Mona Safitri Fatiah, Rispah Purba, Genoveva Chatleen Compehage Molle, Sarni Rante Allo Bela

The Effect of Being Faithful, Condom Use, no Drug Behavior on the Incidence of Sexually Transmitted Infections (STIs) in Unmarried Men Who Have Sex with Men (MSM) in Indonesia

Introduction

The effect of being faithful, condom use, no drug behavior on the incidence of sexually transmitted infections (stis) in unmarried men who have sex with men (msm) in indonesia. Examines faithfulness, condom use, and drug-free behavior's impact on STI incidence in unmarried Indonesian MSM. Identifies key strategies for STI prevention.

Abstract

Background: “BCD” habits can help homosexual people and men who have sexwith men (MSM) prevent the transmission of sexually transmitted infections (STIs)and safeguard their partners. Objective: The purpose of this study was to investigate how BCD behaviour affects the prevalence of STIs among Indonesian MSM.Methods: a cross-sectional study was conducted in 24 provinces in Indonesia fromApril to May 2023. The study population comprised MSM who had ever engaged insexual intercourse, either occasionally, once, or frequently, totaling 6,000 individuals. A sample of 3,515 participants was selected using the Respondent Driven Sampling (RDS) method. Integrated Biological and Behavior Survey (STBP) 2018-2019data was utilized. The data was analyzed using multivariate analyses with STATA14 software. Results: after controlling for the variables of pieces of information exposure and vaginal intercourse, the following behaviors were found to have a significant influence of the occurrence of STIs among MSM (p-value:0.050; AOR:1,62with 95% CI:0.96-2.73), condom use (p-value:0.050; AOR:0.37 with 95% CI:0.14-1.00), no drug use (p-value:0.040; AOR:1,67 with 95% CI:1.02-2.75). Conclusion:promoting faithful behavior towards a steady partner, consistent condom use duringsexual activity, and refraining from injections and drug use can effectively reducethe transmission of STIs among MSM.

Review

This study addresses a critically important public health issue: the prevention of sexually transmitted infections (STIs) among men who have sex with men (MSM) in Indonesia, utilizing a large-scale, national dataset. The objective to investigate the impact of "BCD" behaviors—being faithful, consistent condom use, and abstaining from drug use—on STI prevalence is highly relevant. The methodological approach, including a cross-sectional design across 24 provinces with a substantial sample size of 3,515 participants selected via Respondent Driven Sampling (RDS), represents a robust attempt to capture data from a hard-to-reach population. The utilization of data from the Integrated Biological and Behavior Survey (STBP) further adds to the potential generalizability of the findings, although a clarification regarding the reported "April-May 2023" study conduction period versus the "2018-2019" data utilization is warranted for temporal accuracy. However, the reported results present significant inconsistencies that undermine the study's conclusions. While the finding of condom use (AOR: 0.37, 95% CI: 0.14-1.00, p=0.050) potentially reducing STI risk aligns with established knowledge, the AORs for "faithful behavior" (AOR: 1.62, 95% CI: 0.96-2.73, p=0.050) and "no drug use" (AOR: 1.67, 95% CI: 1.02-2.75, p=0.040) are highly problematic. As presented, these results suggest that being faithful to a partner and abstaining from drug use *increase* the incidence of STIs, which directly contradicts the foundational "BCD" hypothesis the study aims to investigate and is counter-intuitive to public health principles. Furthermore, the p-values for "faithful behavior" and "condom use" are exactly at the 0.050 threshold, and their respective 95% confidence intervals include the null value of 1, indicating that these findings are statistically borderline and may not be robustly significant in a practical sense. This raises serious concerns about the interpretation of the statistical models or potential miscoding/misreporting of the variables. Given these critical inconsistencies, the abstract's conclusion—that promoting faithful behavior, consistent condom use, and refraining from injections and drug use can effectively reduce STI transmission—is not adequately supported by its own stated results for "faithful behavior" and "no drug use." A thorough re-examination of the statistical analysis, particularly the direction and interpretation of the Adjusted Odds Ratios for faithful behavior and no drug use, is essential. The authors must clarify how these variables were operationalized and coded, as the reported findings fundamentally contradict the premise of their work. Without such clarification, the abstract, despite its promising methodology and relevant topic, contains internal inconsistencies that need to be resolved before the study's conclusions can be confidently accepted and disseminated.

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