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Vo
l.
14
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Dec
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I
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s
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J
o
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m
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h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
H
ea
lth
lit
eracy
on
H
IV/
AIDS a
nd
adherence
t
o
anti
r
etrov
ira
l
treatmen
t:
the
m
o
dera
ting ro
le of
so
cia
l suppo
rt
P
uja
a
nn
icha
,
H
er
lin
a
Siwi
Widi
a
na
F
a
c
u
l
t
y
o
f
P
s
y
c
h
o
l
o
g
y
,
U
n
i
v
e
r
si
t
a
s A
h
ma
d
D
a
h
l
a
n
,
Y
o
g
y
a
k
a
r
t
a
,
I
n
d
o
n
e
si
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
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y:
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ec
eiv
ed
Feb
2
5
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2
0
2
5
R
ev
is
ed
Oct
2
5
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2
0
2
5
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ep
ted
No
v
3
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2
0
2
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Th
e
in
c
re
a
sin
g
p
re
v
a
len
c
e
o
f
H
IV/AID
S
c
o
n
ti
n
u
e
s
to
p
o
se
a
sig
n
ifi
c
a
n
t
g
lo
b
a
l
h
e
a
lt
h
c
h
a
l
len
g
e
,
with
d
e
v
e
lo
p
in
g
c
o
u
n
tr
ies
e
x
p
e
rien
c
i
n
g
th
e
fa
ste
st
g
ro
wt
h
in
tran
sm
issio
n
ra
tes
,
in
c
lu
d
in
g
I
n
d
o
n
e
sia
.
T
h
is
q
u
a
n
ti
tati
v
e
c
o
rre
latio
n
a
l
stu
d
y
e
x
a
m
in
e
d
t
h
e
in
flu
e
n
c
e
o
f
HIV
/AIDS
-
re
late
d
h
e
a
lt
h
li
tera
c
y
o
n
a
d
h
e
re
n
c
e
to
a
n
ti
re
tr
o
v
iral
(ARV
)
t
h
e
ra
p
y
a
m
o
n
g
p
e
o
p
le
li
v
in
g
with
HIV
/AIDS
(P
LW
HA
),
wi
th
p
e
e
r
so
c
ial
s
u
p
p
o
rt
c
o
n
sid
e
re
d
a
s
a
m
o
d
e
ra
ti
n
g
v
a
ria
b
le.
P
a
rti
c
i
p
a
n
ts
i
n
c
lu
d
e
d
2
0
8
P
LW
HA
r
e
sid
in
g
i
n
M
a
jale
n
g
k
a
Re
g
e
n
c
y
,
Wes
t
Ja
v
a
,
In
d
o
n
e
sia
.
Da
ta
we
re
g
a
t
h
e
re
d
u
si
n
g
sta
n
d
a
rd
ize
d
in
str
u
m
e
n
ts
m
e
a
su
rin
g
HIV
/AIDS
h
e
a
lt
h
li
tera
c
y
,
trea
tme
n
t
a
d
h
e
re
n
c
e
,
a
n
d
p
e
e
r
so
c
ial
su
p
p
o
rt,
a
n
d
we
re
a
n
a
ly
z
e
d
t
h
ro
u
g
h
m
o
d
e
ra
ti
o
n
a
n
a
ly
sis
u
si
n
g
Ja
m
o
v
i
s
o
ftwa
re
.
Th
e
re
su
l
ts
d
e
m
o
n
stra
ted
t
h
a
t
HIV
/AID
S
h
e
a
lt
h
li
tera
c
y
h
a
d
a
sig
n
ifi
c
a
n
t
p
o
siti
v
e
e
ffe
c
t
o
n
ARV
a
d
h
e
re
n
c
e
,
a
n
d
th
a
t
p
e
e
r
so
c
ial
su
p
p
o
rt
stre
n
g
th
e
n
e
d
th
is
re
latio
n
sh
i
p
.
No
n
e
th
e
les
s,
th
e
stu
d
y
is
li
m
it
e
d
b
y
it
s
c
ro
ss
-
se
c
ti
o
n
a
l
d
e
sig
n
a
n
d
re
li
a
n
c
e
o
n
se
lf
-
re
p
o
rte
d
m
e
a
su
re
s,
wh
ich
m
a
y
re
strict
c
a
u
sa
l
i
n
fe
re
n
c
e
a
n
d
g
e
n
e
ra
li
z
a
b
il
i
ty
.
K
ey
w
o
r
d
s
:
Ad
h
er
en
ce
AR
V
tr
ea
tm
en
t
Hea
lth
liter
ac
y
o
n
HI
V/AI
DS
Peo
p
le
liv
in
g
with
HI
V/AI
DS
So
cial
s
u
p
p
o
r
t
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Her
lin
a
Siwi W
id
ian
a
Facu
lty
o
f
Ps
y
ch
o
lo
g
y
,
Un
i
v
er
s
itas
Ah
m
ad
Dah
lan
Kap
as Str
ee
t N
o
.
9
,
Yo
g
y
ak
ar
t
a,
I
n
d
o
n
esia
E
m
ail: h
er
lin
a.
wid
ian
a@
p
s
y
.
u
ad
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
r
a
p
id
s
p
r
ea
d
o
f
HI
V/AI
DS
ca
s
es
h
as
b
ec
o
m
e
o
n
e
o
f
t
h
e
m
o
s
t
p
r
ess
in
g
g
lo
b
al
h
ea
lth
ch
allen
g
es.
Hu
m
an
im
m
u
n
o
d
ef
icien
c
y
v
i
r
u
s
(
HI
V)
in
f
ec
tio
n
is
an
ep
id
em
ic
d
is
ea
s
e
th
at
tar
g
ets
th
e
im
m
u
n
e
s
y
s
tem
,
p
r
o
g
r
ess
in
g
t
h
r
o
u
g
h
s
tag
es
r
an
g
in
g
f
r
o
m
p
r
im
ar
y
in
f
ec
t
io
n
—
w
ith
o
r
with
o
u
t
ac
u
te
s
y
n
d
r
o
m
e
—
to
an
asy
m
p
to
m
atic
p
h
ase
(
ch
a
r
ac
ter
ized
b
y
th
e
ab
s
en
ce
o
f
s
y
m
p
to
m
s
)
a
n
d
e
v
en
tu
ally
ad
v
an
cin
g
t
o
late
-
s
tag
e
in
f
ec
tio
n
.
Acq
u
ir
e
d
im
m
u
n
o
d
ef
icien
cy
s
y
n
d
r
o
m
e
(
AI
DS)
r
ep
r
esen
ts
th
e
f
in
al
s
tag
e
o
f
HI
V
in
f
ec
tio
n
.
HI
V
tr
an
s
m
is
s
io
n
o
cc
u
r
s
th
r
o
u
g
h
v
ar
io
u
s
r
o
u
tes,
in
clu
d
in
g
s
ex
u
al
co
n
tact,
b
r
ea
s
tf
ee
d
in
g
f
r
o
m
m
o
th
er
to
ch
ild
,
b
lo
o
d
tr
an
s
f
u
s
io
n
s
,
a
n
d
th
e
u
s
e
o
f
c
o
n
tam
in
ated
n
ee
d
les
[
1
]
-
[
5
]
.
T
h
e
h
i
g
h
est
r
ates
o
f
tr
an
s
m
is
s
io
n
an
d
d
is
ea
s
e
p
r
o
g
r
ess
io
n
ar
e
o
b
s
er
v
e
d
in
l
o
w
-
in
co
m
e
co
u
n
tr
ies
th
at
f
a
c
e
ed
u
ca
tio
n
al,
ec
o
n
o
m
ic,
an
d
h
ea
lth
ca
r
e
ac
ce
s
s
b
ar
r
ier
s
,
b
o
th
in
ter
m
s
o
f
av
ailab
ilit
y
an
d
q
u
ality
[
6
]
,
in
c
lu
d
in
g
in
I
n
d
o
n
esia,
s
p
ec
if
ically
in
Ma
jalen
g
k
a
R
eg
en
cy
,
W
est
J
av
a.
