Structural Determinants of Risky Sexual Practices Among Ship Crew Members in Indonesia: A Qualitative Study
Abstract
Introduction: Ship crews are highly susceptible of HIV infection. Masculinity (most of crews were men), highly mobile (less peer intervention), ease of commercial sexual intercourse, and emotional distress (limited working space and interaction) are the main drivers that tend to exacerbate crew's vulnerability to high-risk sexual behaviors. However, understanding their structural vulnerabilities (in socio-behavioral scope) remain underexplored. This study aims to examine the socioal, cultural, economic, and occupational factors that influence risky sexual behavior among ship crew members (ABK) in Ambon Port. with particular attention to masculinity norms, mobility, transactional sex, and emotional needs.
Methods: Qualitative research approach was employed as the analysis basis of the analysis. Data were gathered using semi-structured, in-depth interviews with 25 male ship crews, recruited through snowball sampling. Pre-determined theories (i.e. hegemonic masculinity theory, sexual economy theory, and mobility and health risk frameworks) were utilized as scoping guide to analyze data thematically, focusing on the structural and psychosocial determinants of sexual risk behavior.
Results: Lack of knowledge were not a factor to risky sexual behavior as many informants were aware of HIV risks. On the other hand, the behavior apparently embedded in hypermasculine peer cultures (e.g. normalizing promiscuity, stigmatize prophylactic use, and enforce conformity through social ostracism and marginalization. Crew's financial leverage enables them to have commercial sexual intercourse throughout ship's docking at a port. In addition, permissive culture, identity shifting, and emotional distress (e.g. loneliness, absence of peer-led moral control) alleviates as a coping mechanism.
Conclusion: To address sexual risk behavior among ship crew members structural occupational health interventions are needed, which target the most well-heared crew to build community peer moral control. Our analysis highlights the importance of educate maritime workers via Port Health Officers, since the behavior done within a port or while the ship's docked. Site-specific interventions at ports should be the first mitigation to prevent risky behavior or at the very least, facilitate moral adherence to 'safety' practices.
References
Arifin B, Rokhman MR, Zulkarnain Z, Perwitasari DA, Mangau M, Rauf S, et al. The knowledge mapping of HIV/AIDS in Indonesians living on six major islands using the Indonesian version of the HIV-KQ-18 instrument. PLoS One [Internet]. 2023 [cited 2026 Feb 18];18(11):e0293876. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0293876
Pougnet R, Pougnet L, Dewitte JD, Rousseau C, Gourrier G, Lucas D, et al. Sexually transmitted infections in seafarers: 2020’s perspectives based on a literature review from 2000–2020. Int Marit Health [Internet]. 2020 [cited 2026 Feb 18];71(3):166–73. Available from: https://pubmed.ncbi.nlm.nih.gov/33001427/
UNAIDS. AIDS, Crisis and the Power to Transform [Internet]. 2025. Available from: https://www.unaids.org/en/resources/documents/2025/2025-global-aids-update
Chowdhury SAA, Smith J, Trowsdale S, Leather S. HIV/AIDS, health and wellbeing study among International Transport Workers’ Federation (ITF) seafarer affiliates. Int Marit Health [Internet]. 2016 [cited 2026 Feb 18];67(1):42–50. Available from: https://pubmed.ncbi.nlm.nih.gov/27029929/
Baumeister RF, Vohs KD. Sexual Economics: Sex as Female Resource for Social Exchange in Heterosexual Interactions. Personality and Social Psychology Review [Internet]. 2004 [cited 2026 Feb 18];8(4):339–63. Available from: https://pubmed.ncbi.nlm.nih.gov/15582858/
