Factors related to condom use among four groups of female sex workers in Bali, Indonesia

Abstract

This article tests a behavioral model of condom use for four groups of female commercial sex workers. Data were drawn from a study of 614 female sex workers conducted in Bali, Indonesia. AIDS knowledge, risk behaviors, and factors related to condom use varied substantially among the four groups of women and reflect the social context of their work. Interventions for each group need to reflect these differences. Important factors to consider include the level of AIDS and STD knowledge in their environment, the characteristics of the clients served, and the degree of supervision that they receive.

PIP: The efficacy of a behavioral model of condom use was evaluated in 4 groups of commercial sex workers in Bali, Indonesia, in 1992-93: 1) women working in low-price complexes supervised by a pimp in the Denpasar area (n = 407); 2) mid-price women who rent rooms within family complexes or bungalows (n = 77); 3) women working at high-price houses in and around Denpasar (n = 50); and 4) independent workers at the Kuta tourist resort (n = 80). Mean knowledge scores among the 614 prostitutes ranged from 8.3 to 11.6 out of a possible 19. Common misconceptions were that an HIV-infected person could appear healthy and that AIDS can be cured with medicine or injections. The mean number of clients in the week preceding the interview was 15.8 at low-price brothels, 10.5 in the bungalow group, 4.7 at high-price houses, and 3.2 at the resort. Condom use with clients was 19%, 68%, 71%, and 90%, respectively. The effects of independent variables on condom use were evaluated through multiple regression analysis. Among women in the low-price and bungalow groups, condom use was significantly associated with beliefs about condoms' ability to prevent sexually transmitted disease (STD) and pregnancy, the belief condoms enhance sexual pleasure, perceived susceptibility to STDs (but not HIV), self-efficacy, number of clients in the past week, and pregnancy history. For women in the resort area, condom use was related to beliefs about the ability of condoms to protect against STDs and AIDS, perceived susceptibility to HIV infection, and experience with an STD. Finally, among high-price prostitutes, condom use was associated with the belief condoms prevent AIDS and increase pleasure, self-efficacy, and pregnancy experience. These findings indicate that levels of AIDS knowledge and the extent of risky behaviors are related to the particular social context in which sex work is practiced.