|BRIEF RESEARCH ARTICLE
|Year : 2014 | Volume
| Issue : 4 | Page : 274-277
Safe sex practices of Indian immigrant men living in Australia: An exploratory research
Vijayasarathi Ramanathan, Gomathi Sitharthan
Faculty of Health Sciences, The University of Sydney, NSW, Australia
|Date of Web Publication||5-Dec-2014|
Consultant in Sexual Medicine, Department of Sexual Medicine, Bloom Healthcare, 32, Taramani Link Road, Velachery, Chennai-42, Tamil Nadu, India
Source of Support: None, Conflict of Interest: None
| Abstract|| |
There is a paucity of scientific information about safe sex practices of Indians immigrants living in popular multicultural nations such as Australia. An online survey of adult Indian men living in Australia was conducted to measure the frequency of use of safe sex practices using the Safe Sex Behavior Questionnaire (SSBQ). Among the respondents of the SSBQ (n = 184), 16.8% (n = 31) reported that never insist on condom use, when having sexual intercourse. One in two men surveyed, agreed that it is difficult for them to discuss safe sex issues with their sexual partners. One in two men said that they used alcoholic beverages prior to or during sexual intercourse. There were no significant differences in SSBQ data among Indian men based on their relationship status. The current study has assessed a range of safe sex practices by involving a community sample of Indian men, and provides baseline data for further evaluation and comparison.
Keywords: Indians, safe-sex practices, iImmigrants
|How to cite this article:|
Ramanathan V, Sitharthan G. Safe sex practices of Indian immigrant men living in Australia: An exploratory research
. Indian J Public Health 2014;58:274-7
|How to cite this URL:|
Ramanathan V, Sitharthan G. Safe sex practices of Indian immigrant men living in Australia: An exploratory research
. Indian J Public Health [serial online] 2014 [cited 2022 Jan 29];58:274-7. Available from: https://www.ijph.in/text.asp?2014/58/4/274/146295
In order to have effective risk reduction strategies and policies to promote safe sex practices, more attention have to be paid to the cultural and many other psycho-social influences that surround and form the context for human sexual behavior.  Such an effort is even more important in countries like Australia or Canada or the UK that are highly multicultural and have a high influx of Indian immigrants in their peak sexually active age groups. Despite Indians being a sizeable immigrant population group, there is a paucity of research exploring Indian immigrants' sexual health especially about their safe sex practices. ,,
There is some evidence to demonstrate that Indian immigrants, in general, have a lower number of sexual partners, lower numbers of concurrent partners and low sexual risk-taking profile. ,, On the other hand, Indian and Asian immigrants tend to be naiive about sexuality and have poor knowledge about sexually transmitted infections and sexual health. , This was supported by a detailed review that concluded that sexual health knowledge is poor among young South Asians in the UK.  Indian men tend to believe that condoms are restrictive and reduce pleasure and that condoms should accordingly be reserved for use with commercial sex workers rather than wives. Attitudes toward use of condoms expressed by Indian men in the US are generally negative or ambivalent.  Some sexually active Indian men combine consumption of alcoholic beverages with sexual activity.  However, it is important to bear in mind that much of the above evidence is based on college students samples of Indians, who are young and single. There is a paucity of research data on safe sex practices of Indians across a wide age bracket, in different relationship status and involving a community-representative sample.
The present study was part of a larger study of sexuality and sexual health of Indian immigrant men. The aim of this exploratory study was to measure the frequency of use different safe sex practices, using a psychometrically validated tool, among a community-derived sample of adult Indian immigrant men in Australia.
The survey spanned between December 2010 and August 2011, and was made available in both online and paper versions. Participants were recruited through advertisements on Indian specific websites and social networking websites such as Facebook and Google. The 24-item Safe Sex Behavior Questionnaire (SSBQ) was used to measure frequency of use of recommended practices that reduces one's risk of exposure to, and transmission of sexually transmissible infections (including HIV).  Summing responses, after reverse scoring for negatively worded items, to all 24-item derived a total score, which could range from 24 to 96. Lower scores indicate lower frequency of use of safe-sex practice. Nonparametric tests were used in the analysis, as the data was not normally distributed.
