Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA.
BMJ Glob Health. 2020 Jul;5(7). doi: 10.1136/bmjgh-2020-002463.
Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels.
Between June 2018 and August 2019, we conducted a cross-sectional online study with 318 trans-WSM and cis-MSM respondents from Manila and Cebu cities. Structural equational modelling procedures were performed to determine direct, indirect and overall effects between condom use and latent variables across multiple socioecological levels: personal (ie, condom self-efficacy), social (ie, social capital), environmental (ie, barriers to condom and HIV services) and structural (ie, structural violence, antidiscrimination policies).
Adjusted for gender, age, location and income, our model showed that: (1) all latent variables at the structural and environmental levels were significantly positively associated with each other (all ps<0.05); (2) barriers to condom and HIV services were significantly negatively associated with social capital (p<0.001) as well as condom self-efficacy (p<0.001); and (3) there were significantly positive associations between social capital and condom self-efficacy (p<0.001), and between condom self-efficacy and condom use (p<0.001). Moreover, social capital and condom self-efficacy fully mediated and buffered the negative effects between environmental and structural barriers and condom use.
This is the first known study pointing to multiple relationships and pathways across multiple socioecological levels that can potentially be leveraged for future interventions aimed at improving condom use among Filipinx trans-WSM and cis-MSM. Such interventions should be multicomponent and build and/or strengthen social capital and condom self-efficacy, as well as intentionally target prominent structural and environmental barriers to condom use.
在菲律宾，艾滋病毒最近成为国家公共卫生危机，跨性别女性和与男性发生性关系的顺性别男性（分别为跨性别女性和顺性别男性）发生无保护性行为的风险受到多个层面的各种风险因素的影响和加剧。
在 2018 年 6 月至 2019 年 8 月期间，我们对来自马尼拉和宿务市的 318 名跨性别女性和顺性别男性进行了一项横断面在线研究。采用结构方程模型程序确定了多个社会生态学层面上的 condom 使用与潜在变量之间的直接、间接和总体影响：个人层面（即 condom 自我效能）、社会层面（即社会资本）、环境层面（即 condom 和 HIV 服务障碍）和结构层面（即结构暴力、反歧视政策）。
在调整了性别、年龄、地点和收入因素后，我们的模型表明：（1）结构和环境层面的所有潜在变量均呈显著正相关（均 P<0.05）；（2） condom 和 HIV 服务障碍与社会资本（P<0.001）以及 condom 自我效能（P<0.001）显著负相关；（3）社会资本与 condom 自我效能（P<0.001）以及 condom 自我效能与 condom 使用（P<0.001）之间存在显著正相关。此外，社会资本和 condom 自我效能完全中介和缓冲了环境和结构障碍与 condom 使用之间的负相关关系。
这是首次已知的研究，指出了多个社会生态层面上的多种关系和途径，这些关系和途径可被用于未来旨在提高菲律宾跨性别女性和顺性别男性 condom 使用的干预措施。此类干预措施应是多组分的，建立和/或加强社会资本和 condom 自我效能，并有意针对 condom 使用的突出结构和环境障碍。
