Culture-embedded drivers and barriers to (non) condom use among Filipino MSM: a critical realist inquiry

This qualitative study examines the drivers and barriers of condom use among Filipino men who have sex with men (MSM) using a critical realist inquiry (i.e., shared meanings, norms, and practices related to condom use). Thematic analysis was used to analyze interviews of 105 MSM participants across 21 cities in the Philippines. Key findings showed three social structures that shape how participants view sexual partners as safe (linked to non-condom use) or unsafe (linked to condom use). First, classism is linked to relative economic social position of sexual partner (lower socio-economic class as unsafe; higher socio-economic class as safe). Second, heteronormativity is linked to relationship arrangements (multiple partner as unsafe; exclusive partner as safe) and identity categories (bisexuals as unsafe; straight men are safe). Third, body-ism is linked with notions of health (looks sick as unsafe; looks healthy as safe) and appearance (not good looking as unsafe). Sexual partners perceived as good looking can be construed as either safe or unsafe. Discussion points highlight importance of understanding the cultural and material contexts of looking and sounding educated, looking healthy, looking physically attractive vis-à-vis promoting condom use.