4th International Conference on Reproductive Health and Social Sciences Research August 6th , 2010 Busabongkot Room, Royal River Hotel Bangkok, Thailand
Organizied by Institute for Population and Social Research (IPSR), Mahidol University
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4th International Conference on Reproductive Health and Social Sciences Research August 6th , 2010 Busabongkot Room, Royal River Hotel Bangkok, Thailand
Organizied by Institute for Population and Social Research (IPSR), Mahidol University
Editor : Asst. Prof. Pimonpan Isarabhakdi, Ph.D.
Contents Pages Opening Remarks………….……...…………………………………………….….….....(I) Conference Information……………...………………………………………………….(II) Oral Presentation Schedule…………………………....………………...…...………....(VI)
Proceedings 1)
Effects of Maternal Health Seeking Practices on Pregnancy Outcomes of Nulliparous Adolescent and Adult Mothers in Kanchanaburi Province, Thailand Myitzu Tin Oung (Myanmar)……………………....………………………………………………….……1
2)
Reproductive Health Behaviour of Mother Samin Community In Sumber Village, Blora central Java Yuni Astuti (Indonesia) ………………………….....................………………………………...………12
3)
Postpartum Contraceptive Use in Indonesia: Recent Patterns and Determinants Lina Widyastuti (Indonesia) …………………………………...........…………………………………..18
4)
Factors Influencing Adolescent Sexual Behavior in Indonesia 2007 Yulaecha Padma Ichwanny (Indonesia) ……………………...………………………….….……...…28
5)
Temporary Migration Experience and Contraception Use : A Case Study of Kanchanaburi Demographic Surveillance System (KDSS), Thailand Najeebullah Rafiqi (Afghanistan) ………………………………………………………..……..………40
6)
Ethnicity and Contraceptive Use Among Currently Married Women of Reproductive Age in Lao, PDR Ketmany Chanthakoummane (Laos) ………………………....………………………………..………50
7)
Factors Associated with Contraception Discontinuation in Indonesia Rina Gustiana (Indonesia) ………………………………………………………………..………...……62
8)
How Female Sterilization Plays Its Role in Decreasing Indonesian Total Fertility Rate M.Iqbal Apriansyah (Indonesia) …………….......………………………………………………………72
9)
Risk Behaviors and Unprotected Sex Related to HIV/AIDS Infection Among Men Who Have Sex With Men (MSM) in An Giang Province, Vietnam Nguyen Quang Bao (Vietnam) …………………….....………………………………...………………79
10) Knowledge and Attitudes Towards Sexual Practices Among Unmarried Indonesian Young Adults: A Study From IYARHS 2007 Irmiyanti Kusumastuti (Indonesia) ……………………………………………………………………..93 11) The Factor Affecting Condom Use With Female Sex Workers Among Clients In the Seven Highest HIV/AIDS Prevalence Provinces of Vietnam Nguyen Thi Lan Huong (Vietnam) …………………………………………………………...…..……105 12) Factors Influencing Condom Use Among Injecting Drug Users (IDUs) in Semarang Any Setyawati (Indonesia) ………………………………………………………..…………………….116 13) Impacts of Mass Media Exposure and Language barrier on Comprehensive HIV/AIDS knowledge Among “ Dzao” Ethnic Minority in Yen Bai Province, Vietnam Nguyen Thuy Duong (Vietnam) ……………………………………………………….………….……122 14) Factors Affecting Sexual Risk Behavior Among Injecting Drug Users in Vietnam Vu Van Chieu (Vietnam)……….......……………....…………………………………………………....134
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15) Intention of Sex Workers to visit STIs Clinic in Batangan Health Center, Central Java Shinta Kristianti, Sumarlan (Indonesia) ………………………….....................…………....……..154 16) Factors Affecting HIV Infection Among Injecting Drug Users ( IDUs) In Khan Hoa Province, Vietnam 2008 Truong Tan Minh Vu (Vietnam) …………………………………...........…………………………..…166 17) HIV Related Condom Use Among the Middle Aged Men in Thailand: Evidence from National Sexual Behavior Survey 2006 Narurmol Kingkaew (Thailand) ………………….............…...………………………….….…….....178 18) Factors Related to Sexual Risk Behavior Among Fishermen in Binh Dinh and Binh Thuan Provinces, Vietnam, 2008-2009 Le Xuan Huy (Vietnam) …………………….................…………………………………..……..…….188 19) Factors Affecting Needle Sharing Among Injecting Drug Users in Vietnam Nguyen Huu Tien (Vietnam) ……….............………………....………………………………..……..201 20) HIV/AIDS Related Risk Behaviors Among Male Injecting Drug Users in Son La Province Vietnam Bui Thu Trang (Vietnam) ………………..………………………………………………..………...…..215 21) The Effect of Methadone Maintenance Treatment Program in Improvement Quality of Life for heroin users in Hai Phong, Vietnam Nguyen Thi Thanh Ha (Vietnam) …………….......…………………………………..………………..227 22) The Phenomenon of Student Prostitutes “ Campus Chicken ” in Some Universities in Semarang Ike Putri Setyatama (Indonesia) …………………….....………………………….…...……………..239 23) Unaware Violence: Case Studies of Cyber Bullying in Thai Adolescents Pongkamon Surat (Thailand) ……….........……………………………………………………………246 24) Domestic Violence and Cyber-Bullying Nanthanat Songsiri (Thailnad) ……….....…………………………………………………...…..……253
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Opening Remark 4th International Conference on Reproductive Health and Social Science Research Assoc. Professor Dr. Sureeporn Punpuing Director, Institute for Population and Social Research Mahidol University August 6th, 2010 Distinguished guests, colleagues, IPSR students, professors and students from Diponegoro University, Indonesia, ladies and gentlemen, As the Director of the Institute for Population and Social Research, it is my pleasure to be here for the opening of the 4th International Conference on Reproductive Health and Social Sciences Research. Congratulations and thanks to the Conference’s Organizing Committee and the Committee of International Master Program in Population and Reproductive Health Research. I believe the issue of sexual and reproductive health is a concern to everyone in this room. Despite continuous efforts from many angles we witness a great challenge of sexual and reproductive health. Take a few examples; more than half a million of women around the world die annually from pregnancy and childbirth-related conditions; over 10 million of children under 5 years of age were estimated to die each year; more than 120 million women worldwide who want to prevent pregnancy cannot access contraception; for some 100 to 200 million children and adolescents worldwide, their home are the streets and temporary shelters which pose them to a high risk of sexual and reproductive health problem; and worldwide, over 30 million are suffering from HIV/AIDS. Understanding about social and behavioral aspect of sexual and reproductive health including HIV/AIDS prevention and control remain far below our satisfaction. As social scientists, together we can help unravel the problem. I am hopeful and positive that papers presented at this Conference will in some way contribute to better understanding the issues. I wish the conference every success to achieve the conference’s objectives. Let us now proceed with today’s conference. Thank you.
