Pattern of Condom Use among HIV Positive Street Based Female Sex Workers in Nepal Parangkush Subedi (MPH) Global Health, Rollins School of Public Health, Emory University APPROVED Deborah McFarland, PhD, MPH, Thesis Advisor Date Rob Stephenson, M.Sc, PhD, Co-advisor Date 公开

Subedi, Parangkush (2011)

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Pattern of Condom Use among HIV Positive Street Based Female Sex Workers in Nepal

Parangkush Subedi
Thesis Advisors: Deborah McFarland & Rob Stephenson
Background: About15.6 percent of street-based female sex workers
(SBFSWs) are HIV positive in Kathmandu Nepal. HIV prevention efforts have concentrated
efforts towards established sex workers although SBFSWs may be at higher risk. Condom use is
a critical prevention strategy. This study examines the pattern of condom use among HIV
positive SBFSWs in Nepal.
Objectives: (1) Investigate knowledge of HIV prevention and treatment services and sexual risk
behaviors among HIV positive street based female sex workers; (2) Elucidate relationships
between selected characteristics of HIV+ SBFSW and condom use with partners and/or clients.
Methods: This is an exploratory, descriptive study of self-identified HIV+ SBFSWs in 4 regions
of Nepal. It is a survey with a convenience sample of HIV+ SBFSWs using a
questionnaire bassed on the HIVBSS. In addition to descriptive statistics, Chi-square and t-tests
were performed to analyze bivariate relationships between selected characteristics of the HIV+
SBFSWs and condom use.
Results: 121 HIV positive SBFSWs participated in the study. The prevalence of condom use
among HIV positive SBFSWs was relatively low: with husband 13.9%, with regular clients
33.0% and with irregular clients 55.0%. One of the main obstacles for consistent condom use
was whether street sex was the primary livelihood or only one of the means of livelihood for the
woman (p=<0.0001). Significant predictive factors associated with consistency of condom use
with their clients were age (p=0.0425), education level (p=0.0007), single motherhood
(p=0.0027), knowledge index of HIV/AIDS (mean= 4.163, STD= 2.802, p=<0.0005), stigma
index (mean= 7.315, STD= 1.657, p=0.0076), drug use (p=0.0110), and not visiting health care
facilities (p=0.0041).
Discussion: The results indicate that HIV+ SBFSWs in Nepal do not consistently practice a
major preventive safe practice, i.e. the use of condoms with partners and/or clients and thus may
be a potential bridging group for the transmission of HIV/AIDS to the general population.
HIV/AIDS education and awareness programs must recognize the specific needs of this group of
women and target specific messages in a socially and culturally sensitive way to encourage their

Table of Contents

Introduction 1
Female sex workers 2
Theoretical framework 5
Study Rationale 6

Literature Review 8
Overview 8
The patterns of condom use 8
Perceived Susceptibility 9
Perceived severity 12
Perceived Barriers 14
Stigma 14
Access to healthcare facilities 16
Socio-economic status 18
Violence 19
Self-efficacy 21
Summary 23

Methods 25
Study Population and Study Design 25
Procedure 25
Instrument used 27
Outcome measures 27
Data analysis 28

Results 30
Introduction 30

Result of Univariate analysis 30
Socio-economic status 30
Knowledge of STD and HIV/AIDS 31
Stigma 32
Violence 33
Access to healthcare facilities by SBFSWs 34
Condom use 35
Result of Bivariate analysis 37
Socio-economic characteristics and the outcome measures 37
Knowledge of HIV/AIDS and outcome measures 40
Stigma and outcome measures 44
Access to healthcare facilities and outcome measures 45
Drugs use and outcome measures 46
Violence and outcome measures 47

Socio-economic status 49
Knowledge 51
Stigma 52
Violence 53
Access to healthcare facilities 54
Drug use 55
Limitation of this study 56
Recommendation 56
Conclusions 56

References 58

Appendix A: Survey questionnaire tool 66
Appendix B: Story of a sex worker 83
Appendix C: Support letter from WATCH-Nepal 85

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