E
x
p
an
d
in
g
ac
ce
s
s
to
an
tire
tr
o
v
ir
al
th
er
ap
y
(
AR
T
)
s
er
v
ices
h
as
h
ad
a
s
ig
n
if
ican
t
im
p
ac
t
o
n
r
ed
u
ci
n
g
HI
V
in
f
ec
tio
n
s
an
d
lo
wer
in
g
m
o
r
tality
r
ates
am
o
n
g
b
o
t
h
a
d
u
lts
an
d
c
h
ild
r
e
n
wo
r
ld
wid
e
[
7
]
.
Ho
wev
er
,
it
is
co
n
ce
r
n
in
g
th
a
t
s
o
m
e
p
eo
p
le
liv
in
g
with
HI
V/AI
DS
(
PL
W
HA
)
r
em
ain
n
o
n
-
ad
h
e
r
en
t
to
ad
h
er
en
ce
t
o
an
tire
tr
o
v
ir
al
(
AR
V
)
th
er
ap
y
,
as
ev
id
en
ce
d
b
y
u
n
c
o
n
tr
o
lled
v
ir
al
lo
ad
test
r
esu
lts
,
wh
ich
ar
e
in
f
lu
en
ce
d
b
y
v
ar
i
o
u
s
f
ac
to
r
s
[
8
]
.
I
n
te
r
v
iew
f
in
d
in
g
s
also
r
ev
ea
led
th
at
s
o
m
e
in
d
iv
i
d
u
al
s
f
ail
to
tak
e
AR
V
m
ed
icatio
n
o
n
tim
e
d
u
e
to
f
o
r
g
etf
u
ln
ess
an
d
a
lack
o
f
u
n
d
er
s
tan
d
in
g
o
f
t
h
e
p
r
o
p
er
u
s
ag
e
g
u
id
elin
es.
T
h
is
s
itu
atio
n
u
n
d
er
s
co
r
es
th
e
n
ee
d
f
o
r
a
d
ee
p
e
r
u
n
d
er
s
tan
d
in
g
o
f
th
e
f
ac
to
r
s
a
f
f
ec
tin
g
AR
V
tr
e
atm
en
t
ad
h
er
e
n
ce
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Hea
lth
liter
a
cy
o
n
HI
V
/AI
DS
a
n
d
a
d
h
eren
ce
to
a
n
tir
etro
vira
l trea
tmen
t:
th
e
mo
d
era
tin
g
…
(
P
u
ja
a
n
n
ich
a
)
1659
Ad
h
er
en
ce
to
tr
ea
tm
en
t
r
ef
er
s
to
th
e
ex
ten
t
to
wh
ich
an
in
d
iv
id
u
al
f
o
llo
ws
th
e
m
ed
icatio
n
r
eg
im
en
p
r
escr
ib
ed
b
y
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
[
9
]
.
Ad
h
er
en
ce
e
n
co
m
p
ass
es
f
o
u
r
d
im
en
s
io
n
s
:
f
o
r
g
ettin
g
t
o
ta
k
e
m
ed
icatio
n
,
th
e
ab
ilit
y
to
s
elf
-
r
eg
u
late
to
m
ai
n
tain
co
n
s
is
ten
t
m
ed
icatio
n
i
n
tak
e,
in
ten
tio
n
al
d
is
co
n
tin
u
a
tio
n
o
f
m
ed
icatio
n
,
an
d
d
is
r
u
p
tio
n
ca
u
s
ed
b
y
m
ed
icatio
n
s
ch
ed
u
les
[
9
]
.
Un
d
er
s
tan
d
in
g
th
es
e
d
im
e
n
s
io
n
s
h
elp
s
id
en
tify
th
e
b
ar
r
ier
s
f
ac
e
d
b
y
PLWHA
in
ad
h
er
in
g
to
AR
V
th
er
ap
y
.
Hig
h
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t
ca
n
im
p
r
o
v
e
th
e
h
ea
lth
co
n
d
itio
n
o
f
PLWHA,
p
r
ev
e
n
t
tr
ea
tm
en
t
f
ailu
r
e,
s
u
p
p
r
ess
v
ir
al
r
e
p
licatio
n
,
r
ed
u
ce
th
e
r
is
k
o
f
HI
V
tr
an
s
m
is
s
io
n
,
an
d
p
r
o
tect
f
am
i
lies
f
r
o
m
in
f
ec
tio
n
[
1
0
]
.
Facto
r
s
in
f
lu
en
cin
g
ad
h
e
r
en
c
e
in
clu
d
e
in
ter
n
al
elem
en
ts
s
u
ch
as
m
o
tiv
atio
n
,
p
er
ce
p
tio
n
,
h
ea
lth
liter
ac
y
lev
el,
awa
r
en
ess
,
an
d
b
elief
s
[
1
1
]
,
[
1
2
]
.
Pre
v
io
u
s
r
esear
ch
h
as
in
d
icate
d
a
r
elatio
n
s
h
ip
b
etwe
en
k
n
o
wled
g
e
an
d
ad
h
e
r
en
ce
to
AR
V
tr
ea
tm
en
t
am
o
n
g
PLW
HA
[
1
3
]
.
Kn
o
wled
g
e
,
wh
ich
f
o
r
m
s
th
e
f
o
u
n
d
atio
n
f
o
r
s
u
s
tain
ab
le
b
eh
av
io
r
,
ca
n
b
e
en
h
an
ce
d
th
r
o
u
g
h
ed
u
ca
tio
n
[
1
4
]
-
[
1
6
]
.
I
n
th
is
s
tu
d
y
,
HI
V/AI
DS
k
n
o
wled
g
e
is
v
iewe
d
as
an
o
u
tco
m
e
o
f
HI
V/AI
DS
h
ea
lth
liter
ac
y
.
HI
V/AI
DS
h
ea
lth
lit
er
ac
y
is
a
cr
itical
f
ac
to
r
in
o
p
tim
izin
g
AR
V
u
s
e
b
y
p
r
o
m
o
tin
g
ad
h
e
r
en
ce
to
tr
ea
tm
en
t
an
d
e
f
f
ec
tiv
e
u
tili
za
tio
n
o
f
h
ea
lth
ca
r
e
s
er
v
ices
[
1
3
]
.
I
t
e
n
co
m
p
ass
es
an
in
d
i
v
id
u
al’
s
k
n
o
wled
g
e,
m
o
tiv
atio
n
,
an
d
a
b
ilit
y
to
a
cc
ess
,
co
m
p
r
eh
e
n
d
,
ev
alu
ate,
an
d
a
p
p
ly
h
ea
lth
in
f
o
r
m
atio
n
in
m
ak
in
g
d
aily
d
ec
is
io
n
s
ab
o
u
t
h
ea
lth
ca
r
e,
d
is
ea
s
e
p
r
ev
en
tio
n
,
a
n
d
h
ea
lth
p
r
o
m
o
tio
n
to
m
ain
tain
o
r
im
p
r
o
v
e
q
u
ality
o
f
life
[
1
7
]
.
T
h
is
h
ea
lth
liter
ac
y
co
m
p
r
is
es
f
o
u
r
d
o
m
ain
s
:
ac
ce
s
s
,
u
n
d
er
s
tan
d
in
g
,
ap
p
r
aisal,
an
d
ap
p
licatio
n
[
1
7
]
.
Ad
h
er
en
ce
to
AR
V
th
er
ap
y
a
m
o
n
g
PLWHA
is
also
in
f
lu
en
ce
d
b
y
s
o
cial
s
u
p
p
o
r
t,
wh
ic
h
in
v
o
lv
es
ac
tio
n
s
th
at
h
el
p
in
d
iv
id
u
als
co
p
e
with
p
r
o
b
lem
s
t
h
r
o
u
g
h
em
o
tio
n
al
ass
is
tan
ce
,
in
f
o
r
m
atio
n
al
s
u
p
p
o
r
t,
in
s
tr
u
m
en
tal
aid
,
a
n
d
p
o
s
itiv
e
ap
p
r
aisal
[
1
8
]
.