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4th International Conference on Reproductive Health and Social Sciences Research th
August 6 , 2010 at the Royal River Hotel, Bangkok, Thailand --------------------
1. Rationale This conference is the fourth in a series of annual conferences sponsored by the Institute for Population and Social Research (IPSR), Mahidol University and co-supported by the Population and Social Research Development Foundation. It aims to disseminate results of research in reproductive health and social sciences conducted by researchers and graduate students in this discipline. In addition, the proceedings containing research articles from the conference will be published to help fulfill the requirements of the Commission for Higher Education. 2. Objectives - To disseminate research results in reproductive health and social sciences conducted by researchers and graduate students in this field; - To provide an opportunity for graduate students to bring the benefits of their research to the public; - To enhance research quality. 3. Expected Benefits This conference is held as one mechanism to ensure the quality of graduate study in Thailand. All papers to be presented in this conference will be reviewed by experts in the field. The papers presented can be used as a partial fulfillment for graduation, according to the regulations of the Commission on Higher Education, Ministry of Education. This event also provides an opportunity for researchers and graduate students to share their research with the public and exchange their experiences with other scholars, which will benefit the development of social science and reproductive health research. 4. Organizer Institute for Population and Social Research (IPSR) Mahidol University, Salaya, Nakhon Pathom 73170, Thailand Tel: 662-441-0201 ext. 112, 223 Website: www.ipsr.mahidol.ac.th E-mail:
[email protected],
[email protected]
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Advisory Committee: Emeritus Prof. Boonlert Leoprapai, Ph.D. Assoc. Prof. Bencha Yoddumnern-Attig, Ph.D. Assoc. Prof. Kusol Soonthorndhada, Ph.D. Assoc. Prof. Wathinee Boonchalaksi, Ph.D. Asst. Prof. Aree Jampaklay, Ph.D. Reviewers: Emeritus Prof. Aphichat Chamratrithirong, Ph.D. Emeritus Prof. Suporn Koetsawang, M.D.,Ph.D. F.R.C.O.G. Prof. Pramote Prasartkul, Ph.D. Assoc. Prof. Bencha Yoddumnern-Attig, Ph.D. Assoc. Prof. Varachai Thongthai, Ph.D. Assoc. Prof. Yothin Sawangdee, Ph.D. Assoc.Prof. Uraiwan Kanungsukkasem,Ph.D. Prof. Kathleen Ford, Ph.D. Mr. Philip Guest, Ph.D. Mr. Simon Baker, Ph.D. Mr. John Bryant, Ph.D. Ms. Kerry Richter, Ph.D. Mrs. Aree Prohmmo, Ph.D.
Organizing Committee: Chair:
Asst. Prof. Aree Jampaklay, Ph.D.
Committee: Assoc. Prof. Orapin Pitakmahaket, Ph.D. Asst. Prof. Pimonpan Isarabhakdi, Ph.D. Asst. Prof. Dr. Panee Vong-ek, Ph.D. Lect. Charamporn Holumyong, Ph.D. Secretariat :
Ms. Luxana Nil-ubol
5. Date and Venue th August 6 , 2010 at the Royal River Hotel, Bangkok 6. Conference includes Presentations & discussions 7. Presentation Full paper: - Research papers submitted for presentations will be in the area of Reproductive Health and Social Sciences. - Research abstracts and full papers will be reviewed by reviewers.
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- The presentation will be oral presentation. Each oral presentation will only be using PowerPoint and will be limited to 20 minutes, including questions and answers. - Language: English. Abstract - Abstract in English, no more than 150 words. - Submission of full paper in English–15 pages, A4 size paper, including figures, tables, references, and appendices. English text should be typed double spaced in Times New Roman, 12 pt font for introduction, objective, methods, results, discussion, conclusion, acknowledgement, and references. - Full paper will be reviewed and the accepted paper will be published in the Proceedings of the Conference. 8. Important Dates Deadline for abstract submission: Abstract approval: Deadline for full paper submission: Registration:
2 July, 2010 16 July, 2010 25 July, 2010 1- 30 July, 2010
9. Expected participants Researchers, graduate students, and interested scholars 10. Registration Fee Participants from Institutes outside IPSR - 600 baht; fee includes copy of the Proceedings. 11. Contact person for more information Institute for Population and Social Research (IPSR) Mahidol University Salaya Campus, Nakhon Pathom 73170 Thailand Website: Email:
Tel: Fax:
www.ipsr.mahidol.ac.th Aree Jampaklay (
[email protected]) Charamporn Holumyong (
[email protected]) Luxana Nilubol (
[email protected]) + 66-2-441-0201 ext. 223, 270, or 112 + 66-2-441-9333 ---------------------------------------
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Oral Presentation Schedule
VI ICRH-SSR 2010: 4th International Conference on Reproductive Health and Social Sciences Research, Mahidol University, Thailand 6th August 2010 Busabongkot Room A&B, Royal River Hotel, Bangkok Time 08.30 09.00 09.2010.55
Busabongkot A
Registration Opening : Assoc Prof. Sureeporn Punpuing, Ph.D, IPSR Theme : Reproductive Health Presenter/Affiliation Chair : Asst. Prof. Pimonpan Isarabhakdi (PhD) 09.20 Effects of Maternal Health Seeking Practices on Pregnancy Outcomes of Nulliparous Adolescent Myitzu Tin Oung and Adult Mothers in Kanchanaburi Province, Myanmar/IPSR, MU Thailand 09.40 Reproductive Health Behaviour of Mother Samin Yuni Community In Sumber Village, Blora central Java 10.00 Postpartum Contraceptive Use in Indonesia: Recent Lina Widyastuti Patterns and Determinants BKKBN, Indonesia 10.20 Factors Influencing Adolescent Sexual Behavior in Yulaecha Padma Ichwanny Indonesia 2007 & Gouranga Lal Dasvarma BKKBN, Indonesia 10.40-10.55 Break : Coffee / Tea Theme : HIV / AIDS / STI 10.55Presenter/Affiliation 11.50 Chair : Assoc. Prof. Orapin Pitakmahaket (PhD) Risk Behaviors and Unprotected Sex Related to Nguyen Quang Bao 10.55 HIV/AIDS Infection Among Men Who Have Sex Vietnam/IPSR, MU With Men (MSM) in An Giang Province, Vietnam Knowledge and Attitudes Towards Sexual Practices Irmiyanti Kusumastuti 11.15 Among Unmarried Indonesian Young Adults: A Indonesia/IPSR, MU Study From IYARHS 2007 The Factor Affecting Condom Use With Female Sex Nguyen Thi Lan Huong 11.35 Workers Among Clients In the Seven Highest Vietnam/IPSR, MU HIV/AIDS Prevalence Provinces of Vietnam Factors Influencing Condom Use Among Injecting Any Setyawati 11.55 Drug Users (IDUs) in Semarang UNDIP, Indonesia 12.15 -13.30 Break : Lunch Theme : HIV / AIDS / STI Presenter/ 13.30 – 15.20 Chair : Asst. Prof. Aree Jampaklay (PhD) Affiliation HIV Related Condom Use Among the Middle Aged Narurmol Kingkaew 13.30 Men in Thailand: Evidence from National Sexual IPSR, MU Behavior Survey 2006 Factors Related to Sexual Risk Behavior Among Le Xuan Huy A-10 Fishermen in Binh Dinh and Binh Thuan Provinces, Vietnam/IPSR, MU 13.50 Vietnam, 2008-2009 Factors Affecting Needle Sharing Among Injecting Nguyen Huu Tien 14.10 Drug Users in Vietnam Vietnam/IPSR, MU HIV/AIDS Related Risk Behaviors Among Male Bui Thu Trang 14.30 Injecting Drug Users in Son La Province Vietnam Vietnam/IPSR, MU 14.50 Closing 15.00 Coffee Break
