Abstract
BackgroundHeterosexual contact is the most common mode of transmission of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) in Nepal and it is largely linked to sex work. We assessed the non-use of condoms in sex work with intimate sex partners by female sex workers (FSWs) and the associated self-efficacy to inform the planning of STI/HIV prevention programmes in the general population.MethodsThis paper is based on a qualitative study of Female Sex Workers (FSWs) in Nepal. In-depth interviews and extended field observation were conducted with 15 FSWs in order to explore issues of safe sex and risk management in relation to their work place, health and individual behaviours.ResultsThe main risk factor identified for the non-use of condoms with intimate partners and regular clients was low self efficacy. Non-use of condoms with husband and boyfriends placed them at risk of STIs including HIV. In addition to intimidation and violence from the police, clients and intimate partners, clients' resistance and lack of negotiation capacity were identified as barriers in using condoms by the FSWs.ConclusionThis study sheds light on the live and work of FSWs in Nepal. This information is relevant for both the Government of Nepal and Non Governmental Organisations (NGO) to help improve the position of FSWs in the community, their general well-being and to reduce their risks at work.
Highlights
Heterosexual contact is the most common mode of transmission of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) in Nepal and it is largely linked to sex work
In order to keep the identity of the female sex workers (FSWs) confidential, each was assigned identification (ID)
Condom use with paying clients/non-paying partners The FSWs who we interviewed did not use condoms for various reasons: Clients’ refusal due to their perception that a condom reduces pleasure during sex, some FSWs offering sex without a condom, FSW’s misconception that well off and healthy clients and familiar men or boyfriends do not harbour STI and HIV were reported as the reasons for not using condoms
Summary
Heterosexual contact is the most common mode of transmission of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) in Nepal and it is largely linked to sex work. We assessed the non-use of condoms in sex work with intimate sex partners by female sex workers (FSWs) and the associated selfefficacy to inform the planning of STI/HIV prevention programmes in the general population. The conditions and environment of sex work in South East Asia have not been well described, despite rising sexually transmitted infections (STI) and human immunodeficiency virus (HIV) incidence rates which are attributed to both sex work and drug use [3,4]. Labour migrants to India constitute one of the ‘bridging populations’ for the transmission of STIs and HIV infection.
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