So
cial
s
u
p
p
o
r
t
in
clu
d
es
em
o
ti
o
n
al,
ap
p
r
aisal,
in
s
tr
u
m
en
tal,
a
n
d
in
f
o
r
m
atio
n
al
co
m
p
o
n
en
ts
[
1
9
]
.
I
t
ca
n
en
h
an
ce
th
e
m
o
tiv
atio
n
an
d
a
d
h
er
en
c
e
o
f
PL
W
HA
b
y
p
r
o
v
id
in
g
r
em
in
d
er
s
a
n
d
en
co
u
r
ag
em
e
n
t
f
r
o
m
f
am
ily
o
r
f
r
ien
d
s
[
2
0
]
,
[
2
1
]
.
Peer
s
o
cial
s
u
p
p
o
r
t
am
o
n
g
PLWHA,
as
a
m
o
d
er
atin
g
v
ar
iab
le,
is
ex
p
ec
ted
to
r
ed
u
ce
th
e
n
e
g
ativ
e
im
p
ac
t
o
f
lo
w
h
ea
lth
liter
ac
y
o
n
AR
V
ad
h
er
en
ce
.
T
h
is
alig
n
s
with
p
r
ev
io
u
s
f
in
d
in
g
s
th
at
s
h
ar
in
g
in
f
o
r
m
atio
n
with
in
clo
s
e
s
o
cial
n
etwo
r
k
s
ca
n
m
itig
ate
th
e
ad
v
er
s
e
ef
f
ec
ts
o
f
lim
ited
h
ea
lth
liter
ac
y
[
2
2
]
.
B
ased
o
n
th
e
s
e
co
n
s
i
d
er
atio
n
s
,
th
is
s
tu
d
y
a
im
s
to
ex
p
lo
r
e
th
e
r
o
le
o
f
p
ee
r
s
o
cial
s
u
p
p
o
r
t
as
a
m
o
d
er
ato
r
s
tr
en
g
th
en
in
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
HI
V/AI
DS
h
ea
lth
liter
ac
y
an
d
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t a
m
o
n
g
PLWHA.
R
esear
ch
o
n
HI
V/AI
DS
h
ea
lt
h
liter
ac
y
,
s
o
cial
s
u
p
p
o
r
t,
a
n
d
AR
V
a
d
h
er
en
ce
h
as
b
ee
n
c
o
n
d
u
cted
in
v
ar
io
u
s
s
tu
d
ies
o
v
er
t
h
e
p
ast
f
iv
e
y
ea
r
s
,
em
p
l
o
y
in
g
d
if
f
er
en
t
m
eth
o
d
o
lo
g
ies
s
u
ch
as
q
u
alitativ
e
ap
p
r
o
ac
h
es
[
2
3
]
-
[
2
5
]
,
as
well
as
q
u
an
titativ
e
m
eth
o
d
s
[
2
6
]
-
[
2
8
]
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
o
f
ten
lin
k
e
d
AR
V
ad
h
er
en
ce
to
v
ar
iab
les
d
is
tin
c
t
f
r
o
m
th
o
s
e
e
x
am
in
ed
h
er
e
,
i
n
clu
d
in
g
k
n
o
wled
g
e,
q
u
ality
o
f
life
,
m
o
tiv
atio
n
,
an
d
s
elf
-
esteem
[
2
8
]
-
[
3
0
]
.
W
h
ile
ex
is
tin
g
liter
atu
r
e
d
em
o
n
s
tr
ates
d
iv
er
s
ity
in
b
o
th
ap
p
r
o
ac
h
an
d
v
ar
iab
les
r
elate
d
to
AR
V
ad
h
er
en
ce
,
th
er
e
r
em
ain
s
a
s
ca
r
city
o
f
r
ese
ar
ch
in
v
esti
g
atin
g
HI
V/AI
DS
h
ea
lth
liter
ac
y
with
s
o
cial
s
u
p
p
o
r
t a
s
a
m
o
d
er
atin
g
f
ac
to
r
,
p
ar
ticu
lar
ly
with
in
t
h
e
I
n
d
o
n
esian
co
n
tex
t.
Su
p
p
o
r
tiv
e
r
eso
u
r
ce
s
with
in
a
n
in
d
iv
id
u
al’
s
s
o
cial
n
etwo
r
k
ca
n
en
h
an
ce
t
h
eir
ab
ilit
y
to
a
cc
ess
an
d
co
m
p
r
eh
e
n
d
m
ed
ical
in
f
o
r
m
at
io
n
,
th
er
e
b
y
p
r
o
m
o
tin
g
h
ea
lth
ier
b
eh
av
i
o
r
s
[
2
2
]
.
Giv
en
th
at
s
o
cial
s
cien
ce
s
ar
e
ess
en
tial
f
o
r
a
co
m
p
r
eh
e
n
s
iv
e
an
d
h
o
lis
tic
u
n
d
er
s
tan
d
in
g
o
f
HI
V/AI
DS
[
3
1
]
,
th
is
r
esear
ch
aim
s
to
co
n
tr
i
b
u
te
p
r
ac
tical
in
s
ig
h
ts
in
to
im
p
r
o
v
in
g
AR
V
ad
h
er
en
ce
am
o
n
g
P
L
W
HA,
w
h
ile
also
en
r
ich
in
g
h
ea
lth
p
s
y
ch
o
l
o
g
y
liter
atu
r
e
th
r
o
u
g
h
n
ew
f
in
d
i
n
g
s
o
n
th
e
in
ter
p
la
y
b
etwe
en
HI
V/AI
DS
h
ea
lth
liter
ac
y
,
p
ee
r
s
o
cial
s
u
p
p
o
r
t,
an
d
tr
ea
tm
en
t
ad
h
er
e
n
ce
.
T
h
e
h
y
p
o
th
eses
o
f
th
is
s
tu
d
y
a
r
e:
i
)
HI
V/AI
DS
h
ea
lth
liter
ac
y
p
o
s
itiv
ely
in
f
lu
en
ce
s
AR
V
a
d
h
er
en
ce
am
o
n
g
PLWHA in
Ma
jalen
g
k
a
R
eg
en
cy
; a
n
d
ii
)
P
ee
r
s
o
cial
s
u
p
p
o
r
t p
o
s
it
iv
ely
m
o
d
e
r
ates th
e
r
elatio
n
s
h
ip
b
etwe
en
HI
V/AI
DS
h
ea
lth
liter
ac
y
an
d
AR
V
ad
h
er
en
ce
a
m
o
n
g
PLWHA
in
Ma
jalen
g
k
a
R
eg
en
cy
.
2.
M
E
T
H
O
D
T
h
is
r
esear
ch
u
tili
ze
s
a
q
u
an
t
itativ
e
ap
p
r
o
ac
h
with
a
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
in
clu
d
es
PLWHA
r
es
id
in
g
in
Ma
jalen
g
k
a
R
eg
en
cy
,
W
est
J
av
a,
I
n
d
o
n
esia.
Pu
r
p
o
s
i
v
e
s
am
p
lin
g
was
em
p
lo
y
ed
,
with
th
e
s
am
p
le
m
ee
tin
g
th
e
f
o
llo
win
g
cr
iter
ia:
h
av
in
g
r
ec
eiv
e
d
AR
T
tr
ea
tm
en
t
f
o
r
at
least
o
n
e
y
ea
r
,
b
ein
g
o
v
er
th
e
a
g
e
o
f
1
7
,
an
d
b
ei
n
g
p
atien
ts
o
f
Ho
s
p
ital "
X".