VII ICRH-SSR 2010: 4th International Conference on Reproductive Health and Social Sciences Research, Mahidol University, Thailand 6th August 2010 Busabongkot Room A&B, Royal River Hotel, Bangkok Time 08.30 09.00 09.2010.55
Busabongkot B
Registration Opening : Assoc Prof. Sureeporn Punpuing, Ph.D, IPSR Theme : Family Planning Presenter/Affiliation Chair : Assoc. Prof. Yothin Sawangdee (PhD) 09.20 Temporary Migration Experience and Contraception Najeebullah Rafiqi Use : A Case Study of Kanchanaburi Demographic Afghanistan/IPSR, MU Surveillance System (KDSS), Thailand 09.40 Ethnicity and Contraceptive Use Among Currently Ketmany Married Women of Reproductive Age in Lao, Chanthakoummane PDR Laos/IPSR, MU 10.00 Factors Associated with Contraception Rina Gustiana Discontinuation in Indonesia Indonesia/IPSR, MU 10.20 How Female Sterilization Plays Its Role in M.Iqbal Apriansyah Decreasing Indonesian Total Fertility Rate BKKBN, Indonesia 10.40-10.55 Break : Coffee / Tea Theme : HIV/AIDS/ STI 10.55Chair : Assoc. Prof. Uraiwan Kanungsukkasem Presenter/Affiliation 11.50 (PhD) Impacts of Mass Media Exposure and Language barrier on Comprehensive HIV/AIDS knowledge Nguyen Thuy Duong 10.55 Among “ Dzao” Ethnic Minority in Yen Bai Vietnam/IPSR, MU Province, Vietnam Factors Affecting Sexual Risk Behavior Among Vu Van Chieu 11.15 Injecting Drug Users in Vietnam Vietnam/IPSR, MU Intention of Sex Workers to visit STIs Clinic in Shinta Kristianti. 11.35 Batangan Health Center, Central Java UNDIP, Indonesia Factors Affecting HIV Infection Among Injecting Truong Tan Minh Vu 11.55 Drug Users ( IDUs) In Khan Hoa Province, Vietnam/IPSR, MU Vietnam 2008 12.15 -13.30 Break : Lunch Theme : Health / Social Issues 13.30 – Presenter/Affiliation 15.20 Chair : Lecturer Charamporn Holumyong (PhD) The Effect of Methadone Maintenance Treatment Nguyen Thi Thanh Ha 13.30 Program in Improvement Quality of Life for Vietnam/IPSR, MU heroin users in Hai Phong, Vietnam The Phenomenon of Student Prostitutes “ Campus Ike Putri Setyatama A-10 13.50 Chicken ” in Some Universities in Semarang UNDIP, Indonesia Unaware Violence: Case Studies of Cyber Bullying Pongkamon Surat 14.10 in Thai Adolescents NICFD, MU Nanthanat Songsiri 14.30 Domestic Violence and Cyber-Bullying NICFD, MU 14.50 Closing 15.00 Coffee Break
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Proceedings 1)
Effects of Maternal Health Seeking Practices on Pregnancy Outcomes Adolescent and Adult Mothers in Kanchanaburi Province, Thailand Myitzu Tin Oung (Myanmar)
of
Nulliparous
2)
Reproductive Health Behaviour of Mother Samin Community In Sumber Village, Blora central Java Yuni Astuti (Indonesia)
3)
Postpartum Contraceptive Use in Indonesia: Recent Patterns and Determinants Lina Widyastuti (Indonesia)
4)
Factors Influencing Adolescent Sexual Behavior in Indonesia 2007 Yulaecha Padma Ichwanny (Indonesia)
5)
Temporary Migration Experience and Contraception Use : A Case Study of Kanchanaburi Demographic Surveillance System (KDSS), Thailand Najeebullah Rafiqi (Afghanistan)
6)
Ethnicity and Contraceptive Use Among Currently Married Women of Reproductive Age in Lao, PDR Ketmany Chanthakoummane (Laos)
7)
Factors Associated with Contraception Discontinuation in Indonesia Rina Gustiana (Indonesia)
8)
How Female Sterilization Plays Its Role in Decreasing Indonesian Total Fertility Rate M.Iqbal Apriansyah (Indonesia)
9)
Risk Behaviors and Unprotected Sex Related to HIV/AIDS Infection Among Men Who Have Sex With Men (MSM) in An Giang Province, Vietnam Nguyen Quang Bao (Vietnam)
10) Knowledge and Attitudes Towards Sexual Practices Among Unmarried Indonesian Young Adults: A Study From IYARHS 2007 Irmiyanti Kusumastuti (Indonesia) 11) The Factor Affecting Condom Use With Female Sex Workers Among Clients In the Seven Highest HIV/AIDS Prevalence Provinces of Vietnam Nguyen Thi Lan Huong (Vietnam) 12) Factors Influencing Condom Use Among Injecting Drug Users (IDUs) in Semarang Any Setyawati (Indonesia) 13) Impacts of Mass Media Exposure and Language barrier on Comprehensive HIV/AIDS knowledge Among “ Dzao” Ethnic Minority in Yen Bai Province, Vietnam Nguyen Thuy Duong (Vietnam) 14) Factors Affecting Sexual Risk Behavior Among Injecting Drug Users in Vietnam Vu Van Chieu (Vietnam) 15) Intention of Sex Workers to visit STIs Clinic in Batangan Health Center, Central Java Shinta Kristianti, Sumarlan (Indonesia) 16) Factors Affecting HIV Infection Among Injecting Drug Users ( IDUs) In Khan Hoa Province, Vietnam 2008 Truong Tan Minh Vu (Vietnam) 17) HIV Related Condom Use Among the Middle Aged Men in Thailand: Evidence from National Sexual Behavior Survey 2006 Narurmol Kingkaew (Thailand)
4th International Conference on Reproductive Health and Social Sciences Research
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18) Factors Related to Sexual Risk Behavior Among Fishermen in Binh Dinh and Binh Thuan Provinces, Vietnam, 2008-2009 Le Xuan Huy (Vietnam) 19) Factors Affecting Needle Sharing Among Injecting Drug Users in Vietnam Nguyen Huu Tien (Vietnam) 20) HIV/AIDS Related Risk Behaviors Among Male Injecting Drug Users in Son La Province Vietnam Bui Thu Trang (Vietnam) 21) The Effect of Methadone Maintenance Treatment Program in Improvement Quality of Life for heroin users in Hai Phong, Vietnam Nguyen Thi Thanh Ha (Vietnam) 22) The Phenomenon of Student Prostitutes “ Campus Chicken ” in Some Universities in Semarang Ike Putri Setyatama (Indonesia) 23) Unaware Violence: Case Studies of Cyber Bullying in Thai Adolescents Pongkamon Surat (Thailand) 24) Domestic Violence and Cyber-Bullying Nanthanat Songsiri (Thailnad)
