Human Immunodeficiency Virus (HIV) is a type of virus that infects white blood

cells that causes a decrease in human immunity. Acquired Immune Deficiency Syndrome

(AIDS) is a collection of symptoms that arise due to decreased immunity caused by

infection with HIV (Infodatin HIV and AIDS, 2020).

14.640 new HIV cases were reported in Indonesia in October-December 2017, with

the highest percentage of HIV risk factors being risky sexual behaviour with heterosexuals

General Hospital reported that 102 people were positively infected. Meanwhile, in 2017,

the number of people infected with HIV increased by 98 people. Then in 2018, it increased

by 98 people. So, within five years, there were 1.016 people infected with HIV in Karo

Regency. This condition continues to grow the prevalence of being infected with HIV every

year as all regions in Karo Regency contribute to the incidence of HIV/AIDS.

The problems faced by PLWHA are not merely a matter of declining physical

condition, but also the acceptance of negative labels that are socially accepted and various

kinds of discriminatory treatment from the environment, including their families and

surrounding communities (Makmur, 2017). Nostlinger (2015) stated that PLWHA faced

physical disorders due to disease progression and social and emotional disturbances.

Solutions offered to solve the problems experienced by people infected with HIV/AIDS

touch many aspects. They include; (1) increasing self-awareness; (2) preventing an increase

in the number of HIV/AIDS; (3) public or public self-awareness not to isolate PLWHA;

(4) self-awareness to take part in Voluntary Counseling and Testing (VCT) that the

government has provided for people with a high risk of HIV/AIDS infection; and (5) self-

aware to maintain the quality of life of PLWHA to live normally. Interventions carried out

by previous research found that PLWHA giving positive spiritual meaning to their illness

experience has eight times more chances to use adaptive coping strategies compared to

those who negatively give spiritual meaning to their illness experience. These findings can

provide evidence for nurses to facilitate and guide PLWHA in finding spiritual meaning

client's needs are treated spiritually based. Researchers developed an approach based on

the culture of the Karo, that is daliken si telu and tutur si waluh. This cultural approach

points out the communication and attitudes that help each other, be optimistic, be tough

and respect each other so that PLWHA can get good treatment and family support. The

strategy chosen from transcultural nursing is preserving (maintaining) the culture,

negotiating/changing the culture and restructuring or changing the culture or habits that are

detrimental to the health of PLWHA. The fundamental assumption of this theory is the

model that PLWHA, cadres and nurses can use to change behaviour to reduce stigma

against PLWHA. The development of the intervention used the Problem – Analysis – Test

method in this study were as follows: 1) Phase Problem (problem): researchers identified,

the internalised stigmatised behaviour of PLWHA, which was then made a model to solve

it. 2) Analysis stage: the researcher used the data obtained in stage 1 and then analysed and

explained them based on relevant theories, concepts, accurate and up-to-date. The results

of the analysis compiled an initial model and were tested. The model referred to in this

study was a model of Karo culture-sensitive spiritual intervention. 3) Test phase (model

The research procedure began with identifying the subject's problem and then

theoretical analysis to create a model. The model was tested, and finally, a Karo culture-

based spiritual intervention model was implemented to reduce HIV stigma. The data

obtained was qualitative and analysed with the following stages: (1) data reduction aimed

to simplify the data that had been collected. Data reduction was intended to summarise,

for relationships, similarities, or differences (Siyoto & Ali 2015).

Nursing is a profession that is constantly evolving following the development of

science and technology. In its implementation in the field, it is necessary to collaborate

with religious leaders and cadres/congregations as companions of PLWHA to assist and

provide higher quality nursing services. One of the efforts to train nurses, cadres, and

PLWHA is through Spiritual: Religion & Culture, Education and Therapy (SABETH).

SABETH module is needed. Through SABETH, the model can objectively help train

The focus of developing this model was increasing the ability of PLWHA in reducing self-

stigma through a Karo cultural approach. It mainly focused on lowering self-stigma by

strengthening the attitude of the Karo people who are optimistic, tough, confident and

assisted by family support to accept PLWHA with family ties to Dalikan sitelu and family

communication with tutur si waluh. Before starting the training activities, identification of

people living with HIV who had internalised stigma, families who stigmatised and

discriminated against family members was carried out to ensure that the results of this study

were right on target.

The family training activity began with a rewinding on cultural and health

materials, followed by communication with PLWHA in Karo culture. The following

Table 1 shows the 14 themes identified from the qualitative phase I research; five

were for model development and 9 for modelling as a series of models.

Meanwhile, the bivariate statistical test of the quantitative study found a relationship

age, personal stigma, negative self-image stigma, Nurse PAS, religiosity and self-

multivariate modelling. Meanwhile, for frequency variables that had p value > 0.25, namely

education (p=0.985), income (p=0.989), knowledge (p=0.354), and public stigma

(p=0.311) could not proceed the multivariate category.

Furthermore, from the last multivariate model, it can be seen that there is no

variable whose p-value is > 0.05. Thus, the variable exclusion process was completed, and

the results from the multivariate analysis, religiosity, turned out to be significantly related

preventing HIV transmission behaviour by 3.5 times higher than those who do not.

After conducting qualitative and quantitative research in phase 1, Karo culture-

sensitive intervention model was developed. The researcher also integrated several theories

and concepts related to the model. The theories and concepts included the idea of

religiosity, cultural, Karo culture, the concept/theory of interpersonal relations, and social

support. Before testing the model, the researcher consulted the model and module with

experts in nursing care with HIV infection, spiritual experts (religion and culture), Karo

cultural anthropologists, and methodological experts to obtain input on the model and

approval the application of the model.

In detail, the description of the theory and concepts used for model development

Phase 1

Qualitative Results

Themes: 4, 5, 7, 8,

14

Themes:1, 2, 3, 6,

9, 10, 11 , 13

Integrated with the

HIV.), education (theme

4), therapy (theme 8),

the process of

implementing the model

(quantitative results:

Module 1: Karo

Module 2: Karo

culture-sensitive

spiritual

intervention

Quantitative

stigma related to HIV

module for

cadres or

companions of

PLWHA (1, 2, 9)

Module 3: Karo

culture-sensitive

intervention

module for

The culturally sensitive spiritual intervention model involved stages of spiritual

concepts as a means of interaction with PLWHA. This spiritual stage included Karo

religion and culture. PLWHA were accompanied by nurses, religious leaders, cadres, or

PLWHA assistants in its implementation. There were stages of the concept of mentoring

in assisting PLWHA. These assistances included the preparation stage, the negotiation

stage, the enabling or implementation stage, the closing stage (evaluation) and the

supervision stage (Zachary (2005). Assistance techniques were disbursement of

c. The researcher first explained to the GBKP Moderament KPA manager, halfway house