T
h
e
s
am
p
le
ch
a
r
ac
ter
is
tics
in
th
is
s
tu
d
y
m
ay
i
n
tr
o
d
u
ce
s
elec
tio
n
b
ias;
h
o
wev
e
r
,
th
e
r
is
k
o
f
s
u
ch
b
ias
is
co
n
s
id
er
ed
lo
w.
T
h
e
cr
iter
io
n
r
eq
u
ir
i
n
g
p
ar
ticip
an
ts
to
h
av
e
u
n
d
er
g
o
n
e
an
tire
tr
o
v
ir
al
(
AR
V)
tr
ea
tm
en
t
f
o
r
at
least
o
n
e
y
ea
r
is
b
ased
o
n
s
ev
er
al
r
ea
s
o
n
s
.
Firstl
y
,
clin
ical
co
n
d
itio
n
s
ten
d
to
s
tab
ilize
af
ter
o
n
e
y
ea
r
o
f
tr
ea
tm
en
t,
m
in
im
izin
g
in
ter
f
er
en
ce
f
r
o
m
p
h
y
s
ical
h
ea
lth
is
s
u
es
an
d
ea
r
ly
s
id
e
ef
f
ec
ts
d
u
r
in
g
th
e
d
ata
co
llectio
n
p
r
o
ce
s
s
.
Seco
n
d
ly
,
r
esp
o
n
d
en
ts
with
lo
n
g
er
tr
ea
tm
en
t
ex
p
e
r
ien
ce
ar
e
ex
p
ec
te
d
to
h
av
e
a
b
ette
r
u
n
d
er
s
tan
d
i
n
g
,
wh
ich
ca
n
lead
to
m
o
r
e
ac
cu
r
ate
r
esp
o
n
s
es
an
d
r
ed
u
ce
p
o
ten
tial
b
ias
ass
o
ciate
d
with
th
e
ea
r
ly
tr
ea
tm
en
t p
h
ase,
wh
er
e
ad
h
e
r
e
n
ce
m
ea
s
u
r
em
en
ts
o
f
ten
s
h
o
w
tem
p
o
r
ar
ily
ele
v
ated
lev
els.
Sam
p
lin
g
p
ar
ticip
an
ts
f
r
o
m
Ho
s
p
ital
“X”
is
d
ee
m
ed
r
ep
r
esen
tativ
e
o
f
th
e
p
o
p
u
latio
n
s
in
ce
th
is
f
ac
ilit
y
s
er
v
es
as
th
e
m
ain
r
ef
er
r
al
ce
n
ter
f
o
r
PLWHA
in
Ma
jalen
g
k
a
R
eg
en
cy
.
Nev
er
th
el
ess
,
ca
u
tio
n
s
h
o
u
ld
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
6
5
8
-
1
6
6
5
1660
b
e
ex
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wh
en
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e
n
er
alizin
g
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e
s
tu
d
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in
d
in
g
s
,
as
th
e
ch
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
in
th
is
s
tu
d
y
m
ay
n
o
t
f
u
lly
r
ep
r
esen
t PL
W
HA
in
o
th
er
r
eg
io
n
s
with
d
if
f
er
in
g
s
o
cia
l,
cu
ltu
r
al,
an
d
h
ea
lth
ca
r
e
s
y
s
tem
co
n
tex
ts
.
A
to
tal
o
f
2
0
8
PLWHA
p
ar
tic
ip
ated
in
th
is
s
tu
d
y
.
T
h
e
m
ajo
r
ity
o
f
th
e
r
esp
o
n
d
e
n
ts
wer
e
ag
ed
1
9
-
4
0
y
ea
r
s
,
with
6
7
%
o
f
th
em
b
ein
g
m
ale
(
6
2
%).
Mo
s
t
o
f
th
e
p
ar
ticip
an
ts
h
ad
a
n
ed
u
ca
tio
n
lev
el
eq
u
iv
alen
t
t
o
ju
n
io
r
h
ig
h
s
ch
o
o
l
(
3
5
%).
T
h
ir
ty
-
n
in
e
p
e
r
ce
n
t
o
f
th
e
r
esp
o
n
d
e
n
ts
wer
e
m
ar
r
ied
,
an
d
th
e
m
ajo
r
ity
wer
e
in
f
ec
ted
with
HI
V
d
u
e
t
o
m
ale
-
to
-
m
ale
s
ex
u
al
co
n
tact
(
4
6
.
6
%).
T
h
e
r
esear
ch
in
s
tr
u
m
en
ts
in
cl
u
d
e
th
e
Me
d
icatio
n
Ad
h
er
en
c
e
R
atin
g
Scale
(
MA
R
S),
a
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
test
,
an
d
a
s
o
cial
s
u
p
p
o
r
t
s
ca
le
f
o
r
PLWHA.
T
h
e
MA
R
S
co
n
s
is
t
s
o
f
1
0
q
u
esti
o
n
s
with
a
d
ich
o
to
m
o
u
s
r
esp
o
n
s
e
fo
r
m
at
[
9
]
.
T
h
e
ad
h
er
en
ce
d
im
e
n
s
io
n
s
wer
e
d
esig
n
ed
to
d
etec
t
n
o
n
-
ad
h
er
en
ce
,
as
s
elf
-
r
ep
o
r
ts
o
f
te
n
ten
d
to
o
v
er
s
tate
co
m
p
lian
ce
(
f
ak
in
g
g
o
o
d
)
,
wh
er
ea
s
ad
m
itti
n
g
n
o
n
-
a
d
h
er
en
ce
is
co
n
s
id
er
ed
a
m
o
r
e
ac
cu
r
ate
r
ef
lectio
n
o
f
a
ctu
al
ad
h
er
en
ce
b
eh
av
i
o
r
[
3
2
]
.
T
h
e
r
esu
lts
o
f
th
e
c
o
n
s
tr
u
c
t
v
alid
ity
test
with
co
n
f
ir
m
ato
r
y
f
ac
to
r
an
aly
s
is
f
o
r
th
e
I
n
d
o
n
esian
v
er
s
io
n
o
f
MA
R
S
s
h
o
wed
a
C
h
i
-
s
q
u
ar
e
(
X²)
v
alu
e
o
f
1
2
.
6
,
with
a
s
ig
n
if
ican
ce
lev
el
(
p
)
o
f
0
.
1
2
6
,
C
FI
o
f
0
.
9
9
6
,
T
L
I
o
f
0
.
9
9
2
,
a
n
d
R
MSE
A
o
f
0
.
0
6
0
0
.
T
h
e
r
eliab
ilit
y
test
re
s
u
lts
in
d
icate
d
item
d
is
cr
im
in
atio
n
in
d
ices
r
an
g
in
g
f
r
o
m
0
.
4
2
0
to
0
.
9
1
7
,
with
an
av
e
r
ag
e
ite
m
d
is
cr
im
in
atio
n
in
d
e
x
o
f
0
.
7
9
4
an
d
a
C
r
o
n
b
ac
h
'
s
alp
h
a
co
ef
f
icien
t
(
α
)
o
f
0
.
9
1
5
.
T
h
ese
r
esu
lts
s
u
g
g
est
th
at
th
e
I
n
d
o
n
esian
v
e
r
s
io
n
o
f
M
AR
S
is
b
o
th
v
alid
an
d
r
eliab
le
in
m
ea
s
u
r
in
g
ad
h
er
en
ce
am
o
n
g
I
n
d
o
n
esian
s
PLWHA
s
.
T
h
e
h
ea
lth
liter
ac
y
o
n
HI
V/
AI
DS
T
est
(
HL
HAT
)
wa
s
d
ev
elo
p
ed
b
ased
o
n
th
e
h
ea
lt
h
liter
ac
y
d
o
m
ain
s
ac
c
o
r
d
in
g
to
Sø
r
e
n
s
en
,
in
clu
d
i
n
g
th
e
a
b
ilit
y
to
ac
ce
s
s
,
u
n
d
er
s
tan
d
,
ev
alu
ate
,
an
d
ap
p
ly
h
ea
lth
in
f
o
r
m
atio
n
[
1
7
]
.
