Abstract

Why seafarers remain a very high risk group to HIV

D.E.I. Lucero-Prisno<sup>1,2

1</sup>University of the Philippines, College of Medicine, Manila, Philippines, ²Cardiff University, School of Social Sciences, Cardiff, United Kingdom

Background: Seafarers have always been historically seen as vulnerable to sexually transmitted infections because of many factors including mobility. The first cases of HIV in the history of AIDS were traced to seafarers. There have been an increasing number of seafarers infected since the early part of the epidemic until the present prompting various AIDS programs in the maritime industry as early as the 80s. Yet decades after, there seems to be a steady increase of infections despite the high level of awareness. Why the continued risky behaviour?
Methods: In-depth interviews and focus group discussions with international seafarers were conducted in a number of ports. Seafarers with HIV were also interviewed. Ethnographic studies in the bars frequented by seafarers in Brazil and South Africa were conducted.
Results: Ports all over the world are known to have bars catering to seafarers. Many risk factors were identified: economic capability, psychosocial needs, social organization and occupational determinants. Some of these factors are related to temporality and liminality. Distorted knowledge remains one major determinant despite exposure to many information. This changes their perception of risk leading to non-use of condom. The group has developed its own 'knowledge culture' such as the concept of 'suction effect' (withdrawal in the middle of ejaculation), various criteria of 'cleanliness' of sex workers, regular HIV testing and negative results leading to continued risky behaviour, rationale for sexual engagements, etc. 'Relationships' with sex workers still remains the defining factor in condom use. Frequency (temporal) of sex decreases the likelihood of condom use.
Conclusions: Seafarers remain a high risk group due to a variety of risk factors. Their risky behaviour is shaped by their 'knowledge' and risk perception. AIDS programs need to be 'repackaged' to make them more effective. Continuous monitoring of the various issues of the problem remains necessary.