HIV risk, partner violence, and relationship power among Filipino young women: testing a structural model

Men's Involvement in Sexual and Reproductive Health Care and Decision Making in the Philippines: A Systematic Review of the Literature

Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men’s involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men’s involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men’s involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men’s deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men’s attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men’s involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men’s involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.

Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey

BACKGROUND

The prevalence of having ever tested for HIV in the Philippines is very low and is far from the 90% target of the Philippine Department of Health (DOH) and UNAIDS, thus the need to identify the factors associated with ever testing for HIV among Filipino women.

METHODS

We analysed the 2013 Philippine National Demographic and Health Survey (NDHS). The NDHS is a nationally representative survey which utilized a two-stage stratified design to sample Filipino women aged 15-49. We considered the following exposures in our study: socio-demographic characteristics of respondent and her partner (i.e., age of respondent, age of partner, wealth index, etc.), sexual practices and contraception (i.e., age at first intercourse, condom use, etc.), media access, tobacco use, HIV knowledge, tolerance to domestic violence, and women's empowerment. The outcome variable is HIV testing. We used logistic regression for survey data to study the said associations.

RESULTS

Out of 16,155 respondents, only 372 (2.4%) have ever tested for HIV. After adjusting for confounders, having tertiary education (adjusted odds ratio (aOR) = 2.15; 95% Confidence Interval (CI): 1.15-4.04), living with partner (aOR = 1.72; 95% CI: 1.19-2.48), tobacco use (aOR = 1.87; 95% CI: 1.13-3.11); belonging to the middle class (aOR = 2.72; 95% CI: 1.30-5.67), richer (aOR = 3.00; 95% CI: 1.37-5.68), and richest (aOR = 4.14; 95% CI: 1.80-5.91) populations, having weekly television access (aOR = 1.75; 95% CI: 1.04-2.94) or internet access (aOR = 2.01; 95% CI: 1.35-3.00), living in a rural area (aOR = 1.87; 95% CI: 1.34-2.61); and being a Muslim (aOR = 2.30; 95% CI: 1.15-4.57) were associated with ever testing for HIV.

CONCLUSIONS

The low percentage of respondents who test for HIV is a call to further strengthen efforts to promote HIV testing among Filipino women. Information on its determinants can be used to guide the crafting and implementation of interventions to promote HIV testing to meet DOH and UNAIDS targets.

The Scale of Sexual Aggression in Southeast Asia: A Review

Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases, the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those, 32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information available by country, missing information within studies, and cultural differences hampered the comparability between and within countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent, based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future research are presented in the discussion.

Women's Healing Journey From Intimate Partner Violence: Establishing Positive Sexuality

Survivors of intimate partner violence (IPV) have an elevated risk for negative sexual health outcomes, including HIV and sexually transmitted infection (STI). Given the unique risk contexts for survivors, there is a need for effective sexual health interventions that take into account the imbalances of power for women who are survivors of IPV. Toward the aim of informing contextually relevant intervention approaches, this article describes women's strategies toward maintaining their sexual health in the context of violent, controlling relationships. Strategies are examined across women's healing process. Data were collected through semi-structured, in-person interviews with women who had experienced IPV ( N = 28). Participants had a wide range of negative sexual health outcomes and commonly used an analogy of a journey to describe their healing. Throughout these journeys, women gained more confidence and ownership over their sexuality. Themes centered around enhanced self-acceptance, ownership of personal sexuality, and readiness for desirable sexual partnerships.

Behind prison walls: HIV vulnerability of female Filipino prisoners

PURPOSE

The imprisoned population is increasing worldwide and is overrepresented in the HIV epidemic. The purpose of this paper is to explore the HIV vulnerability of female Filipinos who are pre-trial prisoners, as the specific needs of imprisoned women are poorly understood and fewer resources are granted to pre-trial detainees, especially in low and middle-income countries (LMICs).

DESIGN/METHODOLOGY/APPROACH

This study was based on a Qualitative Descriptive Design. In total, 18 semi-structured interviews were conducted with prisoners and NGO directors. Data were analysed through Framework Analysis, using the individual, social and community categories of the Modified Socio-Ecological Model.

FINDINGS

Results from this study suggest that the prison environment and management practices maximise the HIV vulnerability in the sample. This vulnerability is shaped by low HIV knowledge, combined with the existence of multiple social vulnerabilities prior to incarceration.

SOCIAL IMPLICATIONS

HIV care in Filipino prisons needs urgent attention from government and international organisations, as it is a major public health and human rights concern. International goals of ending the epidemic by 2030 cannot be reached if efforts are not translated into action within this setting.

ORIGINALITY/VALUE

In the Philippines, few studies have addressed this issue and little is known about the conditions of Filipino prisons. This paper aims to fill a gap in literature regarding the vulnerability of imprisoned women in LMICs, which is even more limited in examining pre-trial detention.