T
h
e
HL
HA
T
was
d
ev
elo
p
e
d
with
a
d
ich
o
to
m
o
u
s
r
esp
o
n
s
e
f
o
r
m
at,
with
o
p
tio
n
s
f
o
r
t
r
u
e
o
r
f
alse.
T
h
e
r
esu
lts
o
f
t
h
e
co
n
s
tr
u
ct
v
alid
ity
test
with
co
n
f
ir
m
ato
r
y
f
ac
t
o
r
a
n
aly
s
is
f
o
r
th
e
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
test
s
h
o
w
a
ch
i
-
s
q
u
ar
e
(
X²)
v
alu
e
o
f
6
1
.
5
,
a
s
ig
n
if
ican
ce
lev
el
(
p
)
o
f
0
.
0
6
5
,
C
FI
o
f
0
.
9
8
6
,
T
L
I
o
f
0
.
9
8
0
,
a
n
d
R
MSE
A
o
f
0
.
0
4
5
9
.
T
h
e
r
eliab
ilit
y
is
0
.
7
2
5
,
with
a
n
av
er
a
g
e
item
d
if
f
ic
u
lty
o
f
0
.
5
1
1
an
d
an
av
e
r
ag
e
item
d
is
cr
im
in
atio
n
p
o
we
r
o
f
0
.
6
5
7
.
T
h
ese
r
esu
lts
s
u
g
g
est
th
at
th
e
HL
HAT
is
b
o
th
v
alid
an
d
r
eliab
le
in
m
ea
s
u
r
in
g
h
ea
l
th
liter
ac
y
o
n
HI
V/AI
DS
am
o
n
g
I
n
d
o
n
esian
s
PLWHA
s
.
T
h
e
s
o
cial
s
u
p
p
o
r
t
s
ca
le
f
o
r
P
L
W
HA,
m
o
d
if
ied
f
r
o
m
th
e
s
o
cial
s
u
p
p
o
r
t
s
ca
le
[
3
3
]
,
is
b
as
ed
o
n
th
e
asp
ec
ts
o
f
s
o
cial
s
u
p
p
o
r
t
[
1
9
]
,
wh
ich
in
clu
d
e
em
o
tio
n
al,
a
p
p
r
aisal,
in
s
tr
u
m
en
tal,
an
d
in
f
o
r
m
atio
n
al
s
u
p
p
o
r
t.
T
h
e
co
n
s
tr
u
ct
v
alid
ity
test
r
es
u
lts
with
co
n
f
ir
m
ato
r
y
f
ac
to
r
an
aly
s
is
f
o
r
th
e
m
o
d
if
ie
d
s
o
ci
al
s
u
p
p
o
r
t
s
ca
le
f
o
r
PLWHA
s
h
o
wed
a
ch
i
-
s
q
u
ar
e
(
X²)
v
alu
e
o
f
5
7
.
9
,
a
s
ig
n
if
ican
ce
lev
el
(
p
)
o
f
<0
.
0
2
6
,
C
FI
o
f
0
.
9
8
6
,
T
L
I
o
f
0
.
9
7
7
,
an
d
R
MSE
A
o
f
0
.
0
5
5
.
T
h
e
r
eliab
ilit
y
test
r
esu
lts
in
d
icate
d
item
d
is
cr
im
in
atio
n
in
d
ices
r
an
g
in
g
f
r
o
m
0
.
1
9
1
t
o
0
.
6
7
4
,
with
an
av
e
r
a
g
e
item
d
is
cr
im
in
atio
n
in
d
ex
o
f
0
.
4
6
3
an
d
a
C
r
o
n
b
ac
h
'
s
alp
h
a
co
ef
f
icien
t
(
α
)
o
f
0
.
8
0
3
.
T
h
ese
r
esu
lts
s
u
g
g
est
t
h
at
th
e
s
o
cial
s
u
p
p
o
r
t
s
ca
le
is
b
o
th
v
alid
an
d
r
eliab
le
to
m
ea
s
u
r
e
s
o
cial
s
u
p
p
o
r
t
am
o
n
g
I
n
d
o
n
esian
PLWHAs
.
T
h
e
an
aly
tical
tech
n
i
q
u
es
ap
p
lied
in
th
is
s
tu
d
y
i
n
clu
d
e
t
h
e
p
r
o
d
u
ct
-
m
o
m
en
t
c
o
r
r
elati
o
n
test
an
d
m
o
d
er
ato
r
an
aly
s
is
,
with
J
am
o
v
i
v
er
s
io
n
2
.
3
.
2
8
.
T
h
e
Pear
s
o
n
co
r
r
elatio
n
was
ca
r
r
ied
o
u
t
to
d
eter
m
in
e
t
h
e
r
elatio
n
s
h
ip
b
etwe
en
HI
V/AI
DS
h
ea
lth
liter
ac
y
an
d
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t.
Me
a
n
wh
ile,
m
o
d
er
ato
r
an
aly
s
is
was
co
n
d
u
cted
to
e
x
am
in
e
th
e
m
o
d
er
atin
g
ef
f
ec
t
o
f
s
o
cial
s
u
p
p
o
r
t
f
r
o
m
f
ello
w
PLWHA
o
n
th
e
r
elatio
n
s
h
ip
b
etwe
en
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS a
n
d
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
B
ef
o
r
e
co
n
d
u
ctin
g
m
o
d
e
r
ato
r
an
aly
s
is
,
a
Pear
s
o
n
co
r
r
elatio
n
test
was
p
er
f
o
r
m
ed
.
T
h
e
Pear
s
o
n
co
r
r
elatio
n
test
was
u
s
ed
to
e
x
am
in
e
th
e
r
elatio
n
s
h
ip
b
etw
ee
n
two
v
ar
iab
les:
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
an
d
ad
h
e
r
en
ce
to
AR
V
tr
ea
tm
en
t.
T
h
e
co
r
r
elatio
n
b
etwe
e
n
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
an
d
ad
h
er
e
n
ce
to
AR
V
tr
ea
tm
en
t
h
as
a
Pear
s
o
n
’
s
co
r
r
elatio
n
co
ef
f
icien
t
(
r
)
o
f
0
.
7
6
1
,
with
a
s
ig
n
if
ican
ce
lev
el
(
p
)
<0
.
0
0
1
.
T
h
is
r
esu
lt
in
d
icate
s
th
at
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
h
as
a
s
ig
n
if
ican
t
p
o
s
itiv
e
ef
f
ec
t
o
n
a
d
h
er
en
ce
t
o
AR
V
tr
ea
tm
en
t.
T
h
e
h
ig
h
er
th
e
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
am
o
n
g
PLWHA,
th
e
h
ig
h
er
th
eir
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t.
C
o
n
v
er
s
ely
,
th
e
lo
wer
th
e
h
ea
lth
liter
ac
y
o
n
HI
V
/AI
DS
am
o
n
g
PLWHA,
th
e
lo
wer
th
eir
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t.
T
h
e
r
esu
lts
o
f
m
o
d
er
at
o
r
a
n
al
y
s
is
in
T
ab
le
1
s
h
o
w
th
at
h
ea
l
th
liter
ac
y
o
n
HI
V/AI
DS
is
a
s
ig
n
if
ican
t
p
o
s
itiv
e
p
r
e
d
icto
r
o
f
AR
V
tr
ea
tm
en
t
ad
h
e
r
en
ce
in
PLWHA,
with
a
s
ig
n
if
ican
ce
lev
el
o
f
<0
.
0
0
1
(
m
o
d
er
at
e
esti
m
ate
p
<0
.
0
1
)
with
an
esti
m
ate
o
f
0
.
1
0
3
.