4th International Conference on Reproductive Health and Social Sciences Research
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Effects of Maternal Health-seeking Practices on Pregnancy Outcomes of Nulliparous Adolescent and Adult Mothers in Kanchanaburi Demographic Surveillance System, Thailand Myitzu Tin Oung Abstract Adolescent pregnancies and childbirths carry greater risks of morbidity and mortality for both mothers and babies. Use of maternal health care can be a key proximate determinant for the improvement of pregnancy outcomes. This study investigated whether use of antenatal and delivery care could reduce the risk of adverse pregnancy outcomes of nulliparous adolescent mothers compared with nulliparous adult mothers. The data were derived from Survey of Pregnancy, Birth and Early Life conducted in Kanchanaburi province, 2003. Nulliparous adolescents aged 15-19 (n=117) and adults aged 20-29 (n=193) who had delivered singleton live births within two years were selected for this study. We found that adolescent mothers were significantly less likely to have had proper maternal health-seeking practices and more likely to experience adverse pregnancy outcomes than adult mothers. Adolescent mothers had twice the risk of adverse outcomes than adult mothers after controlling other factors. However, health-seeking practices had no significant effect on pregnancy outcomes in both groups. Keywords: Adolescent mothers, adult mothers, pregnancy outcomes, health-seeking practices Introduction Adolescent pregnancy has become a significant social and reproductive health concern in both developed and developing countries. Approximately 16 million women aged 15-19 give birth each year, accounting for about 11% of births worldwide. About 95% of these births occur in developing countries (World Health Organization, 2008). Its consequences affect health, social, psychological, and economic well-being of adolescent mothers, their babies, and society at large. Early pregnancy and childbirth can bring social deprivation, lower educational attainment, and poverty. Together with these disadvantageous circumstances, they are more likely to be unemployed, smoke (Gupta, Kiran, & Bhal, 2008), use recreational drugs and alcohol, and have poor nutrition and emotional stresses (Thato, Rachukul, & Sopajaree, 2007). Not only social factors but also biological immaturity of young mothers influences on their pregnancy outcomes. Low gynecological age ( 35 years had a greater incidence of female sterilization compared with women aged 25-34 years. Engenderhealth (2002) explains that the social economy, religion, marital status, number of children, child sex, age at sterilization, race and ethnicity as well as social and psychological factors have a strong influence for female sterilization. Previous cesarean section have a statistically significant relationship response to female sterilization. This can be seen on the results of bivariate analysis. Analysis showed that the incidence of female sterilization is greater in women who did the previous cesarean section than did the previous cesarean section. This is consistent with research Mutihir et al. (2007) explains that there is a relationship between previous cesarean section and female sterilization. According Mochtar, the factors that influence to do female sterilization among others which were included in obstetric medical indication is recurrent toxemia gravidarum, repeated cesarean section and obstetric hysterectomies. The result of bivariate analysis showed that there was no significant relationship between age and cesarean section. Women aged > 35 years the incidence of cesarean section have a lower Elective than women aged 25-34 years. This is consistent with studies of Al Nuaim et al. (2003) showed that women age > 35 years the incidence of cesarean section have a Elective of lower than 25-34 years old lady. However, these results contrast with research Krebs & Langhoff-Ross (1987) concluded that women age > 35 years the incidence of cesarean section have more Electives than women aged 25-34 years. According to Braveman et al., that age > 35 years had significant relationship with cesarean section. However, in contrast to the results of research Taffel et al., stated that the age 25-34 had significant relationship with cesarean section. Similarly, results of studies showing that parity has no significant relationship with cesarean section. Women of parity > 3 has a lower incidence of cesarean section compared with women of parity 1-2. This is consistent with studies of Al Nuaim, et al. which states that a higher incidence of cesarean section in women compared with women of parity 1-2 parity > 3. While the results of this study contrast with Hopkins & Amaral studies showing that women of parity > 3 has a significant relationship with cesarean section. Women of parity > 3 has a greater incidence of cesarean section
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compared with women of parity 1-2. These results support research conducted by Mikki et al. 8 which proves that there is a significant relationship between previous cesarean section cesarean section. Multivariable analysis found that previous cesarean section had the same significant relationship to female sterilization and cesarean section. It can be seen from the results of the analysis showed a statistically significant. So we can say that previous cesarean section is a potential confounding variable (confounding) in the relationship between cesarean section on female sterilization. Conclusions and recommendations Incidence female sterilization is higher in elective cesarean section compared with emergency cesarean section. Incidence female sterilization is higher in the women aged > 35 years, parity >3 children and previous cesarean section compared with a group of women aged 25-34 years, parity 1-2 and did not do the previous cesarean section. Previous cesarean section variables proved to be a confounding variable (confounding) variables on the relationship between cesarean section with female sterilization. For health care workers to perform better counseling to women about female sterilization during cesarean section. Women who had >3 children, age over 35 years and have a history of previous cesarean section should get more attention for the use of contraceptive methods especially female sterilization during cesarean