Sexual behavior experience of former injecting drug users infected with HIV in Bali, Indonesia
Nyoman Agus Jagat Raya
, Komang Menik Sri Krisnawati, I. Gusti Ayu Pramitaresthi
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Department of Nursing, Faculty of Medicine, Universitas Udayana, Indonesia
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Gusti Ayu Pramitaresthi" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Nyoman Agus Jagat" "apellidos" => "Raya" "email" => array:1 [ 0 => "jagatraya91@unud.ac.id" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Komang Menik Sri" "apellidos" => "Krisnawati" ] 2 => array:2 [ "nombre" => "I. Gusti Ayu" "apellidos" => "Pramitaresthi" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Nursing, Faculty of Medicine, Universitas Udayana, Indonesia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Injecting Drug Users (IDUs) have become a serious concern to public health. Globally, an estimated 190,000 drug-related deaths in 2015, wherein HIV transmission is one of the causes of drug-related deaths which can spread rapidly through the sharing of needles with partners among IDUs.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> In Indonesia, accumulated data from April 1987 to March 2016 reported 32,711 cases of HIV, wherein IDUs totaled 8835 and were one of the high case number group infected with HIV.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> In addition, the IDU's life is not only focused on sharing needles but unsafe sexual behavior which carries the risk of transmitting HIV in the community. More than 25% of IDUs shared needles and 40% have had sex with a casual partner of which 65% reported using condoms inconsistently.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sex is a physiological need according to the basic category of Maslow's hierarchy, however, unsafe sex is one of the risky sexual behaviors that spreads HIV among IDUs. Engaging with paid sexual partners and having injected drugs frequently for more than 36 months put IDUs at high-risk of spreading HIV.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> A previous study has focused on the experience of injecting practices by IDUs,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> but has not focused on sexual practice as a risky behavior. The major issue of spreading HIV among IDUs is not only the injecting practice but also risky sexual behaviors, e.g., inconsistency in using a condom, and sex with multiple partners<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> which can impact on an increasing number of HIV infections in the community.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Even though HIV prevalence and risk behaviors among IDUs in Indonesia have been reported,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> that study did not explore clearly about sexual behavior. Moreover, a previous study concluded on their mix method that needle sharing contributes to HIV transmission intra-prison and in a community after the prisoners are released.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> In light of the recent events in previous studies, there is now considerable concern about risky sexual behavior among IDUs due to the high-risk in spreading HIV infection. Therefore, our qualitative study aimed to describe the sexual behavior experience of former IDUs infected with HIV in Bali, Indonesia.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">A qualitative study with a phenomenology approach was used in this study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Participants and study setting</span><p id="par0025" class="elsevierStylePara elsevierViewall">Purposive sampling was used to find participants until the saturation point was reached. The inclusion criteria were a former IDU aged from 18 years old or above; a former IDU who knows their status as HIV positive; willingness to join to this study through signed informed consent; communicative and could speak in Bahasa Indonesia.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Data collection</span><p id="par0030" class="elsevierStylePara elsevierViewall">The data collection started with the preparation phase which was to develop semi-structured questions and to obtain permission from the government. The interview process was conducted in a small room at the non-government organization (NGO) office from August to October 2017. In-depth interviews were done individually for about 25–35<span class="elsevierStyleHsp" style=""></span>min. All data transcribed and assigned a number on the transcription to protect the anonymity of each participant. The termination phase was done after all the participants validated the results of the interview transcriptions.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Data analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The process of analyzing the data used the method from Colaizzi (1978): read and re-read transcriptions; extract the significant data; formulate the meaningful data; categorize the meaning data into the themes; integrate the themes, categories, and codes to the objective; validate the result; finalize the result. Internal validation was done by person triangulation of the data through interviewing a field worker from the NGO who was also a former IDU infected with HIV, and compared with the literature.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical aspects</span><p id="par0040" class="elsevierStylePara elsevierViewall">Ethical approval was obtained and issued from the Research Ethics Committee of Faculty of Medicine, Udayana University/Sanglah Hospital Denpasar, Bali (1804/UN.14.2/KEP/2017).</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results and discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The total participants were five persons who all were males infected with HIV. The average time of the interview process was 30.1<span class="elsevierStyleHsp" style=""></span>min. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the other variables of the socio-demographic data of the participants. Moreover, there were two themes and nine categories found. The themes were knowledge related to drugs and HIV/AIDS and risky sexual behavior.