T
h
e
s
ig
n
if
ica
n
ce
lev
el
o
f
th
e
m
o
d
er
ate
esti
m
ate
(
p
)
b
etwe
en
t
h
e
in
d
ep
en
d
en
t
v
ar
iab
le,
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS,
an
d
th
e
m
o
d
er
ato
r
v
ar
iab
le,
s
o
c
ial
s
u
p
p
o
r
t
am
o
n
g
PLWHA,
i
s
0
.
0
1
7
(
m
o
d
er
ate
esti
m
ate
p
<0
.
0
5
)
with
an
esti
m
ate
o
f
-
0
.
0
0
4
.
T
h
is
r
esu
lt
in
d
icate
s
th
at
s
o
cial
s
u
p
p
o
r
t a
m
o
n
g
PLWHA sig
n
if
ican
tly
m
o
d
e
r
ates th
e
ef
f
ec
t o
f
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS o
n
AR
V
tr
ea
tm
en
t
ad
h
er
en
ce
.
T
ab
le
2
s
h
o
ws
th
e
s
im
p
le
s
lo
p
e
an
aly
s
is
r
ev
e
als
th
e
r
o
le
o
f
h
ea
lth
liter
ac
y
o
n
HI
V/AI
DS
as
a
p
r
ed
icto
r
v
ar
iab
le
f
o
r
AR
V
tr
e
atm
en
t
ad
h
e
r
en
ce
,
at
v
a
r
io
u
s
l
ev
els
o
f
s
o
cial
s
u
p
p
o
r
t
am
o
n
g
PLWHA.
I
t
ca
n
b
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Hea
lth
liter
a
cy
o
n
HI
V
/AI
DS
a
n
d
a
d
h
eren
ce
to
a
n
tir
etro
vira
l trea
tmen
t:
th
e
mo
d
era
tin
g
…
(
P
u
ja
a
n
n
ich
a
)
1661
s
ee
n
th
at
at
all
lev
els
o
f
s
o
cial
s
u
p
p
o
r
t
am
o
n
g
PLWHA,
h
ea
lth
liter
ac
y
o
n
H
I
V/AI
DS
h
as
a
s
ig
n
if
ican
t
p
o
s
itiv
e
r
o
le
in
AR
V
tr
ea
tm
e
n
t
ad
h
er
e
n
ce
.
Fig
u
r
e
1
illu
s
tr
ates
th
e
m
o
d
er
atin
g
r
o
le
o
f
s
o
cial
s
u
p
p
o
r
t
o
n
th
e
r
elatio
n
s
h
ip
b
etwe
en
h
ea
lth
li
ter
ac
y
o
n
HI
V/AI
DS
an
d
a
d
h
er
en
ce
to
AR
V
tr
ea
tm
en
t.
A
m
o
n
g
PLWHA
with
lo
w
s
o
cial
s
u
p
p
o
r
t f
r
o
m
f
ello
w
PLWHA,
th
e
s
tr
en
g
t
h
o
f
th
e
r
o
le
o
f
h
ea
lth
liter
ac
y
o
n
HI
V
/AI
DS in
ad
h
er
en
ce
to
AR
V
tr
ea
tm
en
t
is
h
ig
h
e
r
co
m
p
ar
ed
to
t
h
o
s
e
wh
o
r
ec
ei
v
e
m
o
d
er
ate
o
r
h
i
g
h
s
o
cial
s
u
p
p
o
r
t
f
r
o
m
f
ello
w
PLWHA.
T
ab
le
1
.
T
h
e
r
esu
lts
o
f
th
e
m
o
d
er
ato
r
a
n
aly
s
is
V
a
r
i
a
b
l
e
Est
i
m
a
t
e
M
o
d
e
r
a
t
e
e
st
i
mat
e
p
H
e
a
l
t
h
l
i
t
e
r
a
c
y
o
n
H
I
V
/
A
I
D
S
0
.
1
0
3
<
0
.
0
0
1
S
o
c
i
a
l
su
p
p
o
r
t
f
r
o
m
f
e
l
l
o
w
P
LWH
A
0
.
1
3
9
<
0
.
0
0
1
H
e
a
l
t
h
l
i
t
e
r
a
c
y
o
n
H
I
V
/
A
I
D
S
*
S
o
c
i
a
l
su
p
p
o
r
t
f
r
o
m
f
e
l
l
o
w
P
LWH
A
-
0
.
0
0
4
0
.
0
1
7
T
ab
le
2
.
T
h
e
r
esu
lts
o
f
th
e
s
im
p
le
s
lo
p
e
an
aly
s
is
Le
v
e
l
o
f
s
o
c
i
a
l
su
p
p
o
r
t
Est
i
m
a
t
e
p
Lo
w
0
.
1
2
8
<
0
.
0
0
1
M
o
d
e
r
a
t
e
0
.
1
0
3
<
0
.
0
0
1
H
i
g
h
0
.
0
7
9
<
0
.
0
0
1
Fig
u
r
e
1
.
Simp
le
s
lo
p
e
p
lo
t
T
h
e
an
aly
s
is
r
esu
lts
d
em
o
n
s
tr
ate
th
at
HI
V/AI
DS
h
ea
lth
liter
ac
y
p
lay
s
a
s
ig
n
if
ican
tly
p
o
s
itiv
e
r
o
le
i
n
AR
V
th
er
ap
y
.
T
h
is
f
in
d
in
g
co
n
f
ir
m
s
th
at
h
ig
h
e
r
lev
els
o
f
HI
V/AI
DS
h
ea
lth
liter
ac
y
am
o
n
g
PLWHA
co
r
r
esp
o
n
d
to
b
etter
ad
h
er
e
n
ce
to
AR
V
tr
ea
tm
en
t,
wh
ile
lo
wer
liter
ac
y
lev
els
ar
e
as
s
o
ciate
d
with
p
o
o
r
er
ad
h
er
en
ce
.
Hea
lth
liter
ac
y
p
e
r
tain
s
to
an
in
d
iv
i
d
u
al'
s
ab
ilit
y
to
m
ak
e
i
n
f
o
r
m
ed
d
ec
is
io
n
s
r
eg
ar
d
in
g
h
ea
lth
-
r
elate
d
ac
tio
n
s
[
3
4
]
.
Fu
n
ctio
n
al
h
ea
lth
liter
ac
y
is
d
ef
in
ed
as
th
e
co
g
n
itiv
e
ca
p
ac
ity
t
o
co
m
p
r
eh
en
d
,
in
te
r
p
r
et,
an
d
ap
p
ly
b
o
th
wr
itten
an
d
v
er
b
al
h
ea
lth
in
f
o
r
m
atio
n
.
C
o
n
s
eq
u
en
tly
,
in
d
iv
id
u
als
with
ad
eq
u
ate
liter
ac
y
s
k
ills
ten
d
to
ex
p
er
ien
ce
m
o
r
e
f
av
o
r
ab
le
h
ea
lth
o
u
tco
m
es
co
m
p
ar
e
d
to
th
o
s
e
with
lim
ited
liter
ac
y
[
1
3
]
.
Pre
v
io
u
s
r
esear
ch
also
h
ig
h
lig
h
ts
th
at
en
h
an
cin
g
h
ea
lth
liter
ac
y
am
o
n
g
PLWHA
th
r
o
u
g
h
o
n
lin
e
s
o
cial
n
etwo
r
k
s
m
o
tiv
ates
th
em
to
en
g
a
g
e
ac
tiv
ely
with
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
d
u
r
in
g
c
o
n
s
u
ltatio
n
s
,
f
o
llo
w
m
ed
ical
ad
v
ice,
im
p
r
o
v
e
ad
h
e
r
en
ce
to
tr
ea
tm
e
n
t
p
lan
s
,
an
d
r
ed
u
ce
an
x
iety
th
r
o
u
g
h
s
u
p
p
o
r
t
g
r
o
u
p
d
is
cu
s
s
io
n
s
[
2
3
]
.
