Determinants of the STD/AIDS Related Behaviors of Female Commercial Sex Workers in Kramat Tunggak, Jakarta, Indonesia

Sedyaningsih-Mamahit, Endang Rahayu (1996) Determinants of the STD/AIDS Related Behaviors of Female Commercial Sex Workers in Kramat Tunggak, Jakarta, Indonesia. UNSPECIFIED thesis, Pusat Penelitian dan Pengembangan Bio Medis.

Abstract

The objectives of this research were to study the personal, professional, and contextual determinants of the STDI AIDS-related behaviors of the female commercial sex workers (FCSWs) in the Kramat Tunggak brothel complex, Jakarta, and to investigate which factors among them determined the FCSWs' safer-sex behaviors (i.e., "consistent condom use"). Our hypothesis was that, after controlling for sociodemographic factors, the women's continuous condom use would be positively associated with knowledge of STD and AIDS, perceptions of self-susceptibility to STD/AIDS infection and of the severity of the diseases, positive attitudes towards STD/AIDS, positive beliefs of condoms, self-efficacy in using condoms, intentions to practice safer-sex in the near future (as well as self-efficacy in carrying out this intention), previous experience in using and negotiating condom use with clients, a past history of at least one STD, consistent condom provision by the brothel managers, and attending government's programs. This continuous condom use was also hypothesized to be negatively associated with the FCSWs' negative beliefs of condoms, and perceived clients' and managers' attitudinal barriers towards condom use. A preliminary study in 1993, a behavioral survey, laboratory tests for gonorrhoea and syphilis, and an ethnographic study were conducted in 1995 to accomplish the above objectives. The ethnographic study, which was conducted from April to November 1995, had the participation of 30 FCSW s, 12 brothel managers, 5 vocational teachers, 6 government officers, and 46 clients, arrived at the following findings: 1. There were 3 types of brothels: the bar-like brothel (operating more like a discobar plus sex service), the bar-brothel type (small bar and dancing floor, with more emphasise on sex service), and the pure-brothel type (mainly sex service). 2. From the FCSWs' point of view, clients were divided into "occasional" (new client or rarely visited), "regular" (have visited 3 times or more in a relatively short period), and "lovers." Regulars and lovers were less willing to use condoms, as well as older clients. 3. Based on the women's motivating factors to enter and to stay in the sex trade, the FCSWs can be divided into 4 categories, each with its own characteristics (though these are not mutually exclusive): the economically-forced (who had little choice other than to work as a FCSW), the economically-driven (who had more options, but chose this job because it is acceptable in their culture), the victimized (who experienced various types of abuse before entering the profession), and the professional (who saw sex-working as a job similar to any other). In general, such category has also its characteristic with regards to condom use. 4. There were 4 brothel-management styles in Kramat Tunggak: paternalistic (where managers ruled authoritatively but also with a great amount of attention for the benefit of the FCSWs), familial (where the managers behaved like were practically operating on their own), and business-like (where the managers' main interest was to make money, and they paid little attention to the FCSWs, welfare). There seemed to be no association between these management styles with the managers' concern about condom use. 5. The government's STD/AIDS-related programs were the monthly health mobile service and the occasional talks; both were poorly planned and the former had created the false belief that the FCSW s were being protected from STD/AIDS. In the behavioral survey, an interviewer-administered questionnaire was used to interviewer 459 random samples, and laboratory tests were conducted on specimens from voluntary respondents. With regards to the prevalence of gonorrhoea and syphilis, found that there was no difference between FCSWs who said that they always used condoms over the previous two weeks with those who did not. We also found that, after adjusting for age, educational attainment, hometown, and years of working in Kramat Tunggak, the FCSWs ' " consistent condom use" was significantly associated with their :previous experience in negotiating condom use and using them for family-planning purposes, the clients' and managers' low attitudinal barrier towards condom use, and with low exposure to the government's programs. To assure the quality of the FCSWs' self-reported condom use, estimated reproducibility was obtained using a 2-week apart test-retest interview. Results showed that condom use had a moderate reproducibility with Spearman rho estimated (p=0.04). A 2-week daily diary method was used to estimate the condom-use relative validity , and the results showed a moderate correlation between the self-reported and the recorded condom use (Spearman rho: 0.61 with p=0.004). Our study, therefore, gave sufficient evidence that self-reporting was a reasonably good method to assess condom use. Finally, based on the study findings, we suggested the following: 1. Brothels managers and clients are strong inhibiting factors for the FCSWs consistent condom use. Therefore. the government should make every effort to change the condom-related "norm" in brothels (especially in official ones), so that using condom is the "in" thing. This can be done by adding a policy on condom use on top of existing regulations for brothels, brothel managers, FCSWs, and clients. Brothel managers should be compelled to provide condoms in their brothel, and a condom booth should be placed at each gate, where clients can purchase (or receive free) condoms and get leaflets about safe sex. This policy will at least encourage the FCSWs to bring up the issue of condoms to their clients. 2. More aggressive and effective methods should be used to convey STDI AIDS-related messages to the FCSWs and the brothel managers. Since the study revealed that previous experience in using and negotiating condoms would increase their use, regular, longer-term classes are preferable to the current short-term intensive training. In official brothels this method is possible, because the system already has regular vocational training programs. The curriculum should include condom desensitization, techniques to use and negotiate condom use with clients, and should involve brothels as a unit, i.e., involving the managers and bodyguards, as well. It is preferable to have mobile classes will go from brothel to brothel to conduct their training . 3. The existence health mobile clinic was not only ineffective to prevent STDs, but also created a false secure feeling among the brothel community , which could be detrimental to the women's--and the clients'--health. A clinic with a simple laboratory inside the brothel complex is a necessity for controlling the STD rates in this community health team should mainly be staffed by women, and it should pay attention to what FCSWs perceive as their health problems. The health professionals should act as the FCSWs' family physicians, who are able to listen and refer the women to more capable health centers, if necessary . 4. This study did not cover non-brothel-based FCSWs which might have totally different social structure. Therefore, studies of this type of sex workers and their clients should be conducted to find effective methods to promote safer sex among them. Furthermore, studies on the general community surrounding official brothels are also necessary to be able to convey safer-sex messages to them without offending the religious parties. In our opinion, a combination of a behavioral survey and an ethnographic study is method of choice.

Actions (login required)

View Item