Demographic Correlates of Constant Condom Use among Sex Workers in Tangail, Dhaka, Bangladesh
Eva, Nilufar Akter, Munakata, Tsunetsugu, Onuoha, Francis N., Adolescence
The first reported case of HIV infection in Bangladesh was in 1989; by the year 2000, 248 HIV cases were known (Rahman et al., 2000). Although Bangladeshi HIV cases might be considered low, HIV-risk behaviors among the people are high (Islam et al., 1999). For example, there is a low condom use rate, a high level of sex worker patronage, a low knowledge of HIV/AIDS, and extensive needle/syringe sharing by injecting drug users (Government of Bangladesh, 2001). Bangladesh is surrounded on the north, east, and west by India, and on the southeast by Myanmar. Both countries are experiencing a significant HIV epidemic, estimated at 7.6 and 0.6 million, respectively among India and Myanmar children and adults up to age 45 (UNAIDS, 2004). In those countries there is significant cross-border vehicular traffic (Barkat & Majid, 2001) which may facilitate HIV spread. UNAIDS estimates that over 13,000 Bangladeshi adults and children may have HIV/AIDS.
In the last two decades, Bangladesh has experienced a high urban growth rate estimated at over 6% as compared with a rural rate of 2% (Barkat & Akter, 2001). About 65% of this urban growth is rural poverty driven, and the result in most places has been described as "slumization" (Barkat & Akter, 2001). These poor migrants tend to have behavioral characteristics which leave them vulnerable to HIV infection (Binayek, 2000). They tend to have more than one wife, engage in higher pre-marital and extra-marital sexual relationships, and exhibit higher violence against women (Binayek, 2000). There is a greater prevalence of drug use, lack of access to proper health care, and higher divorce rate and destitution among women (Opel, 1998). Rape is common, and a raped girl is unfit for marriage because she is no longer a virgin (Human Rights Watch Bangladesh, 2003). Unable to find a spouse, some of these girls, divorced women, and/or school dropouts may become sex workers (Human Rights Watch Bangladesh, 2003). The major economic opportunities for Bangladeshi women is employment in the urban garment industry. Lured by brokers, some women migrate to the cities only to be turned over to brothel madams as sex workers for a fee (Hosain & Chattrejee, 2005).
Bangladesh has the lowest condom use with partner rate in Asia; only 4.4% of men use condoms (Chanda & Bhowmik, 2004). Among sex workers, regular condom use with clients rate is low, resulting in the high prevalence of syphilis (57%) and gonorrhea (28%) (Azim et al., 2000; World Bank Group, 2003). It has been reported that the age of sex workers may influence condom use. Younger workers may lack the negotiating skill to demand condom use by clients (Chanda & Bhowmik, 2004; Campbell, 2000).
The present study attempts to examine the sociodemographic correlates of regular condom use with clients among sex workers in the Tangail/Dhaka areas of Bangladesh. Sporadic to non-use of condoms in transactional sex accounts for over 95% of reported HIV episodes worldwide (UNAIDS, 2004; Campbell, 2000). Health educators try to promote consistent, regular use of condoms, particularly by high-risk groups such as sex workers (UNAIDS, 2004).
Participants and Study Instrument
Two groups of sex workers (N = 308) participated in the study; 196 of them were brothel-based at Kandapra in Tangail, while 112 were street-based in Dhaka. Local AIDS NGOs collaborated to locate the sex workers. The study instrument was the researcher-administered questionnaire written in Bangla, the indigenous language. The instrument was adapted from HIV/AIDS (WHO, 1991) and pre-tested among 50 brothel/street sex workers for reliability before use in the present study. This questionnaire method was chosen because of the limited writing ability of the sex workers.
The structured, anonymous questionnaire included demographic information (e.g., age, marital status, education). Questions included HIV knowledge, attitude and practice (KAP). …