Overall, 438 men attempted and 278 of them completed the entire survey (100-item). Of those who completed the survey, 184 completed the section on safe sex behavior, a response rate of 42%. The mean age of the survey sample was 31 years (SD = 9.72), range 18-64 years. The majority of the Indian men had a university degree (81%), was employed (78%) and identified themselves as Hindus (71%). Less than one-fifth of respondents (17%) were students. Nearly, one in every two men (49%) was married. Of the total, about two-thirds (64%) of participants were in a relationship (married, living together or in a relationship).
Of all SSBQ respondents, 16.85% (n = 31) reported that never insist on condom use when having sexual intercourse. One hundred and fifteen men said that they never engage in anal sex and over three-fourth of men (79.35%, n = 146) reported that they never engage in anal intercourse without a condom. One in two men surveyed agreed that it is difficult for them to discuss safe sex issues with their sexual partners. A large proportion of men (62.50%, n = 115) reported that they would never engage in sexual intercourse on a first date. The vast majority of men (n = 174) reported that never use any form of illicit drugs. Fifty percent of respondents (n = 92) said that they used alcoholic beverages prior to or during sexual intercourse. Of them, 74 men use it sometimes while the rest use it most of the times or always. Proportion of response to all 24-item is provided in [Table 1].
|Table 1: Descriptive statistics of safe sex behavior questionnaire (n = 184)|
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The survey respondents of the SSBQ section (n = 178, six men did not report their relationship status) were divided into two groups based on their relationship status. Group 1 was men who were "not in a committed relationship" (i.e., single/never married, divorced or separated) (n = 86) and Group 2 was those "in a committed relationship" (i.e. married or live together/de facto) (n = 92). The mean SSBQ score of Group 1 was 65.97 (SD: 12.29, 95% CI: 63.34-68.61) and Group 2 was 64.32 (SD: 11.76, 95% CI: 61.58-66.75).
Mann-Whitney U-test was performed to examine whether there is a difference in safe sex practice frequency between men, who were in a committed relationship or not. The result indicated that the overall SSBQ score of men, who are not in a committed relationship (mean rank = 95.44, n = 86) was not significantly different to men who are in a committed relationship (mean rank = 83.95, n = 92). However, the test had a power <70% failed to have a minimum power (of 80%) due to inadequate sample size.
Much of the information we have about safe sex behavior among Indian immigrants has been mainly derived from young people (school or college students). , Very few studies of sexual health have involved older (e.g., 30-40 years) Indian immigrants in the United States of America and the United Kingdom. ,, Past studies ,,, on safe sex practice/risky sexual behavior of Asian/Indians were much narrow in its approach and relied on one or two measurable items/questions such as frequency of condom use, age at first sexual intercourse, or number of sexual partners. In contrast, the present study employed a validated scale that not only covered these topics but also included much broader topics related to safe sex such as interpersonal skills, intentions/mental preparedness to practice safe sex, and assessment of sexual partners. The present study has generated data on safe sex behavior among adult Indian immigrant men who were recruited from the general community rather than from a particular high-risk group.
In the present study, Indian men who were in a committed relationship tended to practice safe sex less frequently (lower SSBQ mean score) than those who were not in a committed relationship. Although the difference could not be proven statistically, this finding does not come as a surprise. There is clearly less reason to practice safe sex with a steady sexual partner because of the trust involved in a committed relationship. It is important, nonetheless, to consider other factors that may be significant in the Indian context. Women in a monogamous relationship have been identified as an at-risk group for HIV in India.  This is mainly because Indian men who engage in casual and extramarital sexual activities tend not to use condoms when having sex with their wives, fearing this may lead to relationship and family break-up. Finally, lower frequency of safe sex practice could be due to poor sexual health knowledge or denial of personal risk of infection, as previous research suggests. ,
While an online survey reaches out to a much wider community and provides total anonymity, it has its disadvantages. It is possible for noneligible persons (e.g., under 18 years, female, living outside Australia) to participate, and the same person could participate multiple times. The online survey tool (Zoomerang) had the facility to collect participants' IP addresses, which could have enabled responses to be tracked to the source. Although this feature could have eliminated some of these problems, it was not used because it would have affected anonymity and potentially limited the sample size.