section delivery. Especially for women of parity > 3 children are encouraged to perform female sterilization as a contraceptive method. Relevant agencies such as the health department and BKKBN have to provide communication, information and education (IEC) better about female sterilization during cesarean section. I hope that other researcher will conduct further study to complete and enrich the information and knowledge about the female sterilization and cesarean section with different side or variables. The most expecting result is there will be many suggestions and contributions for family planning and reproductive health program. References World Health Organization, Johns Hopkins Bloomberg School of Public Health & United States Agency for International Development. (2007) Family Planning: A Global Handbook for Providers. Baltimore and Geneva. Dasuki, D., Sawarni, A. & Siswosudarmo, R. (2000) Randomized clinical trial: safety and efficacy of one quinacrine pellets insertion compare to two quinacrine pellets insertion sterilization. Indon J Clin Epidemiol Biostat, 7 (2): 3-6. Ezegwui, H.U. & Nwogu-Ikojo, E.E. (2004) Sterilization at cesarean section in Nigeria. Int J Gynecol Obstet, 87: 157-158. Mochtar, R. (1992) of obstetrics: obstetric operative, social obstetrics. 2nd edition. Jakarta: EGC Medical Book Publishers. Pastorek, J.G. 2nd. & White, C.A. (1988) Surgical sterilization at the time of cesarean delivery. Obstet Gynecol Clin North Am, 15 (4): 771-81. Moreno, J.M., Bartual, E., Carmona, M., Araico, F., Miranda, J.A. & Herruzo, A.J. (2001) Changes in the rate of tubal ligation done after cesarean section. Eur J Obstet Gynecol Reprod Biol, 97: 147-151. Verkuyl, D.A.A. (2002) Sterilisation during unplanned caesarean sections for women likely to have a completed family – should they be offered? Experience in a country with limited health resources. Br J Obstet Gynaecol, 109: 900-904.
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Mikki, N.S., Abu-Rmeileh, N., Wick, L.A., Abu-Asab, N.S.A. & Hasan, S.J. (2005) Cesarean delivery rates, determinants and indications in Maqassed Hospital, Jerusalem, 1993 and 2002. Institute of Community and Public Health, Jerusalem: Birzeit University. Hopkins, K. & Amaral, E. (2005) The role of non clinical factors in cesarean section rates in Brazil. Population Research Center, Austin: University of Texas. Omu, A., Al-Azemi, M., Al-Harmi, J., Azeem, H.A. & Al-Salem, H.N. (2007) Delivery after prior cesarean section in Kuwait. Kuwait Med J, 39 (2): 157-161. Braveman, P., Egerter, S., Edmonston, F. & Verdon, M. (1995) Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Public Health, 85 (5): 625-630. Ross, J.A. (1992) Sterilization: Past, Present, Future. Fam Plann Perspect, 23 (3): 187-198. Engenderhealth. (2002) Contraceptive Sterilization: Global Issues and Trends. Chapter 5. United States: New York. Mutihir, J.T., Aisien, A.O. & Ujah, I.A. (2007) A review of bilateral tubal ligation at caesarean section in Jos, Nigeria. Niger Postgrad Med J, 14 (3): 252-5. Al Nuaim, L. Soltan, M.H., Khasboggi, T. Addar, M., Chowdhury, N. & Adelusi, B. (1996) Outcome in elective and emergency cesarean sections: a comparative study. Ann Saudi Med, 16 (6): 645-649. Krebs, L. & Langhoff-Ross, J. (2003) Elective cesarean delivery for term breech. Obstet Gynecol, 101 (4): 690-6. Taffel, S.M., Placek, P.J. & Liss, T. (1987) Trends in the United States cesarean section rate and reasons for the 1980-85 Rise. Am J Public Health, 77: 955-959.
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Risk Behaviors and Unprotected Sex Related to HIV/AIDS Infection Among Men Who Have Sex with Men in Anglang Province, Vietnam Nguyen Quang Bao
Abstract Risk behaviors and unprotected sex were examined among men who have sex with men (MSM) (N=386) to support information for setting up a guideline to design an HIV/AIDS intervention program among this population in Angiang province, Vietnam. A cross-sectional method with time location sampling was used to collect data. Chi-square and logistic regression were used to identify selected risk factors and unprotected sex. Results show that a majority of MSM was young and consistent condom use was low. Younger MSM used condoms more inconsistently with their male clients than older MSM. Lower educated MSM used condoms more inconsistently with female sex workers than higher educated MSM. Likewise, lower educated MSM were more likely to be injecting drug users than higher educated MSM. In contrast, higher educated MSM were more likely to drink alcohol and have sex when drunk, use more MDMA (Methylenedioxymethamphetamine) or both MDMA and injecting drugs, and share needles and syringes with drug use partners when compared to lower educated MSM. The key findings show that risk behaviors such as MDMA use and types of partners affect unprotected sex among MSM. It is suggested that results of this study could be used as a MSM information database for policy makers and stakeholders to comprehensively understand the situation of MSM in Angiang province. These results can also be used to advocate HIV/AIDS policy makers, encourage more effective data to support harm reduction intervention programs among MSM in Angiang province. Keywords : MSM, risk behaviors, unprotected sex, Angiang, Vietnam Introduction Asia’s epidemic has long been concentrated in specific populations, such as injecting drug users, sex workers and their clients, and men who have sex with men (MSM). However, the epidemic in many parts of Asia is steadily expanding into lower-risk populations through transmission to the sexual partners from specific populations. Additionally, Asia’s epidemic has different transmission routes in different parts of the region. While injecting drug users and sex workers and their clients have accounted for most HIV infections, sexual transmission to drug users’ partners and sex workers’ clients is increasingly apparent. In addition, MSM and transgender people are documented to have exceptionally high transmission rates (UNAIDS, 2009). Although Vietnam is less affected by HIV/AIDS than other countries in Asia and is classified as having a concentrated epidemic, it is now facing the possibility of a growing epidemic, especially among high-risk populations. Although the number is increasing, Vietnam is still at an early enough stage to prevent further expansion of the epidemic.
