Filipino Men’s Condom Use During Gay Sex: Findings from the 2003 National Demographic and Health Survey

Abstract

Using data from the 2003 National Demographic and Health Survey, this report presents baseline findings on Filipino men’s self-reported condom use during gay sex. A nationally representative sample of N = 4,766 Filipino men ages 15 to 54 indicate that 6.8% of sexually active men had had sex with another man at least once, with a higher proportion among the young adult, 15 to 24 year-old subset (15.5%). Despite prevalent beliefs that condoms could protect against disease, the level of actual condom use during first gay sex was very low (10.1%). Descriptive findings are analyzed using a sexual culture perspective, which points to further sexuality research directions including improved assessment of sexual behaviors and more in-depth investigation of social dynamics and contexts of sex between Filipino men. Filipino Gay Condom Use 3 of 21 Filipino Men’s Condom Use during Gay Sex: Findings from the 2003 National Demographic & Health Survey Sexual culture is the system of practices, meanings, knowledge, beliefs, and symbols that structure sexuality in different social contexts (Parker, Herdt & Carballo, 1991). With the recognition that sex is not simply a “natural” biological fact but a culturally informed experience shaped by subjective and material realities in which we live, the analysis of sexual culture has become a critical task for social scientists, especially those working in the area of sexual health. One approach in the analysis of sexual culture is the empirical description of actual sexual practices in a population. Social, public norms surrounding sexuality may prescribe or proscribe certain forms of sexual expression, but whether these cultural ideals are translated into actual experiences is an empirical question. In this paper, I analyze baseline findings from a nationally representative dataset on one particular aspect of contemporary Filipino sexual culture: condom use or non-use during gay sex among Filipino men. Previous empirical work on condom use as a sexual health behavior has focused only on Filipinos’ experiences of heterosexual sex (e.g., Laguna, 2004; Manalastas, 2005). This report aims to expand our knowledge on Filipino condom use and contribute to a less heterocentric, more inclusive analysis of Filipino sexual health behaviors. Filipino Gay Condom Use 4 of 21 Gay Sex Among Filipino Men Although sexuality is becoming an increasingly popular topic in Filipino social research, relatively less is known about aspects of our sexual culture related to gay identities and sexual behaviors, possibly due to widespread heterosexism in contemporary Filipino society (Manalastas & del Pilar, 2005; Sabo, 2000). In one cross-national survey of 33,590 respondents from 24 countries conducted by the International Social Survey Program, the Philippines was found to be the nation with the most extremely negative views about gay/lesbian sex and other forms of sex outside the context of heterosexual marriage (Widmer, Treas & Newcomb, 1999). In fact, Philippine data were set apart in their cluster analysis, because of a highly uniform negativity toward diverse sexual behaviors, which was not found in other countries. Despite the cultural heteronormative ideals in the Philippines, however, some research reveals a slightly different empirical picture for gay sex among Filipino men. Findings from the third Young Adult Fertility and Sexuality Survey (YAFSS3), for example, show that 15.1% of young sexually active Filipino men report having had sex with other men (Silverio, 2004). One could argue that such survey results are likely to be underreported since the behavior of interest (i.e., sex between men) is negatively viewed and considered sexually transgressive (Catania, Gibson, Chitwood & Coates, 1990). So contrary to traditionalist, heteronormative views of Filipinos and their sexualities, Filipino men have and do engage in sex not solely with women, but with each other. Filipino Gay Condom Use 5 of 21 Condom Use During Gay Sex: Beyond “Contraception” Apart from the scholarly analysis of sexual culture, research into gay sex is also of particular interest to those working in the area of sexual health and HIV/AIDS. Although it is now widely acknowledged that the HIV pandemic is driven largely by heterosexual transmission and is not a “gay disease” as earlier claimed, men who have sex with other men remain to be one of four internationally recognized key populations that may be neglected and therefore at risk for HIV (UNAIDS, 2006). In the Philippines, HIV has been largely heterosexually driven. As of September 2006, the majority of the reported N = 2,655 cases in the National HIV/AIDS Registry has been linked to male-female sex. However, almost a fifth of known HIV cases in the country (N = 497, or 18.7%) indicate “homosexual contact” as the mode of infection, making it the second leading means of HIV transmission among Filipinos. Given that the sexual transmission of HIV between women is extremely rare (CDC, 2006), gay sex appears to be a smaller yet significant locus for the spread of HIV in the context of Filipino sexual culture. While the surest way to avoid the sexual transmission of HIV is to abstain from sex altogether, a number of strategies have been identified to decrease sexually active men’s risk for HIV. One is to engage in behaviors that are known to have a relatively lower probability of HIV transmission, for example, mutual masturbation or oral sex (versus anal intercourse). Another is negotiated safety, when partners in a steady relationship who are both HIV-negative agree to dispense with condoms during sex while negotiating an explicit safety agreement regarding their sexual practices both within and outside their relationship (Kippax et al., 1997). And finally, Filipino Gay Condom Use 6 of 21 perhaps the most well-established strategy for HIV prevention among gay men is the use of condoms during sex. Correct and consistent condom use is considered to be the single most efficient technology to reduce the transmission of HIV and other sexually transmitted infections (UNAIDS, 2004). When used correctly and consistently during gay sex, condoms provide both male partners a significant degree of protection against HIV and a spectrum of other STIs. Condom use is particularly important for men who engage in receptive anal intercourse, a behavior associated with a high risk of HIV infection (Center for HIV Information-UCSF, 2003). The analysis of condom use during gay sex also highlights how some lay people and even researchers have come to view – and indeed, reify – the contraceptive feature of condoms. While biomedical research has indeed shown that condoms are highly effective in preventing unwanted pregnancy, it is incorrect to refer to condoms as contraceptives per se, without considering the specific sexual and relational contexts in which condoms are used (Cooper, Agocha & Powers, 1999). Because pregnancy prevention motivation is not a factor in the use of condoms during gay sex, the examination of condom use (or non-use) among men having sex with other men also serves as reminder for caution about falling into the trap of essentialist, reproduction-centered discourses in the analysis of sexuality.