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Knowledge related to drugs and HIV/AIDS</span><p id="par0050" class="elsevierStylePara elsevierViewall">Knowledge among the former IDUs infected with HIV regarding drugs and HIV/AIDS included these categories: the re-using of syringes is not sterile, harm to the body, the type of drugs, and understanding the correlation between drugs and HIV/AIDS after joining the NGO. The re-using of syringes is not sterile was proven by the codes of swapping syringes, changing syringes, using unsterile syringes, sharing syringes, for example, a participant stated, “<span class="elsevierStyleItalic">A needle is shared from one friend to another friend, so one friend has already been exposed to the blood from the previous needle, and used it again for another friend.”</span> (P2, Male, 46). Re-using of non-sterile syringes among IDUs had a risk for HIV transmission.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5,10</span></a> This could point out that blood is an intermediary media to transmit HIV from one person to another person.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Addiction, affecting the brain, changing attitudes, feeling cold and heat, and transmission to HIV were the codes for the category of harm to the body. These were reflected by the participants knowing that drugs have a negative impact physically and psychologically, e.g., “<span class="elsevierStyleItalic">A substance that changes minds, behaviors, and feelings.”</span> (P3, Male, 39). Moreover, a participant opined that drugs have a long-term impact on the spread of HIV through the sharing of syringes, “<span class="elsevierStyleItalic">… the long-term effects are like we do not know until now, it could be the disease or transmission of HIV.”</span> (P5, Male, 36). The consequences of substance abuse regarding low cardiovascular functions can impact on organs in the body.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> A study revealed that marijuana, as one of the substances of drug abuse, has a negative impact on mental illness and psychological consequences.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">For the type of drugs, the participants knew the name, e.g., a statement of a participant, “<span class="elsevierStyleItalic">Drugs like amphetamine, there are heroin, marijuana. There are opioids and ecstasy, and many kinds anyway.”</span> (P2, Male, 46). This finding is congruent with the previous study in Indonesia that described the type of drugs such as heroin, methadone or buprenorphine, opiates, benzodiazepine, amphetamine, marijuana, and ecstasy.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> Mostly the participants understand the correlation between drugs and HIV/AIDS when they joined the NGO, for example, the participant stated, “<span class="elsevierStyleItalic">… through a non-sterile needle syringe, there is blood with HIV and the virus is still there in the syringe and enters our bodies.”</span> (P1, Male, 36). Virtually, the knowledge of the participants of this study increased about drugs and HIV/AIDS after joining the NGO. It might be the NGO gave information and education about HIV/AIDS to IDUs who wanted to quit abusing drugs abuse and wanted to join rehabilitation. NGO has the role to give counseling, training, social assistance and social support, medical services, and HIV education. These activities could improve the knowledge among IDUs about drugs and HIV/AIDS.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Risky sexual behaviors</span><p id="par0065" class="elsevierStylePara elsevierViewall">Sex with more than one partner and using local prostitutes was stated from participants: “<span class="elsevierStyleItalic">I still prefer to have sex with another girl.“</span> (P4, Male, 38) and“<span class="elsevierStyleItalic">I always have sex, but in the prostitution area.”</span> (P2, Male, 46). Previous studies have revealed that IDUs had sex with multiple sexual partners.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6,15</span></a> There might be several reasons for IDUs engaging in risky sexual behavior such as the side effects of drugs, curiosity, and social-economic factors among IDUs. IDUs having multiple sexual partners were associated with several factors such as getting an illegal income, monthly income, enjoyment, curiosity, the effect of drugs, and history of sharing their needles or syringes.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> Moreover, injecting drugs is also used in prostitution areas which may increase the high-risk of HIV transmission in sexual practices.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Two codes in the category of sex after a drug party consisted of the need for sex after taking drugs and the desire for sex lower compared to the need for drugs. This participant stated, “<span class="elsevierStyleItalic">At that time, party in my boss's home. After taking drugs, my boss told me to choose one girl for sex. I used one girl (laugh).”</span> (P1, Male, 36). However, there were participants who would prefer drugs rather than a girl, “<span class="elsevierStyleItalic">For 100%, I think only 10% for sex with the girl, I prefer drugs.”</span> (P4, Male, 38). Most participants prefer drugs than sex. This might be due to sex as only an additional pleasure after taking drugs. Similarly, the previous study revealed that sex was only for pleasure or enjoyment for IDUs.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> Furthermore, participants prefer vaginal sex without any additional sensation during sex, such as violence during sex, sexual intercourse with sex toys, and bloody sex. A participant stated, “<span class="elsevierStyleItalic">Oral sex and vaginal sex, it was enough!”</span> (P5, Male, 36).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Participants admitted that they were still having sex despite knowing themselves to be an HIV infected person. “<span class="elsevierStyleItalic">After I knew that I am HIV, I have used a condom for sex.”</span> (P1, Male, 36) and “<span class="elsevierStyleItalic">I continue my sexual activity but with a condom.”</span> (P4, Male, 38) are the statements from two participants that they were still involved in sexual activity using a condom. Conversely, there were participants who opined of not using condoms frequently, “<span class="elsevierStyleItalic">… because it (condom) can reduce satisfaction, not good.”