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Typically, HIV spreads from high-risk groups, such as sex workers, to a “bridge” population such as their clients. Other “bridge” populations include the partners of sex-worker clients, injecting drug users, and other people who practice risky behaviors, namely, migrant or mobile populations; and truck drivers. In Vietnam, the rising number of cases among pregnant women and their infants provides evidence that HIV is spreading to the general population (HIV/AIDS in Vietnam – Hanoi, 2006). In Vietnam, there is no program of surveillance or routine testing to follow the prevalence of HIV infection in MSM over time, little is known about the HIV prevalence among MSM. HIV prevalence among MSM was 5% in Hochiminh city and 9% in Hanoi, but this is not a statistically significant difference (IBBS, 2006) and a survey of 208 MSM who came to the Pasteur Institute in Hochiminh city for voluntary testing in 2000 and 2002 found an HIV prevalence of 5.8% and 5.6% of 72 MSM tested positive for HIV respectively. It is clear that significant populations of MSM living in major cities have behaviors putting them at high risk of HIV infection. With more information and support, MSM would be better able to understand their risks and to protect themselves from HIV (Colby, 2004). Like other most at risk populations, drug injection among MSM is one risk factor for HIV infection. Up to now, there are but a few descriptive surveys of drug use data in Vietnam in general or in Angiang province in particular. Data has begun to provide proof of increasing drug use among MSM in Vietnam with fewer than 2% of MSM admitting to using intravenous drugs in 2001 in Hochiminh city, 9.2% in Hanoi and 3.8% in Hochiminh city in 2005 (IBBS, 2006). “Fewer than one in 20 men who have sex with men have access to the HIV prevention, treatment and care services they need” (UNAIDS, 2006). Now epidemiologists cannot predict with certainty how fast a given epidemic will expand and when it will peak, although short-term predictions can be made on the basis of HIV trends and information on risk behavior. Fortunately, there is strong evidence showing that countries will ultimately reduce their new infections if they carry out effective prevention programs encouraging abstinence, fidelity and safer sex. A crucial factor is promoting condoms, both the traditional kind and the female condom, and making good quality condoms cheaply and conveniently available. Condoms are protective irrespective of the age or mobility of the partners, the scope of their sexual networks, or the presence of another sexually transmitted infection (UNAIDS, 2000) In many countries, it is recognized that MSM may be vulnerable to HIV and other sexually transmitted infections. Although limited to a few surveys, the available data on MSM in Vietnam show that they are at increased risk of HIV infections due to high numbers of sexual partners, high rates of unsafe sex, and inconsistent condom use (HIV/AIDS in Vietnam – Hanoi 2006). MSM is also a MARP in Vietnam who remains largely invisible and marginalized; although there have been some studies on the MSM population in Hanoi, Hochiminh city (IBBS, 2006) and Khanhhoa province (Colby, 2005). These studies stressed the need for detailed information on socio-demographic characteristics, the rate of HIV and knowledge, attitude and risk behaviors among the MSM population. However there’s not any focus on factors affecting inconsistent condom use among MSM in those studies. Therefore, there is a need for research on MSM in the Mekong river delta area to evaluate the trends in risk behaviors related to HIV in which the interaction between drug use and sexual behavior are analyzed, the base for intervention programs to increase consistent condom use among this group.
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Methods This study come from a cross sectional study on Knowledge, Attitudes, Beliefs , and Practices (KABP) among MSM in Angiang province, which was the baseline survey for the Vietnam HIV/AIDS Prevention Project funded by the World Bank. The survey was conducted by the Pasteur Institute in Hochiminh city and the provincial Project Management Unit of Angiang province, during October and December 2009. This sample used a probability sampling method, Time Location Sampling. 386 MSM in communities in Angiang province were recruited for this survey. A criterion of MSM in this survey is men who have had hand, anal or oral sex with other men during the last 12 months. The data was analyzed using statistical package in social science (SPSS/PC+). Univariate and bivariate analysis was used to describe personal factors, selected risk behaviors and unprotected sex of the respondents. Nonparametric test (χ2) was used to test the relationship between risk behaviors and unprotected sex. A binary logistic regression was used to examine the effect risk behaviors and other factors on unprotected sex. Results General Characteristics of MSM in Angiang Province Table 1 reveals socio-demographic characteristics for 386 MSM who participated in this study. On average, this was a young group with a median age of 20, although age was ranged from 14 to 50. 43% of MSM were adolescent, followed by youth (30%) and the rest were adult. MSM in this study had low education levels, 75% of them attended lower than high school education which included 38% with secondary school, 28% with primary education and 8% never attending school. The remainder of the sample, 22% of them attended high school education and only 3% had been educated at college or university. Table 1 Distribution of general characteristics among MSM in Angiang province Personal factor Age group 14-19 yrs 20-24 25-34 35-50 Total Mean = 22.3; Median = 20.0; Min = 14; Max = 50; SD = 6.2 Education Illiterate Writing fluently Primary (Grade 1-5) Secondary school (Grade 6-9) High school (Grade 10 – 12) College, university (>12) Total Occupation Farmer Government employee Entertainment employee
Frequency N=386
Percent (%)
165 114 82 24 385*
42.9 29.6 21.3 6.3 100.0
30 2 109 148 86 10 385*
7.8 .5 28.3 38.4 22.3 2.6 100.0
6 1 48
1.6 .3 12.5
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Table 1 Distribution of general characteristics among MSM in Angiang province (continued) Personal factor Sales/office clerk Business person Student Self-employed Sex worker Currently unemployed Worker Singer Pupil Hairdresser Total Income* Low
Frequency N=386 6 41 6 100 4 106 29 11 18 9 385*
Percent (%) 1.6 10.6 1.6 26.0 1.0 27.5 7.5 2.9 4.7 2.3 100.0
180
48.4
High
192
51.6
Total Mean = US$92; Median = US$78; Min = 0; Max = US$1110; SD = US$88.4
372
100.0
209 64 16 87 10 386
54.1 16.6 4.1 22.5 2.6 100.0
Self-reported sexual orientation Prefers men as partners only Prefers men to women as partners Prefers women as much as men Prefers women to men as partners Prefer women as partners only Total
Respondents were from diverse socioeconomic backgrounds, ranging from unemployed to government employee. Respondents who were current unemployed (28%), self-employed (26%), Entertainment employee (13%) and business person (11%) occupied dominant proportions when compared with other occupations. In terms of income, the mean of income was US$92, with a range from 0 to US$1110. Low income refers to MSM earned money less than monthly income per capita in this province (US$70) and the rest is high income MSM; more than a half of MSM had high income. Regarding self-reported sexual orientation, a high proportion of MSM were homosexual orientation (54%), following by MSM who oriented men and women was not difference (23%), preferred man to woman (17%) and small proportion of them oriented heterosexual (2.6%). Selected characteristics of MSM in Angiang Province Table 2 reveals selected socio-demographic characteristic for the 386 MSM who participated in this study. MSM aged less than 20 occupied 43% of MSM, when older age was 57%. More than one third of MSM had primary education or lower (37%) when higher primary education. A higher percent of them was currently unemployed and the highest percent worked in the business sector. Regarding selfreported sexual orientation, MSM sexual orientation was divided into three distinct groups; 54% were homosexual, 43% were bisexual and 2.1% were heterosexual. Sexual experiences of MSM were showed in table 4-2. This includes types of sexual partners, number of sexual partners, and condom use, which were reported from those MSM who had ever had sex during the last 3 months prior to the survey. And sexual
