Socio-economic status may suppress the effect of knowledge on sexual risk among female sex workers

Abstract

Background: Socio-economic status (SES), human immunodeficiency virus (HIV) knowledge and self-efficacy influence risky behaviors and female sex workers (FSWs) are not exception. Aims: This study was aimed to investigate if SES, HIV knowledge and self-efficacy predict frequency of unprotected sex with injecting drug users (IDUs) among a sample of FSWs in Iran. Setting and Design: Universal Network for Health Information Dissemination and Exchange HIV Risk Study was a survey of IDUs and FSWs, conducted in eight different provinces of Iran, 2009. Materials and Methods: A total of 55 FSWs were entered in this study. Frequency of unprotected sex with IDUs during the past 6 months was the dependent variable. Number of sexual partners during the past 6 month, SES, HIV Knowledge, self-efficacy, perceived HIV risk and intention for change were predictors. Statistical Analysis: We used hierarchical regression for data analysis. In each step, a block of predictors were added to the model. SES block composed of education level, owning a house and living alone. Results: In the absence of SES in the model, HIV knowledge and self-efficacy were not significantly associated with the frequency of unprotected sex with IDUs during the past 6 months, However, with adding SES block to the model, HIV knowledge became significant predictor of the outcome. Thus, among our sample of Iranian FSWs, SES has a suppressor effect for the effect of HIV knowledge on frequency of unprotected sex with IDUs during the past 6 months. Conclusion: Studies which wish to understand the role of theory-based psychological constructs such as HIV knowledge on high risk behaviors need to include SES an essential contextual factor. This finding may also explain why literature is mixed on the effect of HIV knowledge on HIV risk behaviors.