Connell RW. New directions in gender theory, masculinity research, and gender politics. Ethnos [Internet]. 1996 [cited 2026 Feb 18];61(3–4):157–76. Available from: https://www.semanticscholar.org/paper/New-directions-in-gender-theory%2C-masculinity-and-Connell/cc24e56a4a2e5937ea1e8656c6d2b1cdac32e211
Jocelyn, Nasution FM, Nasution NA, Asshiddiqi MH, Kimura NH, Siburian MHT, et al. HIV/AIDS in Indonesia: current treatment landscape, future therapeutic horizons, and herbal approaches. Front Public Health [Internet]. 2024 [cited 2026 Feb 18];12. Available from: https://pubmed.ncbi.nlm.nih.gov/38420030/
Inman EM, Zharima C, Hammock A, Violari A, Kidman R. The role of masculinity in HIV disclosure among adolescent South African boys living with HIV. AIDS Care [Internet]. 2025 Oct 3 [cited 2026 Feb 18];37(10):1785–94. Available from: https://pubmed.ncbi.nlm.nih.gov/40838871/
Gatanaga OS, Lanza DV, Pitts RA, Braithwaite RS, Lim S. Multi-level factors influencing HIV risk behaviors and oral PrEP use among Black and Latino men with heterosexual contact in New York City. PLoS One [Internet]. 2025 Jul 11 [cited 2026 Feb 18];20(7):e0327677. Available from: https://pubmed.ncbi.nlm.nih.gov/40644436/
Connell R. Masculinities in global perspective: hegemony, contestation, and changing structures of power. Theory Soc [Internet]. 2016 [cited 2026 Feb 18];45(4):303–18. Available from: https://philpapers.org/rec/CONMIG
Hergenrather KC, Emmanuel D, Zeglin RJ, Ruda DJ, Rhodes SD. Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model. AIDS Education and Prevention [Internet]. 2021 [cited 2026 Feb 18];33(6):511–33. Available from: https://pubmed.ncbi.nlm.nih.gov/34874760/
Merdassa AB. Traditional masculinity, peer pressure, and sensation seeking as correlates of risky behaviours. Int J Adolesc Youth [Internet]. 2024 [cited 2026 Feb 18];29(1). Available from: https://www.tandfonline.com/doi/full/10.1080/02673843.2023.2298087
Ani JI, Katende-Kyenda LN. Norms of Masculinities and Gender Socialization Among Young Boys in South Africa: Implications for Gender-Based Violence, Policies, and Interventions. Sexes [Internet]. 2025 Oct 2 [cited 2026 Feb 18];6(4):54. Available from: https://www.mdpi.com/2411-5118/6/4/54
Adrian H, Kuo C, Rasmeni A, Gana N, Orchowski LM, Berkowitz AD, et al. Correcting misperceived norms: An integrated intervention to prevent adolescent sexual violence and HIV in South Africa. Glob Public Health [Internet]. 2025 Dec 31 [cited 2026 Feb 18];20(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12836470/
Natalis A. Condom use in Indonesia: Interplay with societal norms and human rights. Journal of Medicine, Surgery, and Public Health [Internet]. 2026 Apr [cited 2026 Feb 18];8:100225. Available from: https://www.sciencedirect.com/science/article/pii/S2949916X26000010
Perales F, Kuskoff E, Flood M, King T. Like Father, Like Son: Empirical Insights into the Intergenerational Continuity of Masculinity Ideology. Sex Roles [Internet]. 2023 [cited 2026 Feb 18];88(9–10):399–412. Available from: https://www.researchgate.net/publication/369823128_Like_Father_Like_Son_Empirical_Insights_into_the_Intergenerational_Continuity_of_Masculinity_Ideology
Nilan P. Contemporary Masculinities and Young Men In Indonesia. Indones Malay World [Internet]. 2009 [cited 2026 Feb 18];37(109):327–44. Available from: https://research-repository.uwa.edu.au/en/publications/contemporary-masculinities-and-young-men-in-indonesia/
Putri FS, Herbawani CK. Risky Sexual Behavior among Men Who Have Sex with Men (MSM) in Indonesia: A Literature Review. Jurnal Kesehatan Pasak Bumi Kalimantan [Internet]. 2024 [cited 2026 Feb 18];7(1):36. Available from: https://www.researchgate.net/publication/391996690_Risky_Sexual_Behavior_among_Men_Who_Have_Sex_with_Men_MSM_in_Indonesia_A_Literature_Review
