Age group-based patterns of sexual activity, condom use and acceptability of HIV preventive measures among Filipino males. Who are most at risk?
Scientific Essay 2016 13 Pages
Current HIV prevention programs in the Philippines have given only some attention to the general adult male population, despite evidence showing that this demographic sector is non-monolithic in terms of their sexual behavior. This report discusses sexual activity, condom use, and acceptability of the most effective HIV preventive measures among population-based Filipino males in order to provide evidence of their HIV risk and of the need for programmatic attention. Data were drawn from a representative sample survey of 3,615 Filipino males aged 15-24, 25-34 and 35-44. Having had sexual experience and being sexually active in primarily heterosexual relationships were markedly common among the respondents, but condom use was uncommon among the group. Except for sexual abstinence, the most effective preventive measures against HIV were all acceptable among high proportions of the respondents. The youngest respondents were the age group that was most at risk for HIV, because of their sexual risk-taking practices. The HIV/AIDS Prevention Program in the Philippines has to bestow attention to population-based Filipino males. Greater attention should be given to those aged 15-24, who should be educated about the risks and consequences of having varied sexual intercourse events and about adopting the most effective preventive measures against HIV.
KEYWORDS: sexual activity, condom use, HIV preventive measures, Filipino males, Philippines
Within the past few years, the Philippines has been seeing its new cases of HIV infections rising to alarmingly high levels. At present, the country is recording more than a dozen new infections of HIV each day compared to less than one infection each day in some distant past. These new HIV cases involve mostly Filipino males-who-have-sex-with-males from the younger age category (UNAIDS, 2013). By 2015, the country’s total number of HIV infections is estimated to increase to about 40,000 (Philippine National AIDS Council, 2011). The government continues to strengthen its control and prevention program in order to avert these burgeoning cases of HIV infection among the Filipino population.
The adult male population has formed part of the target groups of the HIV/AIDS Prevention Program in the Philippines. This is due in large part to the active roles that the adult Filipino males assume in sexual relationships (Lee & Dodson, 1998). Some of these roles, or practices, such as being sexually experienced and being sexually active, having multiple and a variety of sexual partners and not using condoms, are of particular interest to the HIV/AIDS Prevention Program, because these major factors help drive the propensity of males to acquire and transmit HIV. The Program continually seeks for systematic data on sexual and preventive behaviors in order to develop programmatic strategies for reducing the HIV risk of Filipino males.
Much of the programmatic attention on HIV/AIDS in the Philippines pivots around the so-called “high-risk groups”, such as males-who-have-sex-with-males (USAID, 2012). Little, if any in terms of research and intervention, is bestowed to the general Filipino male population (Lucea et al., 2013), albeit there had been a prior call for studies to zero-in on this demographic sector (Philippine National AIDS Council, 1999). The neglect is marked in spite of the fact that the general male population is not necessarily a monolith (Lee & Dodson, 1998). That is, a large number of them may be sexually experienced and sexually active, and more importantly, may be engaging in high-risk sexual behaviors. Data from other countries suggest that there is reason to cast attention to the general or population-based males, because some of their sexual behaviors are in fact risky. For instance, in Denmark, among the population-based males aged 18-45, 69.6% were reported as sexually experienced, 9.8% as sexually active, and 11.3% were indicated to have had sexual intercourse with commercial sex workers (Buttmann et al., 2011). In Malta, among the population-based males aged 16-40, 82.0% were found to be sexually experienced. Although less than 30% were sexually active, only 31.5% had used a condom during their last sexual intercourse (Ministry of Health, 2013). In Jamaica (HOPE Caribbean, 2012) and the Cook Islands (Tamarua, Tangaroa & O’Leary, n.d.), their general male populations aged 15-49 were observed to have also exhibited similar patterns of risky sexual behaviors.
Using findings from a re-analyzed data set, this report describes the general population of Filipino males in terms of their sexual activity and condom use, and their acceptability of the most effective HIV preventive measures. The intent is to highlight the HIV risk that some Filipino males within the general population face and the need for the local HIV/AIDS Prevention Program to also focus on this group, particularly the most vulnerable.
Relative to other research reports, the present report differs in two major respects. Apart from describing the sexual activity and condom use in Filipino males, the current report also describes the group’s acceptability of the most efficacious preventive measures against HIV. The acceptability of HIV preventive measures is hardly a familiar topic in prior sex studies involving males. Typically, males are asked in studies about their knowledge and use of specific HIV preventive measures; seldom have males been asked whether these preventive measures are acceptable to them. It is important to know about the extent of the acceptability of HIV preventive measures in the male population, since acceptability—as an attitudinal foundation—influences one’s consideration, and subsequently, adoption of any preventive measures.