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preferences were reported from those MSM who had ever had sex during the last 12 months prior to the survey. 63% of them had sexual male partners only and the rest had both male and female partners. Two thirds of the MSM (67%) had more than one sexual partner during the last 3 months. 44% of MSM had both insertive and receptive sex, followed by insertive anal sex only (29%), no anal sex with male partners (15%) and receptive anal sex (13%). Table 2 Distribution of selected characteristics among MSM in Angiang province Variable Age Younger Older Total Education Lower Higher Total Occupation Currently unemployed sector Entertainment sector Business sector Total Self-reported sexual orientation Homosexual Bisexual Heterosexual Total Type of partners Male partner only Both male and female partner Total Number of partners More than one One Total Sexual preferences Insertive only Receptive only Both receptive and insertive No anal sex with male partner Total
Frequency N = 386
Percent (%) 165 220 385
42.9 57.1 100.0
141 244 385
36.6 63.4 100.0
130 72 183 385
33.8 18.7 47.5 100.0
209 167 10 386
54.1 43.3 2.6 100.0
244 142 386
63.2 36.8 100.0
241 119 360
66.9 33.1 100.0
110 50 169 56 385
28.6 13.0 43.9 14.5 100.0
Selected risk behaviors: MSM had sexual preferences with their partners was divided into 5 categories based on the way of anal sex and MSM who did not have sex. MSM who were always a giver occupied 29%, followed by about half a giver and half a receiver (26), always a receiver (13%), a receiver most of the time (11%) and a giver most of the time (7%). Three quarters (74%) of MSM never used any kinds of drugs, 12% had injected drugs only, 9% had used MDMA and 4% had used both kinds of drugs. Among MSM injected drug, there was 12% of MSM shared used needle and syringes to drug use partners during the last month, 17% injected by other drug use partners' used needles and syringes during the last month. In terms of alcohol use, almost all MSM had ever
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drunk alcohol (94%). Among MSM ever drank alcohol, three quarters of MSM had sex when got drunk. Table 3 Distribution of selected risk behaviors among MSM in Angiang province Selected risk behaviors
Frequency N = 386
Percent (%)
Sexual preferences 110
28.6
26
6.8
99
25.7
Always a receiver
44 50
11.4 13.0
No anal sex
56
14.5
385
100.0
23 363 386
6.0 94.0 100.0
71 215 286
24.8 75.2 100.0
Always a giver A giver most of the time About half a giver and half a receiver A receiver most of the time
Total Alcohol use Never Ever Total Have sex when got drunk Never Ever Total
Drug use Never 287 36 Ever MDMA use Ever injecting drug use 48 Both ever MDMA and injecting drug use 15 386 Total Sharing needle and syringes to drug use partners during the last month Yes 6 No 46 Total 52 Injected drugs by drug used partners' needle and syringes during last month Yes 9 No 43 Total 52
74.4 9.3 12.4 3.9 100.0 11.5 88.5 100.0 17.3 82.7 100.0
Unprotected sex Generally condom use with all male partners was low among MSM, 21% during the last three months and 20% during the last month, there was a difference of proportion between them because of the sample size which some of MSM had consistent condom use during the last three months were high but they did not have sex during the last month. Condom use with consensual male partner (24%), followed by condom use with MSW (32%) and condom use with male clients (33%). However, condom uses with female partner were different, inconsistent condom use decreased with female clients (40%) and FSW (44%). A relative high proportion of inconsistent condom use with their consensual female partners was 67%.
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Table 4 Distribution of sexual experiences among MSM in Angiang province Sexual experiences Number of partners during the last 1 months 1 2 3 4 and over Total Mean = 3.4; Median = 2.0; Min = 1; Max = 30; SD = 4.7 Sex with male partner and condom used during last 1 month Inconsistent Consistent Total Number of partners during the last 3 months 1 2 3 4 and over Total Sex with all male partner and condom used during last 3 months Inconsistent Consistent Total Number of male clients during the last 1 months 1 2 3 4 and over Total Mean = 3.3; Median = 2.0; Min = 1; Max = 30; SD = 4.8 Anal sex and condom use with clients during last 1 months Inconsistent Consistent Total Number of MSW partners during the last 3 months 1 2 3 4 and over Total Mean = 4.7; Median = 2.0; Min = 1; Max = 50; SD = 11.1 Condom use and anal sex with MSW partners during last 3 months Inconsistent Consistent Total Number of consensual male partner during last 1 months* 1 2 3 4 and over Total Mean = 2.2; Median = 1.0; Min = 1; Max = 15; SD = 2.3
Frequency N=386
Percent (%)
131 59 34 86 310*
42.3 19.0 11.0 27.7 100.0
248 62 310*
80 20 100
119 52 50 136 357*,**
33.3 14.6 14.0 38.1 100.0
285 75 360*
79.2 20.8 100.0
37 32 15 18 102*
36.3 31.4 14.7 17.6 100.0
68 34 102
66.7 33.3 100.0
9 4 3 3 19
47.4 21.1 15.8 15.8 100.0
13 6 19
68.4 31.6 100.0
91 46 17 20 174*
52.3 26.4 9.8 11.5 100.0
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Table 4 Distribution of sexual experiences among MSM in Angiang province (continued) Sexual experiences Anal sex with consensual male partner during last 1 months Inconsistent Consistent Total Sex with FSW during the last 12 months Inconsistent Consistent Total Sex with female clients during last 12 months Inconsistent Consistent Total Sex with consensual female partner during the last 12 months Inconsistent Consistent Total
Frequency N=386
Percent (%)
134 42 176
76.1 23.9 100.0
22 28 50*
44.0 56.0 100.0
4 6 10*
40.0 60.0 100.0
83 41 124*
66.9 33.1 100.0
*Answered “Have all type of sex with” ** due to missing cases Number of partners: Generally, number of sexual partners with every type of partner was one occupied highest proportion, except sex with all sexual partners during the last three months. Percentage of number of sexual partners with all partners during the last three months was 4 and over is much higher than during the last one month. Regarding number of every type of male partners, the highest mean number of male partners is 4.7 with MSWs, followed by MSM who were MSWs (3.3) and consensual male partners (2.2). On average, mean number of all type of partners during the last one month is 3.4. Distribution of age group Table 5 shows that the younger MSM used condom more inconsistent with their male clients than older MSM. However, older MSM tended to use condom in sex with male clients more inconsistent than younger MSM (46% vs. 54%). The older MSM was, the higher proportion of MSM uses drugs, ever drank alcohol and had sex when got drunk. Older MSM injected drug by other drug use partners' used needle and syringes than younger MSM. In sexual preferences, younger MSM were receiver occupied higher proportion (54%) when compared with older MSM.