Singh R, Joshi H. Sexual behavior among truck drivers. Indian J Public Health [Internet]. 2012 [cited 2026 Feb 18];56(1):53. Available from: https://pubmed.ncbi.nlm.nih.gov/22684174/
Pachauri S, Pachauri A, Mittal K. Sexual Behaviors of Long-Distance Truck Drivers. In: Sexual Health and Behaviour [Internet]. 2022 [cited 2026 Feb 18]. p. 61–76. Available from: https://link.springer.com/chapter/10.1007/978-981-16-4578-5_5
Scott A, Davis-Sramek B. Driving in a man’s world: examining gender disparity in the trucking industry. International Journal of Physical Distribution & Logistics Management [Internet]. 2023 [cited 2026 Feb 18];53(3):330–53. Available from: https://www.emerald.com/ijpdlm/article/53/3/330/163182/Driving-in-a-man-s-world-examining-gender
Muhibbuthabry, Jailani, Siregar PA, Hutasoit EF. Qanun, religious education, religiosity and sexual activity among Muslim youth. HTS: Theological Studies [Internet]. 2023 [cited 2026 Feb 18];79(1). Available from: https://hts.org.za/index.php/hts/article/view/8020/24191
McKenzie SK, Oliffe JL, Black A, Collings S. Men’s Experiences of Mental Illness Stigma Across the Lifespan: A Scoping Review. Am J Mens Health [Internet]. 2022 [cited 2026 Feb 18];16(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35125015/
Goodman MK. Reading fair trade: political ecological imaginary and the moral economy of fair trade foods. Polit Geogr [Internet]. 2004 [cited 2026 Feb 18];23(7):891–915. Available from: https://www.researchgate.net/publication/223641403_Reading_Fair_Trade_Political_Ecological_Imaginary_and_the_Moral_Economy_of_Fair_Trade_Foods
Palomera J, Vetta T. Moral economy: Rethinking a radical concept. Anthropological Theory [Internet]. 2016 [cited 2026 Feb 18];16(4):413–32. Available from: https://journals.sagepub.com/doi/10.1177/1463499616678097
UNAIDS. Confronting Inequalities: Lessons for pandemic responses from 40 years of AIDS [Internet]. 2021 [cited 2026 Feb 18]. Available from: https://www.unaids.org/en/resources/documents/2021/2021-global-aids-update
Pollak C, Cotton K, Winter J, Blumen H. Health Outcomes Associated with Loneliness and Social Isolation in Older Adults Living with HIV: A Systematic Review. AIDS Behav [Internet]. 2025 Jan 4 [cited 2026 Feb 18];29(1):166–86. Available from: https://pubmed.ncbi.nlm.nih.gov/39231919/
Becker HS. The Politics of Presentation: Goffman and Total Institutions. Symb Interact [Internet]. 2003 [cited 2026 Feb 18];26(4):659–69. Available from: https://www.cchla.ufpb.br/rbse/BeckerArt.pdf
Schliehe AK. Re-discovering Goffman: contemporary carceral geography, the “total” institution and notes on heterotopia. Geogr Ann Ser B [Internet]. 2016 [cited 2026 Feb 18];98(1):19–35. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/geob.12087
Waldmann G, Zippel S, Reinholz M, Fuchs C. From Misunderstanding to Marginalization: The Role of Knowledge in HIV-Related Discrimination and Risk Behavior Among Adolescents in Germany. AIDS Patient Care STDS [Internet]. 2025 Jul 1 [cited 2026 Feb 18];39(7):281–8. Available from: https://pubmed.ncbi.nlm.nih.gov/40546098/
Perpres. Peraturan Presiden (Perpres) Nomor 124 Tahun 2016 tentang Perubahan Atas Peraturan Presiden Nomor 75 Tahun 2006 Tentang Komisi Penanggulangan Aids Nasional [Internet]. Indonesia. Database Peraturan JDIH BPK; 2016 [cited 2026 Feb 18]. Available from: https://peraturan.bpk.go.id/Details/41028/perpres-no-124-tahun-2016
Permenkes. Peraturan Menteri Kesehatan Nomor 23 Tahun 2022 tentang Penanggulangan Human Immunodeficiency Virus, Acquired Immuno-Deficiency Syndrome, dan Inkubasi Menular Seksual [Internet]. Indonesia. Database Peraturan JDIH-BPK; 2022 [cited 2026 Feb 18]. Available from: https://peraturan.bpk.go.id/Details/245543/permenkes-no-23-tahun-2022
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