Abstract
Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.
Highlights
The HIV epidemic in Indonesia remains concentrated among key populations such as female sex workers (FSWs), men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and prisoners
Based on social capital constructs, less than half of the indirect FSWs perceived a high-level of support from their internal networks (97; 48.50%) and highly trusted their peers (93; 46.50%)
This study found that social cohesion, perceived high-level of support increased the HIV testing uptake by almost three-fold among indirect FSWs even after controlling all socio-demographic characteristics
Summary
The HIV epidemic in Indonesia remains concentrated among key populations such as female sex workers (FSWs), men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and prisoners. Findings from the integrated biological and behavioral survey (IBBS) in 2015 showed that PWID and MSM were the most affected populations with HIV prevalence of 28.76% and 25.80%, respectively, followed by transgender people of 24.80% and FSWs of 5.30% [1,2]. Despite FSWs had the lowest HIV prevalence, they are thought to play important roles in HIV infection to the general population due to heterosexual intercourse is the main mode of HIV transmission in Indonesia [3]. Direct FSWs refers to those whose sex work is the main source of income and they provide sex services in red-light areas, commonly identified as brothel or street FSWs [5,6].
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