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Table 5 Percentage distribution of age group among MSM in Angiang province Age group Risk behaviors Anal sex for money and inconsistent condom use with male partner during the last 1 months Anal sex and inconsistent condom use with MSW during the last 3 months Anal sex and inconsistent condom use with consensual male partner during the last 1 months Sex and inconsistent condom use with FSW during the last 12 months Sex and inconsistent condom use with female partner and receive money for sex during the last 12 months Sex and inconsistent condom use with consensual female partner during the last 12 months Ever use alcohol
Younger MSM
Older MSM
Total
N
53.7
46.3
100
67
30.8
69.2
100
13
36.8
63.2
100
133
18.2
81.8
100
22
50.0
50.0
100
4
43.4
56.6
100
83
42.3
57.7
100
362
Have sex when got drunk
37.7
62.3
100
215
Drug use Ever MDMA use
44.4
55.6
100
36
Ever injecting drug use
18.8
81.3
100
48
Both ever MDMA and injecting drug use
33.3
66.7
100
15
50.0
50.0
100
6
22.2
77.8
100
9
No anal sex with male partner
50.0
50.0
100
56
Insertive only
30.0
70.0
100
110
Receptive only
54.0
46.0
100
50
Both receptive and insertive
45.8
54.2
100
168
Sharing used needle and syringes to drug use partners during the last month Injected drugs by other drug use partners' used needle and syringes during the last month Sexual preferences
Distribution of education level Lower educated MSM used condom more inconsistent with their female partners than higher educated MSM, however condom use with male partner is contradictory, lower educated MSM tended to use condom more consistent than higher educated MSM. The higher educated MSM had, the higher proportion of MSM ever drank alcohol and had sex when got drunk. In term of drug use, lower educated MSM injected drugs higher than higher educated MSM, however, higher educated MSM used more MDMA (72%) or both MDMA and injecting drugs (87%) than others. Using needles and syringes with drug use partners was higher in higher educated MSM. In sexual preferences, higher educated MSM were receiver and/or inserter occupied higher proportion when compared with lower educated MSM.
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Table 6 Percentage distribution of education level among MSM in Angiang province Education Risk behaviors Anal sex and inconsistent condom use with male partner and receive money for sex during the last 1 months Anal sex and inconsistent condom use with MSW during the last 3 months Anal sex and inconsistent condom use with consensual male partner during the last 1 months Sex and inconsistent condom use with FSW during the last 12 months Sex and inconsistent condom use with female partner and receive money for sex during the last 12 months Sex and inconsistent condom use with consensual female partner during the last 12 months
Lower
Higher
Total
N
35.3
64.7
100
68
23.1
76.9
100
13
40.3
59.7
100
134
68.2
31.8
100
22
50.0
50.0
100
4
51.8
48.2
100
83
Ever use alcohol
37.0
63.0
100
362
Have sex when got drunk
39.5
60.5
100
215
Drug use Ever MDMA use
27.8
72.2
100
36
Injecting drug use
62.5
37.5
100
48
Both MDMA and injecting drug use Sharing used needle and syringes to drug use partners during the last month Injected by other drug use partners' used needle and syringes during the last month Sexual preferences No anal sex with male partner
13.3
86.7
100
15
44.4
55.6
100
9
33.3
66.7
100
6
30.4
69.6
100
56
Insertive only
45.5
54.5
100
110
Receptive only
42.0
58.0
100
50
Both receptive and insertive
31.5
68.5
100
168
Distribution of condom use during the last three months In table 7, in all selected risk behaviors, consistent condom uses were lower than inconsistent condom use. Consistent condom use was higher among MSM who never drink alcohol than MSM ever drank alcohol. In term of drug use, consistent condom use among MSM who ever used MDMA was higher than other MSM who did not use drugs or injecting drugs. MSM who had both male and female partners used condom more consistent than MSM had male partners only. Regarding number of partners and sexual preferences, there were no strong different between the groups. In table 4-7, there was no significant association between risk behavior factors and unprotected sex at the 0.05 level.
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Table 7 Distribution of condom use by selected risk behaviors among MSM in Angiang province Selected risk behaviors Alcohol use Never Ever Drug use Drug nonuse Ever MDMA use only Ever injecting drug use only Ever both methods of drug use Number of partners More than one One Type of partners Male partners only Both male and female partners Sexual preferences Insertive anal sex Receptive anal sex Both receptive and insertive anal sex No anal sex with male
Inconsistent
Unprotected sex Consistent Total
(n)
χ2 value
0.55
72.2 79.5
27.8 20.5
100 100
18 342
81.6 65.7 79.1 66.7
18.4 34.3 20.9 33.3
100 100 100 100
267 35 43 15
78.4 80.7
21.6 19.3
100 100
241 119
0.24
81.9 74.2
18.1 25.8
100 100
232 128
2.95
80.8 78.0
19.2 22.0
100 100
52 100
78.3
21.7
100
46
79.5
20.5
100
161
6.26
0.20
Multivariate analysis To examine the net effects of selected risk behaviors, drug and alcohol use and sexual experiences, on inconsistent condom use, binary logistic regression model was used because the outcome factor is a binary variable (yes and no). The results of the models are presented in Table 8. For these analyses, variables that had significance at the 0.05 level were considered statistically significant. Due to not enough observation for analysis, self-reported sexual orientation was recoded into two categories, homosexual and bisexual. The results from table 4-8 indicate that type of partners was positively and significantly associated with condom use. Those who had male partners only were three times more likely to use condoms inconsistently than those who had both male and female partners. The second variable, MDMA use, had a negative association with inconsistent condom use. To be more precise, those who had ever used MDMA were 54% (p