</span> (P2, Male, 46); “<span class="elsevierStyleItalic">I never used it (condom) previously.”</span> (P3, Male, 39); “<span class="elsevierStyleItalic">For me, as long as having sex with my wife, and we never use a condom.”</span> (P5, Male, 36). The reasons for participants not using condoms frequently were those such as having sex after a drug party under the influence of drugs, having not understood yet about the function of condoms, and not being satisfied if using a condom. Another study reported that IDUs have multiple partners, had bought sex from a female sex worker, and only 10% consistently used a condom.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> IDUs were inconsistent in using a condom with occasional and having sex with five or more sexual partners.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> This could point out that the issue of inconsistency in using condoms among IDUs is one of the challenges to decrease the new HIV cases and high-risk behavior in spreading HIV transmission, especially to non-injectors.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Our work has some limitations. Nevertheless, we believe our work could be the foundation knowledge that describes the phenomenon of sexual behavior among IDUs group in Indonesia, however, the study did not explore how the participants solve their problem to terminate the transmission of HIV as their self-management. In addition, all the participants were male who might be having a different experience from female former IDUs infected with HIV. This could eventually lead to further research to solve these limitations.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study provides the phenomenon of sexual behavior among former IDUs infected with HIV in Bali, Indonesia. Knowledge about drugs and HIV improved after joining the NGO. However, risky sexual behavior among former IDUs found having had sex with multiple partners and the inconsistent use of condoms. This study has gone some way toward enhancing understanding for nurses and other health care providers to work in preventing new cases of HIV, especially from IDUs’ group. Results so far have been encouraging nurses to work comprehensively and collaboratively with NGOs to emphasize that condoms must be used among IDUs if they have been diagnosed with HIV.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1441036" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1315180" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Participants and study setting" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data analysis" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical aspects" ] ] ] 4 => array:3 [ "identificador" => "sec0040" "titulo" => "Results and discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Knowledge related to drugs and HIV/AIDS" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Risky sexual behaviors" ] ] ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "xack503042" "titulo" => "Acknowledgments" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-12" "fechaAceptado" => "2020-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1315180" "palabras" => array:5 [ 0 => "AIDS" 1 => "HIV" 2 => "Injecting drug user" 3 => "Phenomenology" 4 => "Sexual behavior" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Injecting Drug Users (IDUs) have become a serious concern in public health due to their potential in HIV transmission. This study aims to describe the sexual behavior experience of former IDUs infected with HIV in Bali, Indonesia. A qualitative study with a phenomenology approach was conducted using purposive sampling. Five former IDUs infected with HIV were selected and analyzed using a thematic analysis. The finding showed two themes; (1) knowledge related to drugs and HIV/AIDS, and (2) risky sexual behavior which consisted of sex with many close friends and using local prostitutes, sex after a drug party or after using drugs, preference for vaginal sex, engaging in sex despite having a known HIV positive status, and not using condoms frequently. This finding can be used to recommend that nurses and other health care providers work collaboratively and comprehensively in preventing the new cases of HIV caused by the risky sexual behavior of the IDUs.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Nursing Research Conference of Udayana University. Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note.</span> PS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Primary School; SHS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Senior High School; JHS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Junior High School; U-E<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Unemployment; P-E<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Private Employment; HS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Heterosexual.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Data \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years old) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Level of education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">JHS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Employment status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">U-E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P-E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P-E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P-E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">U-E \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Religion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Christian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Islam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Christian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hindu \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hindu \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sexual orientation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2478757.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Socio-demographic data of participants.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "United Nations Office on Drugs and Crime. 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| Year/Month | Html | Total | |
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| 2023 March | 1 | 7 | 8 |
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| 2021 March | 1 | 0 | 1 |
