Determinants of HIV Risk among Female Bar Workers in the Philippines: Do Social and Structural Relationships Matter?

HIV continues to rise in developing countries. Although evidence shows that the consistent and correct use of condoms reduces HIV transmission (Fishbein, 1998), previous studies only partially explain the variance in condom use behavior (Morisky, et al, 2002). The predictors of condom use among female bar workers in the Philippines are explored, using the Theory of Planned Behavior (Azjen,1991), political economy and institutional theory, and added constructs that explains how perceived control (over internal and external factors) influences behavior.

Methods: Key informant interviews at national and city government levels, clinics, non-government organizations, and focus groups with female bar workers are conducted. Next, 400 randomly sampled female bar workers and their managers from 20 entertainment establishments across two cities are interviewed, using structured surveys. Measures include condom use, attitudinal and social support scales, with added measures of structural policy, peer and manager support, and partner communication. Qualitative key informant and focus group data are presented with multiple regression analyses from surveys. Hierarchical Linear Modeling is used as appropriate for individuals nested within organizations.

Results: Female bar workers with higher perceived control over condom use or risk behavior are more likely to receive social and structural support to use condoms and to engage in low risk behaviors than female bar workers with lower perceived control.

Conclusions: The political economy supports reinforcement and compliance to City AIDS ordinances in the Philippines, but challenges remain. Social and structural factors contribute to high risk behaviors at the establishment level.