Washington D.C., USA, July 2012www.aids2012.org Condom Attitudes of Female Entertainment Workers in Metro Manila, the Philippines: Setting, Peer Influence and Social Support Lianne A. Urada, PhD, MSW, LCSW 1 Steffanie A. Strathdee, PhD 1 Robert F. Schilling, PhD 2 Benilda de Guia 3 Donald E. Morisky, Sc.D., Sc.M., M.S.P.H. 4 1 University of California at San Diego, Division of Global Public Health, Department of Medicine 2 University of California at Los Angeles, Department of Social Welfare 3 PAMAC-Q (Peer Educator's Movement for Empowerment), Philippines 4 University of California at Los Angeles, Department of Community Health Sciences Funded by: T32 DA023356, UC Pacific Rim Research Program, UCLA International Institute

HIV in the Philippines HIV increased 3-fold among Female Sex Workers (2007 to 2010). Quezon City = largest suburb of Metro Manila (48% of HIV cases) 1 of 7 countries with a ≥ 25% increase in new cases in 2011 (UNAIDS, 2011).

Quezon City Requirements for Female Bar/Spa Workers: Health certificates HIV/AIDS seminars Weekly STI exams...is not legalized. However, Sex Work in the Philippines

Washington D.C., USA, July 2012www.aids2012.org Objective/Hypotheses  To assess individual, social, and physical risk environment factors associated with condom attitudes among female bar/spa workers in Quezon City, Metro Manila. Hypotheses: More positive condom attitudes are associated with: 1)Peer and manager support for condom use 2)Social support

Methods Sampling, Recruitment  Bar/night club, spa/sauna, karaoke bars stratified by size and type.  Modified time-location sampling of individuals at venue/clinic: all interviewed (smaller venues with ≤10 workers) or else randomly sampled. Data collection: Interviews  Trained local NGO peer educators as interviewers.  Interviewer-administered surveys with female bar/ spa workers (N=498) from 54 venues in Quezon City, Metro Manila ( ).

MeasuresDefinition Condom Attitudes Scale *  10-items (1-strongly agree, 5-strongly disagree) Max. possible score: 50 Drug use  How often do you take drugs (0-never, 5-always) General Social Support  Emotional, Tangible, Functional (0-not at all, 4-great deal) Max. possible score: 196 (Norbeck, 1984) Manager Support for condom use* (Yes/No)  (condom use with venue guests) Peer Support for condom use (Co-worker)* (Yes/No)  Ever discussed STI/HIV prevention  Ever tried to convince worker to use condoms with venue guests  Used condom when having sex with venue patron due to co-worker’s advice Venue Policy* (Yes/No)  Condom use rule  Condom availability for workers *Adapted from Morisky et al (2002)

Washington D.C., USA, July 2012www.aids2012.org Statistical Analysis  Data analysis restricted to those having sex past 6 months (N= 356).  Hierarchical Linear Regression, adjusted for age, education, and individuals nested within venues.  Tested for plausible 2-way interactions.

Characteristic%, Median/IQR Individual Age (median years/IQR)22 (20-26) Education (years) (H.S. diploma=10 th grade)10 (9-11) Months worked as bar/spa worker14 (8-32) Drug use (current) (e.g. Methamphetamines)10 Alcohol use (daily)15 Consistent condom use45 Knowledge of AIDS (1-none to 5-great deal)2 (2-4) Social Risk Environment Peer support (co-workers) for condom use1 (0-3) Manager support for condom use25 General social support (not for HIV/STI prevention)79 (53-101) Physical Risk Environment Venue type - Night club/bar Spa/sauna Karaoke bar Condom rule at venue29 Condom availability at venue32 Results: Socio-Behavioral Demographics, N=356*

Condom Attitudes (N=356) %

Factors Significantly Associated with More Positive Condom Attitudes, Female Bar/Spa Workers in the Philippines (N= 356) Model 1Model 2 Beta95% Confidence Intervals Beta95% Confidence Intervals Individual Drug use (inverse association) , , Physical Risk Environment Work in spa/saunas vs. night club/bars , , 2.56 Social Risk Environment Peer support (co-workers) for condom use , Manager support for condom use , 1.33 General social support , 0.01 (Interaction) General social support x Manager support for condoms , 0.05 * Hierarchical Linear Regression, adjusted for individuals nested within venues, age, education

Model 2. Predicted Condom Attitudes for the Average Female Bar/Spa Worker Note: Data were centered by subtracting the mean value

Washington D.C., USA, July 2012www.aids2012.org Limitations  Self-reported data  Cross-sectional design  Potential recall bias for measures without specific time frames  Generalizability limited to venues/individuals who agreed to participate in Quezon City (20% refused)

Individual  Drug use was negatively associated with condom attitudes & needs further exploration for female bar/ spa workers. Physical Risk Environment  Night club/bar workers had poorer condom attitudes than spa workers, suggesting additional intervention is needed. Social Risk Environment  Buy-in from co-workers of condom use is critical.  Efforts needed to increase social support for sex workers and manager support for condom use. Conclusions

Washington D.C., USA, July 2012www.aids2012.org Implications- Next Steps Social support must be bolstered (e.g. collective action/ community mobilization) Remove macro-level structural barriers to condom use (e.g., religious opposition, funding)

Acknowledgements Salamat po! Philippines Team:  Benilda de Guia, Jay Caparida, & Junelyn Tabelin, Philippine Rural Reconstruction Movement, Inc., & PAMACQ (Peer Educator's Movement for Empowerment Pasay, Manila, Caloocan & Quezon City), with Ms. Joy Ferriols-Pavico, Center for Environment and Sustainable Development Foundation, Inc. (CESD)  Professor Laufred I. Hernandez, University of the Philippines Manila  Dr. Nymia Pimentel-Simbulan, University of the Philippines Manila Funding Support:  NIDA (Strathdee T32 DA023356)  University of California’s Pacific Rim Research Program  UCLA International Institute  UCLA Graduate Div. to Community Health Science Dept’s Doctoral Training in the Social & Behavioral Determinants of HIV/AIDS Prevention (Morisky) Special Thanks: Abby Rudolph, Ph.D., Tommi Gaines, Ph.D., UCSD, & the research participants!

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