ HIV/AIDS prevention behavior: A phenomenological study of the experience of planning generation program (GenRe) ambassadors as peer educators. https://www.belitungraya.org/BRP/index.php/bnj/article/view/2883
Ratnawati, D., Setiawan, A., Sahar, J., Widyatuti, Nursasi, A. Y., & Siregar, T. (2024b). Improving adolescents’ HIV/AIDS prevention behavior: A phenomenological study of the experience of planning generation program (GenRe) ambassadors as peer educators. Belitung Nursing Journal, 10(1), 56–66. https://doi.org/10.33546/bnj.2883
Ribeiro Banze, Á., Muleia, R., Nuvunga, S., Boothe, M., & Semá Baltazar, C. (2024). Trends in HIV prevalence and risk factors among men who have sex with men in Mozambique: Implications for targeted interventions and public health strategies. BMC Public Health, 24, 1185. https://doi.org/10.1186/s12889-024-18661-0
Romantir, R., Mangonto, Y., Karim, M., Siktaop, A., Duwiri, W., & Tepmul, Y. (2024a). The Relationship between Knowledge and HIV/Aids Prevention Behavior At the Ngalum Putra Dormitory Students in the Pegunungan Bintang in Jayapura, Papua. Jurnal Intelek Insan Cendikia, 1(8), Article 8.
Romantir, R., Mangonto, Y., Karim, M., Siktaop, A., Duwiri, W., & Tepmul, Y. (2024b). The Relationship between Knowledge and HIV/Aids Prevention Behavior At the Ngalum Putra Dormitory Students in the Pegunungan Bintang in Jayapura, Papua. Jurnal Intelek Insan Cendikia, 1(8), Article 8.
Ruff, A., Dlamini, X., Nonyane, B. A., Simmons, N., Kochelani, D., Burtt, F., Mlotshwa, F., Gama, N., Scheepers, E., Schmitz, K., Simelane, L., Van Lith, L. M., & Black, M. M. (2023). A trial of nurturing care among children who are HIV‐exposed and uninfected in eSwatini. Journal of the International AIDS Society, 26(Suppl 4), e26158. https://doi.org/10.1002/jia2.26158
Solihin, S., Pannyiwi, R., Zaenal, Z., & Naka, A. S. B. (2023). Penyuluhan Kesehatan Dengan Kejadian HIV/AIDS/AIDS Pada Remaja Di Wilayah Kerja Puskesmas Sorong Papua. Sahabat Sosial: Jurnal Pengabdian Masyarakat, 2(1), Article 1. https://doi.org/10.59585/sosisabdimas.v2i1.246
Sulistina, D. R., Martini, S., Prasetyo, B., Rahman, F. S., Adji, A. S., Li, C.-Y., & Lusida, M. I. (2024). A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations. Journal of Public Health Research, 13(2), 22799036241239464. https://doi.org/10.1177/22799036241239464
Sundareshan, V., Swinkels, H. M., Nguyen, A. D., Mangat, R., & Koirala, J. (2024). Preexposure Prophylaxis for HIV Prevention. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK507789/
Tao, Y., Byrne, M., Ho, D., Zhu, Z., Conklin, J. L., Hlatshwako, T. G., Zhang, L., Aribodor, O. B., Magista, M., Shan, W., Onyeama, U. F., Anikamadu, O., Mutisya, L. M., Chima, K., Mustapha, A., Paipilla, K. A., Omenugha, I., Magongo, E. N., lwelunmor, J., … Tucker, J. D. (2024). HIV interventions across the care continuum for adolescents in high-burden countries: A systematic review and meta-analysis. eClinicalMedicine, 78, 102989. https://doi.org/10.1016/j.eclinm.2024.102989
Terra, M., Okereke, P. U., Wandera, F., Edith, K., Kitonga, M. S., Ally, A. M., Noah, O. A., Iheanyichukwu, N. R., Luyirika, E., AbdulBasit, A. O., Ogunlana, O. E., Ciswaka, H. K., Abdelghafar, F. A., Gebretsadik, H. W., Mustapha, M. J., Okereke, W. O., Chisom, I. W., Victor, U. C., Khashaba, E., & El-Gilany, A.-H. (2024). HIV related knowledge and practices among undergraduate students in Africa: A cross-sectional multinational study. Journal of Medicine, Surgery, and Public Health, 3, 100126. https://doi.org/10.1016/j.glmedi.2024.100126
UNICEF. (2024). HIV Statistics—Global and Regional Trends. UNICEF DATA. https://data.unicef.org/topic/hivaids/global-regional-trends/
United Nations in Indonesia. (2023). Breaking the Taboo: Health Workers in Papua Explore New Outreach Methods to Promote Youth HIV Testing | United Nations in Indonesia. https://indonesia.un.org/en/246058-breaking-taboo-health-workers-papua-explore-new-outreach-methods-promote-youth-hiv-testing
Wagner, C., Gossett, K., Hasnain, M., Linsk, N., & Rivero, R. (2025). Integration of the national HIV curriculum in medicine, nursing, and pharmacy programs in the United States. BMC Medical Education, 25(1), 422. https://doi.org/10.1186/s12909-025-07017-w
Wulandari, L. P. L., Lubis, D. S., Kurniati, D. P. Y., Sumintang, K., Ardrini, D. A. M., Mariani, P., Januraga, P. P., Camellia, A., Laksmi, N. M. D. P., Mahmudah, L., Ong, J. J., Causer, L., Liverani, M., Guy, R., & Wiseman, V. (2024). Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia. PLOS Global Public Health, 4(3), e0002977. https://doi.org/10.1371/journal.pgph.0002977