Hea
lth
liter
ac
y
is
a
cr
i
tical
d
r
iv
er
o
f
p
o
s
itiv
e
p
atie
n
t
o
u
tco
m
es
[
3
5
]
.
T
h
ese
f
in
d
in
g
s
r
ein
f
o
r
ce
th
e
ev
id
en
ce
th
at
h
ea
lth
liter
ac
y
c
an
p
r
o
m
o
te
a
d
h
er
e
n
ce
to
t
r
ea
tm
en
t
r
eg
im
e
n
s
an
d
im
p
r
o
v
e
t
h
e
q
u
ality
o
f
life
f
o
r
PLWHA.
PLWHA
with
s
tr
o
n
g
HI
V/AI
DS
h
ea
lth
liter
ac
y
u
n
d
e
r
s
tan
d
th
e
im
p
o
r
tan
ce
o
f
AR
V
th
er
ap
y
i
n
co
n
tr
o
llin
g
v
ir
al
l
o
ad
a
n
d
r
ec
o
g
n
ize
th
e
b
en
ef
its
o
f
ad
h
er
en
c
e
in
p
r
o
lo
n
g
in
g
life
an
d
en
h
an
cin
g
q
u
ality
o
f
life
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
6
5
8
-
1
6
6
5
1662
T
h
is
u
n
d
er
s
tan
d
in
g
b
o
o
s
ts
m
o
tiv
atio
n
an
d
s
elf
-
awa
r
en
e
s
s
r
eg
ar
d
in
g
p
er
s
o
n
al
r
esp
o
n
s
ib
ilit
y
in
h
ea
lth
m
an
ag
em
en
t.
T
h
e
b
elief
th
a
t
co
n
tin
u
in
g
AR
V
tr
ea
tm
en
t
d
esp
ite
s
id
e
ef
f
ec
ts
co
r
r
ela
tes
p
o
s
itiv
ely
with
ad
h
er
en
ce
[
3
6
]
.
T
h
is
is
co
n
s
is
ten
t w
ith
th
e
Hea
lth
B
elief
Mo
d
el
(
HB
M)
,
wh
ich
p
o
s
its
th
at
b
elief
s
ab
o
u
t h
ea
lth
b
eh
av
io
r
s
ar
e
in
f
l
u
en
ce
d
b
y
v
ar
io
u
s
d
o
m
ain
s
,
in
clu
d
i
n
g
p
er
ce
iv
ed
b
ar
r
ier
s
.
I
n
c
r
ea
s
ed
u
n
d
er
s
tan
d
in
g
im
p
ac
ts
attitu
d
es,
wh
ich
in
tu
r
n
in
f
lu
e
n
ce
b
eh
a
v
io
r
[
3
7
]
.
T
h
is
s
tu
d
y
also
f
o
u
n
d
th
at
s
o
cial
s
u
p
p
o
r
t
f
r
o
m
f
ello
w
PLWH
A
s
ig
n
if
ican
tly
m
o
d
er
ates
th
e
r
elatio
n
s
h
ip
b
etwe
en
HI
V/AI
DS
h
ea
lth
liter
ac
y
a
n
d
AR
V
ad
h
er
e
n
ce
.
HI
V/AI
DS
h
ea
lt
h
liter
ac
y
p
o
s
itiv
ely
af
f
ec
ts
AR
V
ad
h
er
en
ce
ac
r
o
s
s
all
lev
els
o
f
p
ee
r
s
o
cial
s
u
p
p
o
r
t,
b
u
t
its
in
f
lu
en
ce
is
s
tr
o
n
g
est
am
o
n
g
PLWHA
r
ec
eiv
in
g
l
o
w
p
ee
r
s
u
p
p
o
r
t
co
m
p
ar
ed
to
th
o
s
e
with
m
o
d
er
at
e
o
r
h
ig
h
s
u
p
p
o
r
t.
T
h
is
alig
n
s
with
f
in
d
in
g
s
th
at
s
o
cial
s
u
p
p
o
r
t
ca
n
m
o
d
if
y
th
e
s
tr
en
g
th
o
r
d
ir
ec
tio
n
o
f
th
e
r
elatio
n
s
h
ip
b
etwe
en
h
ea
lth
liter
ac
y
an
d
ad
h
er
en
ce
[
3
8
]
.
T
h
e
ef
f
ec
t
o
f
h
ea
lth
liter
ac
y
o
n
ad
h
er
en
ce
v
ar
ies
d
ep
en
d
in
g
o
n
th
e
p
er
ce
i
v
ed
a
v
ailab
ilit
y
an
d
q
u
ality
o
f
s
o
cial
s
u
p
p
o
r
t,
wh
i
ch
en
c
o
m
p
ass
es
b
o
th
q
u
a
n
tity
an
d
q
u
ality
o
f
s
o
cial
co
n
n
ec
t
io
n
s
[
3
8
]
.
Am
o
n
g
PLWHA
w
ith
lo
w
p
ee
r
s
u
p
p
o
r
t,
HI
V/AI
DS
h
ea
lth
liter
a
cy
b
ec
o
m
es
a
cr
itical
f
ac
to
r
d
r
iv
in
g
ad
h
er
e
n
ce
.
T
h
is
s
itu
atio
n
f
o
s
ter
s
s
elf
-
r
elian
ce
in
h
ea
lth
m
a
n
ag
em
e
n
t,
en
co
u
r
a
g
in
g
in
d
iv
id
u
als
to
f
o
llo
w
h
ea
lth
ca
r
e
in
s
tr
u
ctio
n
s
an
d
p
r
o
ac
tiv
ely
s
ee
k
in
f
o
r
m
atio
n
to
im
p
r
o
v
e
t
h
eir
h
ea
lth
liter
ac
y
.
R
esear
ch
s
h
o
ws
th
at
6
0
%
o
f
PLWHA
with
co
m
p
r
eh
en
s
iv
e
k
n
o
wled
g
e
ab
o
u
t
tr
an
s
m
is
s
io
n
,
ca
r
e,
an
d
tr
ea
tm
en
t
r
ec
eiv
e
lo
w
s
o
cia
l
s
u
p
p
o
r
t
s
u
p
p
o
r
t [
3
8
]
.
T
h
e
in
f
lu
en
ce
o
f
HI
V/AI
DS
h
ea
lth
liter
ac
y
o
n
ad
h
er
e
n
ce
is
les
s
p
r
o
n
o
u
n
ce
d
am
o
n
g
PLWHA
w
ith
m
o
d
er
ate
o
r
h
ig
h
p
ee
r
s
u
p
p
o
r
t
.
T
h
o
s
e
r
ec
eiv
in
g
s
u
f
f
icien
t
p
ee
r
s
u
p
p
o
r
t
b
en
e
f
it
f
r
o
m
p
r
o
b
l
em
-
s
o
lv
in
g
ad
v
ice,
in
f
o
r
m
atio
n
o
n
HI
V/AI
DS
a
n
d
AR
V
tr
ea
tm
en
t,
an
d
em
o
tio
n
al
en
co
u
r
ag
e
m
en
t.
C
o
n
s
eq
u
en
tly
,
th
e
d
ir
ec
t
ef
f
ec
t
o
f
h
ea
lth
liter
ac
y
o
n
ad
h
er
en
ce
is
d
im
in
is
h
e
d
b
ec
au
s
e
s
o
cial
s
u
p
p
o
r
t
its
elf
s
ig
n
if
ican
tly
p
r
o
m
o
tes
a
d
h
er
en
c
e.
Fam
ily
m
em
b
er
s
,
r
elativ
es,
a
n
d
f
r
ien
d
s
ar
e
o
f
ten
p
r
im
a
r
y
c
o
n
s
u
ltatio
n
s
o
u
r
ce
s
f
o
r
h
ea
lth
is
s
u
es,
an
d
th
eir
s
u
p
p
o
r
t o
f
f
er
s
p
r
o
tectiv
e
ef
f
ec
ts
o
n
h
ea
lth
b
eh
av
io
r
s
[
2
2
]
.