Online methods of data collection have the advantage of wider access for participants to take part in the survey. At the same, the disadvantage of online surveys is that it is limited to people who have access to computer and Internet. This limitation has the potential to impose bias in sample selection especially in societies that have a higher proportion of people who don't have access to computers and internet or not computer literate.
A limitation of the present study is that it did not collect data on the number of sexual partners, frequency of partner change and the nature of sexual activity. Given that the present study was first of its kind, the above-mentioned data were perceived to be highly sensitive to be collected through an online survey especially from a community sample and furthermore impacted on the sample size. Due to this limitation, the safe sex behavior frequency data could not be categorized based on risk profile of the survey respondents.
Indian immigrant men, in the present and past studies, might not appear to be an at-risk group for any targetted strategy or intervention. Given that culture shapes sexual practices and that India continues to go through an era of rapid westernization, it is important to monitor the sexual risky behavioral pattern of Indian immigrants so that sexual health promotion could be tailored accordingly.
| Acknowledgments|| |
The authors acknowledge the contributions of Dr. Gomathi Sitharthan, Ms. Karen Pepper and Dr. Kevan Wylie.
| References|| |
Kelly JA, Kalichman SC. Increased attention to human sexuality can improve HIV-AIDS prevention efforts: Key research issues and directions. J Consult Clin Psychol 1995;63:907-18.
Griffiths C, Prost A, Hart G. Sexual and reproductive health of South Asians in the UK: An overview. J Fam Plann Reprod Health Care 2008;34:251-60.
Dhar J, Griffiths CA, Cassell JA, Sutcliffe L, Brook GM, Mercer CH. How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England. Sex Transm Infect 2010;86:366-70.
Griffiths C, Johnson AM, Fenton KA, Erens B, Hart GJ, Wellings K, et al
. Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: Evidence from a national probability survey. Int J STD AIDS 2011;22:131-9.
Fenton KA, Mercer CH, McManus S, Erens B, Wellings K, Macdowall W, et al
. Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: A probability survey. Lancet 2005;365:1246-55.
Tosh AK, Simmons PS. Sexual activity and other risk-taking behaviors among Asian-American adolescents. J Pediatr Adolesc Gynecol 2007;20:29-34.
Shedlin MG, Drucker E, Decena CU, Hoffman S, Bhattacharya G, Beckford S, et al
. Immigration and HIV/AIDS in the New York metropolitan area. J Urban Health 2006;83:43-58.
Groetzinger LL. Attitudes and Behaviours of South Asian Men in Chicago. Culturally Contextualizing Health Risk. Chicago: The University of Illinois; 2004.
DiIorio C, Parsons M, Lehr S, Adame D, Carlone J. Measurement of safe sex behavior in adolescents and young adults. Nurs Res 1992;41:203-8.
Bradby H, Williams R. Behaviours and expectations in relation to sexual intercourse among 18-20 year old Asians and non-Asians. Sex Transm Infect 1999;75:162-7.
Coleman L, Testa A. Sexual health knowledge, attitudes and behaviours among an ethnically diverse sample of young people in the UK. Health Educ J 2007;66:68-81.
Gagnon AJ, Merry L, Bocking J, Rosenberg E, Oxman-Martinez J. South Asian migrant women and HIV/STIs: Knowledge, attitudes and practices and the role of sexual power. Health Place 2010;16:10-5.
Gangakhedkar RR, Bentley ME, Divekar AD, Gadkari D, Mehendale SM, Shepherd ME, et al
. Spread of HIV infection in married monogamous women in India. JAMA 1997;278:2090-2.