Predictors of Community Engagement Among Men Who Have Sex with Men Living with HIV/AIDS in Taiwan: Implications for International Social Work Practice

Background and Purpose: As medical advancements have resulted in increased longevity for people living with HIV/AIDS (PLWHA), attention has turned to enhancing the engagement of PLWHA in the HIV/AIDS community. The greater involvement of PLWHA (GIPA) principle was declared in 1994, with the aim of encouraging the active participation of PLWHA in determining the scope and delivery of services to best meet their needs. Although GIPA was founded on a global level, implementation of the principle has been understudied in certain contexts. Compared to the abundance of research of community engagement of PLWHA in North America, community engagement of this population has limited empirical support in Taiwan. Understanding this phenomenon in countries such as Taiwan, where an absence of monetary resources for HIV/AIDS services necessitates engagement of PLWHA in offering peer support, advocating, and influencing policy makers, is of key importance to increase engagement and ultimately, to increase quality of life for this population. 

Methods: A cross-sectional, purposive sampling survey was distributed in Mandarin in an urban center of Taiwan. Participants completed questions about their experience of community engagement and associated factors, such as HIV-related internalized stigma, life satisfaction, AIDS knowledge, medication adherence, empowerment, and socio-demographics. Informed consent was obtained. The data were analyzed using multivariate logistic regression, controlling for key socio-demographics. Two dichotomized questions, whether or not the participant engaged in HIV-related community events and whether or not the participant engaged in HIV-related academic events, were operationalized as community engagement outcomes.

Results: A total of 178 participants were recruited from 9 community-based organizations (CBOs) in Taiwan. 65.7% of the participants were from the north of Taiwan, aged 18 to 64 years (M=35.01, SD = 9.84). The time since diagnosis ranged from 8 months to 20 years and the range of CD4 counts was 20 to 1250. 63.5% of participants had ever engaged in HIV-related community events (CE) and 47.8% in HIV-related academic events (AE) in the past year. In multivariate logistic regression, significant predictors of being engaged in HIV-related CE were being a community representative (OR=1.17, CI=1.01-1.36), being involved in a CBO (OR=2.15, CI=1.60-2.90) and increased AIDS knowledge (OR=1.68, CI=1.05-2.67).  In multivariate logistic regression, being engaged in HIV-related AE was associated with less HIV-related internalized stigma(OR=0.97, CI=0.95-1.00).  Participants who were engaged in a CBO had almost double the odds of engaging in HIV-related AE(OR=1.71, CI=1.40-2.08). 

Conclusions and Implications: These results describe what community engagement may look like in an international context. According to these results, CBO’s may offer an entry point for MSM who are living with HIV to participate in both HIV-related community events and HIV-related academic events.  Accurate knowledge of AIDS was a facilitator to community engagement.  Additionally, an important outcome of decreased HIV-related internalized stigma was associated with engagement.  Given the potential of community engagement to strengthen community cohesion and empower PLWHA, social workers engaged as policy makers and practitioners in an international context should accentuate the importance and benefit of community engagement in global settings.