Academic journal article The Qualitative Report

Assessment of the Utilization of HIV Interventions by Sex Workers in Selected Brothels in Bangladesh: An Exploratory Study

Academic journal article The Qualitative Report

Assessment of the Utilization of HIV Interventions by Sex Workers in Selected Brothels in Bangladesh: An Exploratory Study

Article excerpt

In Asia, commercial sex has been identified as an important factor in the epidemic spread of HIV/AIDS (Ford, Wirawan, Suastina, Reed, & Muliawan, 2000). Female Sex Workers (FSWs) have diversified clients that include students, businessmen, transport workers, and others. All sex workers are engaged in high-risk sexual behaviours, such as multiple partners, unprotected sex, untreated sexually transmitted infections (STIs) and drug-abuse (Currie, 2008; Nuttbrock, Rosenblum, Magura, Villano, & Wallace, 2004). In general, commercial sex workers (CSWs) who inject drugs exhibit higher levels of risk-taking behavior (Kyrychenko & Polonets, 2005; Persaud, Klaskala, Baum, & Duncan, 2000; Spice, 2007) and high prevalence of HIV compared to non-CSWs (Kyrychenko & Polonets, 2005; Spice, 2007). Physical violence is also considered the greatest threat to the health and well-being of CSWs (Kyrychenko & Polonets, 2005; Malta et al., 2008; Spice, 2007), and this violence with clients and intimate partners is associated with increased vulnerability to STIs and HIV (Stachowiak, Sherman, Konakova, Krushkova, Beyrer, Peryskina, & Strathdee, 2005). In 1998, between 3,000 and 4,000 brothel-based sex workers were estimated to work at 28 registered brothels across Bangladesh. However, the report showed cautiousness about the actual number, which is likely to be much higher (Jenkins & Rahman, 2002). Sex workers in Bangladesh have the highest reported numbers of clients and the lowest reported rates of condom-use among Asian countries. This makes them extremely vulnerable to HIV and AIDS (Currie, 2008). Therefore, both FSWs and their clients are playing an important role as vectors for STI/HIV transmission among the general population.

The overall rate of HIV prevalence among FSWs is reportedly low (0.2%) in the 7th sero-surveillance because of the AIDS prevention interventions within these brothels over several years (Government of Bangladesh [GoB], 2007). Since 2004, within the HIV/AIDS Prevention Project of the Government of Bangladesh, three non-governmental organizations (NGOs): (a) Bangladesh Women's Health Coalition (BWHC); (b) Population Service and Training Center (PSTC); and (c) Community Health Care Project (CHCP), in addition to the International Centre for Diarrheal Disease, Bangladesh (ICDDR, B), have established a consortium and implemented a comprehensive HIV/AIDS prevention program in 8 selected brothels in Bangladesh. In this consortium, the three NGOs provided services, and ICDDR, B has conducted five censuses and a process-documentation since the inception of the program. This comprehensive program comprised a clinic-based drop-in centre (DIC) integrated with community-based intervention (peer education) in selected areas of the NGOs.

Peer education has been widely used to control the spread of HIV among the FSWs. In the comprehensive HIV prevention approach for FSWs, peer educators have been integrated to provide HIV/AIDS-related information to the FSWs, playing a role in condom distribution, bringing them to the health facilities and acting as a link between program management and the beneficiaries (UNAIDS, 1999; Campbell, 2000; Steen & Dallabettab, 2003). Involving the multiple components of peer interventions showed effectiveness in demanding condom-use and access to care for STIs: thus, having a public-health effect on a larger scale (Dandona et al., 2005; Jana, Rojanapithayakorn, & Steen, 2006; UNAIDS, 1999; Vuylsteke, 2001). According to Bandura's theory (Bandura, 1996), the above-mentioned approaches are expected to increase the level of perceived control over one's health. Albert Bandura recommends that educators foster or facilitate increased levels of self-efficacy beliefs. Education fosters positive learning strategies in which learners are aware of what they know, what they believe and how the difference between the two affects learning and task performance. Bandura situates the construct of self-efficacy within the context of social cognitive theory that personal factors (e. …

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