Pra
ctica
l
s
o
cia
l
s
u
p
p
o
r
t
f
r
o
m
p
ee
r
s
is
a
s
tr
o
n
g
f
ac
to
r
i
n
im
p
r
o
v
in
g
AR
V
ad
h
er
en
ce
,
r
ed
u
cin
g
th
e
d
ir
ec
t
im
p
ac
t
o
f
h
ea
lth
liter
ac
y
o
n
ad
h
er
en
ce
[
3
9
]
.
T
h
e
av
ailab
ilit
y
o
f
s
o
cial
s
u
p
p
o
r
t
an
d
r
eso
u
r
ce
s
is
esp
ec
ially
cr
u
cial
f
o
r
in
d
iv
id
u
als
with
lo
w
liter
ac
y
to
f
ac
ilit
ate
th
e
d
ev
elo
p
m
en
t
o
f
h
ea
lth
y
attitu
d
es
an
d
b
eh
a
v
io
r
s
,
en
h
an
ce
h
ea
lth
ca
r
e
ac
ce
s
s
,
im
p
r
o
v
e
h
ea
lth
s
tatu
s
,
an
d
r
ed
u
ce
co
s
tly
ca
r
e
[
2
2
]
.
Ho
wev
er
,
s
o
cial
s
u
p
p
o
r
t
alo
n
e
d
o
es
n
o
t
n
ec
ess
ar
ily
in
cr
ea
s
e
liter
ac
y
s
k
ills
[
2
2
]
.
I
n
s
tead
,
s
o
cial
s
u
p
p
o
r
t
s
er
v
es
as
a
b
u
f
f
er
ag
ai
n
s
t
th
e
n
eg
ativ
e
ef
f
ec
ts
o
f
li
m
ited
h
ea
lth
liter
ac
y
,
with
its
im
p
ac
t m
o
r
e
ev
id
e
n
t a
m
o
n
g
i
n
d
iv
id
u
als with
lo
wer
liter
ac
y
[
2
2
]
.
L
o
w
h
ea
lth
liter
a
cy
is
ass
o
ciate
d
with
p
o
o
r
m
e
d
icatio
n
ad
h
e
r
en
ce
[
3
8
]
,
a
n
d
o
ld
er
a
d
u
lts
with
lim
ited
liter
ac
y
f
ac
e
h
ig
h
er
m
o
r
tality
r
is
k
s
[
3
8
]
.
PLWHA
with
lo
w
h
ea
lth
liter
ac
y
ten
d
to
m
is
u
s
e
o
r
n
eg
lect
AR
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tr
ea
tm
en
t,
ad
v
er
s
ely
af
f
ec
tin
g
th
eir
h
ea
lth
o
u
tco
m
es
[
1
3
]
,
[
3
4
]
,
[
3
6
]
.
Hea
lth
liter
ac
y
in
v
o
lv
es
th
e
s
k
ills
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ee
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ed
to
m
a
k
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in
f
o
r
m
ed
h
ea
l
th
-
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elate
d
d
ec
is
io
n
s
[
3
4
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an
d
i
s
a
v
ital
d
r
iv
er
o
f
p
o
s
itiv
e
p
ati
en
t
o
u
tco
m
es
[
3
5
]
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Fu
n
ctio
n
al
h
ea
lth
liter
ac
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d
escr
ib
es
th
e
co
g
n
itiv
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ac
ity
to
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n
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er
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tan
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ter
p
r
et,
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d
ap
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ly
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ea
lth
in
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o
r
m
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n
,
wh
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e
h
ig
h
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r
liter
ac
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co
r
r
elate
s
with
b
etter
h
ea
lth
co
n
d
itio
n
s
[
1
3
]
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T
h
ese
f
in
d
in
g
s
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ig
h
lig
h
t
th
e
n
ee
d
f
o
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ta
r
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eted
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n
ter
v
en
tio
n
s
f
o
r
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s
o
cia
l
s
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p
p
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r
t.
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m
m
u
n
ity
-
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ased
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u
ca
tio
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al
p
r
o
g
r
am
s
ca
n
im
p
r
o
v
e
HI
V/AI
DS
h
ea
lth
l
iter
ac
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an
d
AR
V
ad
h
er
en
ce
b
y
em
p
h
asizin
g
tr
ea
tm
en
t
b
en
ef
its
,
r
is
k
s
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f
d
is
co
n
tin
u
atio
n
,
an
d
p
r
o
p
e
r
m
ed
icatio
n
u
s
e.
Ad
d
itio
n
ally
,
h
ea
lth
ca
r
e
p
r
o
v
id
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s
ca
n
im
p
lem
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ig
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m
in
d
er
s
y
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tem
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o
r
h
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wo
r
k
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co
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p
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n
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to
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lar
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ef
f
o
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ts
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r
PLWHA
with
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h
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s
u
p
p
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r
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to
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h
an
ce
h
ea
lth
liter
ac
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an
d
em
p
o
wer
p
ee
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s
u
p
p
o
r
t
g
r
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p
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r
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o
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s
is
ten
t
g
u
id
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r
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with
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o
w
s
u
p
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r
t
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e
n
o
t
p
ar
t
o
f
p
ee
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g
r
o
u
p
s
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th
e
g
o
v
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n
m
e
n
t
an
d
NGOs
co
u
ld
f
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ate
th
e
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m
atio
n
o
f
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ew
s
u
p
p
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t
g
r
o
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p
s
o
r
p
r
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v
i
d
e
p
er
s
o
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alize
d
co
u
n
s
elin
g
t
o
tailo
r
s
tr
ateg
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ac
co
r
d
in
g
to
v
a
r
y
in
g
s
o
cial
s
u
p
p
o
r
t le
v
els.
T
h
is
s
tu
d
y
h
as
s
ev
er
al
lim
itatio
n
s
,
in
clu
d
in
g
d
ata
co
llectio
n
s
tr
ateg
ies
f
o
cu
s
in
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ly
o
n
h
o
s
p
itals
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h
o
ts
p
o
ts
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PLWHA
h
o
m
es,
th
er
eb
y
ex
cl
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d
in
g
th
o
s
e
lo
s
t
to
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llo
w
-
u
p
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Mo
r
e
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v
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n
u
m
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u
s
f
ac
to
r
s
b
ey
o
n
d
p
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p
p
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r
t,
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ch
as
s
u
p
p
o
r
t
f
r
o
m
f
am
ily
,
n
o
n
-
PLWHA
f
r
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d
s
,
co
m
m
u
n
it
y
,
an
d
g
o
v
er
n
m
en
t,
m
ay
also
in
f
lu
en
ce
AR
V
ad
h
er
en
ce
.
T
h
er
e
f
o
r
e,
f
u
t
u
r
e
r
ese
ar
ch
s
h
o
u
ld
ex
p
lo
r
e
ad
d
itio
n
a
l
f
ac
to
r
s
af
f
ec
tin
g
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er
en
ce
am
o
n
g
PLWHA
n
o
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d
r
ess
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in
th
is
s
tu
d
y
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d
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clu
d
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in
d
iv
id
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als
lo
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to
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ll
o
w
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u
p
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E
x
p
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llectio
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to
d
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s
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ettin
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ce
th
e
g
e
n
er
aliza
b
ilit
y
o
f
f
in
d
in
g
s
.
4.
CO
NCLU
SI
O
N
T
h
e
f
in
d
in
g
s
in
d
ic
at
e
th
at
HI
V/
AI
DS
h
ea
lth
l
it
er
a
cy
p
l
ay
s
a
cr
u
ci
al
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d
p
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s
i
t
iv
e
r
o
le
in
p
r
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m
o
t
in
g
A
R
V
th
er
ap
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Sp
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PL
W
HA
wh
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p
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s
e
s
s
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ig
h
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l
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ter
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Ad
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th
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