Trends and emerging directions in HIV risk and prevention research in the Philippines: A systematic review of the literature

BACKGROUND

The Philippines is experiencing one of the fastest growing epidemics globally. Evidence-based public health policies are needed. To describe the public health literature on HIV risk groups and prevention approaches in the Philippines, we reviewed published empirical studies with HIV-related outcomes.

METHODS

Based on an a priori systematic review protocol, we searched PubMed, PsycINFO and CINAHL databases for quantitative studies conducted in the Philippines that reported on HIV risk groups factors and interventions to prevent HIV. The search included studies published as of April 2018.

RESULTS

We identified 755 records, screened 699 unique titles and abstracts, and conducted full text review of 122 full reports of which 51 articles met inclusion criteria. The majority were cross-sectional studies describing HIV and STI prevalence and risk factors in samples recruited from the Philippines. Four HIV prevention programs conducted in the Philippines were identified, all of which reported improvements on HIV knowledge, attitudes, and behaviors. Overall, female sex workers (FSWs) constituted the primary study population, and few studies reported data from men who have sex with men (MSM), people who inject drugs (PWIDs), and youth. No studies reported on transgender populations. Most studies were focused on examining condom use-related outcomes and STI history, few had biomarkers for HIV, and none addressed biomedical HIV prevention strategies.

CONCLUSION

This review identifies an agenda for future HIV research that is needed to address the growing and shifting nature of the HIV epidemic in the Philippines.

Do the status and empowerment of mothers predict their daughters' reproductive outcomes?

BACKGROUND

Despite increased recognition of the important influences of women's status and empowerment on social and health outcomes for women and their families, there are few investigations that examine the extent to which any gains in women's empowerment may be transmitted intergenerationally, that is, between mothers and their daughters.

METHODS

This study seeks to address this gap by using data from a unique, longitudinal, and intergenerational dataset from Cebu, Philippines (1994-2009), to examine potential influences of the status of mothers on subsequent reproductive health outcomes among their daughters. Using data from 648 mother-daughter dyads, we examine a multidimensional set of women's status and empowerment measures among the mothers to predict three outcomes among their daughters: sexual onset by 2009 (ages 25-26), use of family planning, and experience of an unintended pregnancy.

RESULTS

We find that that while some of the mothers' characteristics and measures of empowerment and status were predictive of their daughters' sexual initiation, these effects were not consistent across empowerment indicators, nor were there significant effects on two of the outcomes: use of family planning or occurrence of an unintended pregnancy. Older mothers (45+ years in 1994) and mothers who were considered to be "well-kept", a locally defined measure of empowerment, were more likely to have daughters who had not engaged in sex by 2009 (ages 25-26). Daughters with higher educational levels were also more likely to delay sex, as compared to their peers. Among young women who had become sexually active, 54% reported an unintended pregnancy (mistimed or unwanted) by the age of 25-26, yet their mothers' empowerment and status were not predictive of daughters' reports of an unintended pregnancy.

CONCLUSIONS

Overall, these findings suggest that further research is needed to explore more proximal impacts on young women's reproductive behavior in this setting, given other related investigations on women's empowerment and its linkages to sexual debut and educational attainment in this setting. Findings from this examination of daughters' reproductive outcomes suggest that there are likely additional intervening mechanisms between onset on sexual activity and mistimed or unintended pregnancy that need further elaboration.

Household Financial Management and Women’s Experiences of Intimate Partner Violence in the Philippines

This study explores the causal impact of independent management of household finances upon women’s experiences of intimate partner violence (IPV) in the Philippines. Propensity score matching is used to generate a casual estimate of the impact of women’s roles as household financial managers on their experiences of IPV. Findings demonstrate that managing household finances independently significantly increased the severity of IPV women experienced from their partners compared with women who managed finances jointly with partners. Findings reinforce the importance of explicit attention to intrahousehold power dynamics and gender norms in the implementation of microfinance interventions intended to empower women.

INTER-GENERATIONAL RELATIONSHIPS BETWEEN WOMEN'S FERTILITY, ASPIRATIONS FOR THEIR CHILDREN'S EDUCATION AND SCHOOL COMPLETION IN THE PHILIPPINES

Women's education is associated with positive social and health outcomes for women and their families, as well as greater opportunities and decision-making power for women. An extensive literature documents ways in which broader, societal changes have facilitated roles for women beyond reproduction, yet there is minimal exploration at the family level. This study used inter-generational cohort data from the Philippines to examine mothers' aspirations for their children's education, and how these aspirations predict children's subsequent educational attainment. Mothers' education, household wealth and a locally developed measure of women's status were positively associated with higher educational aspirations for children; however, only mothers with the highest fertility were less likely to desire their children to attend college or higher. Mothers' fertility and aspirations both significantly and independently predicted children's school completion. Together, these findings indicate that increased opportunities for Filipina women beyond childbearing may not only positively benefit these women themselves, but also future generations.