Transactional Sex Risk across a Typology of Rural and Urban Female Sex Workers in Indonesia: A Mixed Methods Study

Dewi Ismajani Puradiredja,Ernestina Coast

doi:10.1371/journal.pone.0052858

Abstract

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n = 310), in-depth interviews (n = 11), key informant interviews (n = 5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13–0.90, p = 0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology.

Highlights

Indonesia has one of the fastest growing HIV epidemics in Asia, and sexual transmission is among the primary modes of transmission [1,2,3]
Projections suggest that 43% of new HIV infections due to sexual transmission will be attributable to unprotected transactional sex by female sex workers (FSWs) and their clients by 2014 in Indonesia [3]
Ethics statement Ethical approval was granted by the London School of Economics (LSE) Research Ethics Committee on 04 August 2006 and verbal informed consent obtained from all participants

Summary

Introduction

Indonesia has one of the fastest growing HIV epidemics in Asia, and sexual transmission is among the primary modes of transmission [1,2,3]. Projections suggest that 43% of new HIV infections due to sexual transmission will be attributable to unprotected transactional sex by female sex workers (FSWs) and their clients by 2014 in Indonesia [3]. Up to 16% of Indonesian FSWs are infected with HIV, and more than 60% of FSWs do not consistently use condoms with clients [4,5]. The importance of unprotected transactional sex in countries with concentrated HIV epidemics requires an improved understanding of the context and organisation of at-risk groups, such as female sex workers. Sex work typologies or distinctions between types of sex workers are usually taken into account as part of a study’s sampling strategy [4,6,7,8,9], but can be considered as an independent variable in subsequent analysis on sex work, HIV/ STI risk and associated behaviours [6]. The setting in which FSWs engage clients may affect FSWs’ ability to negotiate condom use, as well as client numbers and type [6,9,10]

Methods

Results

Discussion

Conclusion