Examining the association between environmental-structural factors and condom use among male clients in Indonesia

Using data from the 2007 IBBS in Indonesia, the study investigated the influence of individual- and contextual-level factors on condom use among 1,371 clients of female sex workers (FSW). A two-level random intercept model was specified for the multilevel analysis. The model included individuals at the first level and derived aggregates of an environmental-structural index, constructed using principal component analysis (Cronbach’s α = 0.71; Eigenvalue 2.94), at the second level. The analysis measured three outcome variables: condom use at last sex; in past 3 months; and in past year. Controlling for sociodemographic characteristics, environmental-structural support was a significant predictor of condom use at last sex (OR 1.77; 95% CI: 1.22-2.55; p<0.01), in the past 3 months (OR 2.23; 95% CI: 1.31-3.82; p<0.01); and in the past year (OR 2.09; 95% CI: 1.27-3.42; p<0.01). Almost one-fourth of the variation of condom use at last sex was accounted for by environmental-structural factors; this increased to almost one-third for condom use in the past 3 months and year. HIV prevention programs would benefit from efforts targeting the environmental-structural context to improve condom use behaviors and reduce HIV risk among male clients.