Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines

Abstract

BackgroundRisks 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.MethodsBetween 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).ResultsAdjusted 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.ConclusionThis 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.

Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition

“…The heterogeneity of results in the IF-based SC and CS-based SC might be attributed to the "mixed" effects. Specifically, for CS-based SC, our study reinforced the evidence that reduction of IH could decrease condomless sex by encouraging community participation and improving government support [26,31]. In contrast to the CSbased SC, however, we observed an adverse trend for IF-based SC, i.e., the risk of condomless sex due to the direct effect of IH increased when IF-based SC was fixed at a higher level.…”

“…As our findings suggested, those with both high SC and IH still had a high risk of condomless sex. These findings provided information on the professions or service providers of the indispensable reduction of psychological problems and minority stress like IH and to improve the family, community, and social support towards MSM to mitigate the impact of IH on condomless sex [15,26,31,67]. Further efforts are needed at civil and political levels to address structural discrimination, establish a supportive environment and strengthen peer support [68,69].…”

“…In the past 20 years, there has been a pronounced increase in studies testing potential roles of social capital in health [23]. Social capital (SC), which was described as a source of support and benefits embodied in interpersonal and social networks [24], may play an essential mediation role between mental health and risky behaviors [25][26][27]. The social capital theory contends that the accumulation of human capital is determined by resources of social relationships [28].…”

A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations

“…The social indicator is the absence of social capital to access condoms and the individual factor is low self-efficacy. 14 Model socioecological contains cognitive factors, especially knowledge. 17 These factors influence LGBT to prevent risky behavior, especially unsafe sex behavior, there by increasing the prevalence of HIV incidence.…”

Transgender-specific developmental milestones and associated experiences of violence, discrimination, and stigma among Filipinx transgender women who are sexually active with men

“…A key aspect of this inquiry is the potential role of structural violence, defined as "avoidable impairment of fundamental human needs" that stops individuals and/or groups from reaching their full potential [8]. Structural violence is one of many factors that perpetuates the marginalization of trans women and, consequently, may be associated with achievement of trans-specific developmental milestones [9]. In the US, some of the structural factors linked to adverse health outcomes among trans women include lack of nondiscriminatory policies across institutional domains (e.g., healthcare, schools, employment), lack of health care insurance coverage for transgender-specific services like hormone therapy, and lack of provider training and education [5,[10][11][12][13].…”