Two, the current report describes sexual activity, condom use and acceptability of the most effective HIV preventive measures in Filipino males, using age category as an analytical framework. As a robust marker of one’s physical, cognitive, psychological and social development, and as both a subject and an object of socio-cultural norms and expectations, age would strongly define one’s predispositions to engage in certain sexual practices and to evaluate a given set of HIV preventive measures. The three age categories used, which were estimated to guide behaviors and attitudes related to sexual and preventive behaviors variations in the general male population, owing to normative age-graded developments and social roles, were 15-24, 25-34 and 35-44. Broadly speaking, the 15-24 Filipino males are senior high school or university students, or those who are in the formative phase of their career. The 25-34 Filipino males are usually fathers who are building a stable career for their family. The 35-44 Filipino males are generally established insofar as their personal, professional and social lives are concerned.
The re-analyzed data were drawn from a survey, which was carried out in three key Philippine cities of Quezon, Cebu and Davao, involving a representative sample of 3,615 Filipino males. These males were categorized in the survey and in this re-analysis into three age groups as follows: 15-24 (n=960), 25-34 (n=960), and 35-44 (n=1695). Respondents were recruited for the survey using a two-stage cluster sampling design. In this sampling, the village served as the primary sampling cluster while the household was the second and final sampling cluster. A total of 125 randomly-selected villages in the three aforementioned cities were surveyed. In each sampled village, households and one eligible respondent in every household were randomly chosen. Trained male researchers performed the tasks of selecting and interviewing respondents.
The survey covered 103 questions on marriage and partnerships, sexual behavior, condom use, sexually transmitted infections, HIV/AIDS including preventive behaviors, and exposure to interventions. For the purpose of this report, 14 original or recoded dichotomous variables—six core variables on sexual activity, two core variables on condom use, and six core variables on the most effective HIV preventive measures—were analyzed.
The Statistical Package for the Social Sciences Version 20 was used to process and analyze the data in two steps. Using frequencies, the re-analysis first determined the patterns of sexual activity, condom use and acceptability of the most effective HIV preventive measures among Filipino males. Using p values, the re-analysis then determined if sexual activity, condom use and acceptability of the most effective HIV preventive measures statistically significantly differed across the three age groups of respondents.
Respondents were either high school or college educated. Most were Roman Catholic. About six of every 10 of them were employed, most of whom were non-professional workers (e.g., in service and manufacturing) earning a monthly income of US$270 on average.
In their lifetime, most of the 3,615 respondents (84.1%) were found to have had sexual experience (Table 1). In the past 12 months prior to their interview, two-thirds were sexually active. Nearly all of the sexually active (98.4%) had vaginal intercourse, while a small number of them (1.6%) had anal intercourse, or both vaginal and anal intercourse. Of every 10 sexual intercourse events that respondents had in the past 12 months, about 9 (92.8%) were unpaid sex while about 1 (7.2%) were paid sex.
Respondents were asked about their most recent sexual partner. Almost all (97.4%) reported that they knew their most recent sexual partner well; in contrast, 2.6% claimed to have a limited knowledge of their most recent partner.
Of the six variables on sexual activity, five were found to be strongly statistically associated with age category (Table 1). These variables were lifetime sexual experience (p=0.00), sexual activity in the past 12 months (p=0.00), type of sex in the past 12 months (p=0.00), if sex was paid in the past 12 months (p=0.00), and if respondents knew their most recent sexual partner well (p=0.00). The sex category of most recent sexual partner was not statistically significantly related with the independent variable (p=0.25).
The foregoing statistical results suggest that the older age groups were more likely to be sexually experienced and to be sexually active. The youngest respondents (15-24) were more likely to engage in anal sex or in both anal and vaginal sex than their older counterparts (3.7% versus 2.4% for 25-34 and 0.8% for 35-44). Furthermore, the younger respondents, 15-24 (15.2%) and 25-34 (9.2%), were more inclined to have paid sex than the 35-44-year-olds (4.3%). The youngest, or the 15-24 respondents, were similarly found to be the ones more likely to not know their most recent sexual partner well (10.7% against 1.2%-1.6% for other groups).
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Significant at p<0.00** and p<0.05*.