Document Type: Original Articles

Authors

1 Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;

2 Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;

3 Vice Chancellor for Health Affairs, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Human Immunodeficiency Virus (HIV) epidemics are largely linked to high-risk populations such as female commercial sex workers (FSWs). This study assessed sexual behaviors, attitudes and knowledge of this marginalized group.Methods: We conducted a cross- sectional study on 278 selfidentified FSWs by using Respondent Driven Sampling (RDS) method in Shiraz, south of Iran, from June 2010 to March 2011. Volunteer women were interviewed in order to explore issues such as sexual behavior, sexual violence, work conditions, contraceptive methods, HIV/AIDS knowledge, HIV test, and source of HIV information.Results: The majority of participants (95.1%) knew about condoms; however, only 40.6% used condoms consistently. Despite the subject’s wide knowledge regarding modes of transmission, 61% and 40% did not use any protection with anal and oral intercourse, respectively. 21% of FSWs experienced sexual violence. Nearly half (45.2%) of them had an HIV test and more than three-quarters knew their test results. The women in our study preferred to receive their information from health workers (63%) and peer group (45.2%).Conclusion: This study sheds light on the existing knowledge and practices of this high-risk group. Although the majority of FSWs were familiar with HIV/AIDS, risky behaviors such as anal and oral sex are still in practice; this calls for education and HIV prevention campaigns focusing on risk education awareness. Efforts in addressing the problem of inconsistent condom use needs to be directed towards client specific approaches and must be regarded a top priority.

Keywords

  1. Mills S, Saidel T, Magnani R, Brown T. Surveillance
  2. and modelling of HIV, STI, and risk behaviours in
  3. concentrated HIV epidemics. Sex Transm Infect 2004
  4. Dec; 80 Suppl 2: ii57-62.
  5. National AIDS Committee Secretariat, Ministry of
  6. Health and Medical Education. Islamic Republic of
  7. Iran. AIDS Progress Report On Monitoring of the
  8. United Nations General Assembly Special Session on
  9. HIV and AIDS. March 2012, http://www.unaids.org/
  10. en/ dataanalysis/knowyourresponse/countryprogress
  11. reports/2012countries
  12. Ruxrungtham K, Brown T, Phanuphak P. HIV/AIDS
  13. in Asia. Lancet 2004; 364(9428): 69–82.
  14. Ghahfarokhi SM, Forouzan AS, Roshanfekr P,
  15. Mohammadi MA, MasoumehDejman M, Vameghi M,
  16. et al. HIV/AIDS related knowledge and attitude among
  17. female sex workers in Tehran/Iran. Retrovirology 2010;
  18. (Suppl 1): P130.
  19. Zhang XD, Temmerman M, Li Y, Luo W, Luchters S.
  20. Vulnerabilities, health needs and predictors of highrisk
  21. sexual behaviour among female adolescent sex
  22. workers in Kunming, China. Sex Transm Infect 2013
  23. May; 89(3): 237-44.
  24. Grayman JH, Nhan DT, Huong PT, Jenkins RA, Carey
  25. JW, West GR, et al. Factors associated with HIV testing,
  26. condom use, and sexually transmitted infections among
  27. female sex workers in NhaTrang, Vietnam. AIDS
  28. Behav 2005 Mar; 9(1): 41-51.
  29. Kriitmaa K, Testa A, Osman M, Bozicevic I, Riedner
  30. G, Malungu J, et al. HIV prevalence and characteristics
  31. of sex work among female sexworkers in Hargeisa,
  32. Somaliland, Somalia. AIDS 2010 Jul; 24Suppl 2: S61-7.
  33. Wingood GM, DiClemente RJ. The influence of
  34. psychosocial factors, alcohol, drug use on African-
  35. American women’s high-risk sexual behavior. Am J
  36. Prev Med 1998 Jul; 15(1): 54-9.
  37. Mishra S, Thompson LH, Sonia A, Khalid N,
  38. Emmanuel F, Blanchard JF. Sexual behaviour,
  39. structural vulnerabilities and HIV prevalence among
  40. female sex workers in Pakistan. Sex Transm Infect
  41. Sep; 89Suppl 2: ii34-42.
  42. Kolahi AA, Rastegarpour A, Abadi AR, Nabavi M,
  43. Sayyarifard A, Sohrabi MR. The knowledge and
  44. attitudes of a female at-risk population towards the
  45. prevention of AIDS and sexually transmitted infections
  46. in Tehran. J Res Med Sci 2011 Nov; 16(11): 1452-8.
  47. Ramezani Tehrani F, Malek-Afzali H. Knowledge,
  48. attitudes and practices concerning HIV/AIDS among
  49. Iranian at-risk sub-populations. East Mediterr Health
  50. J 2008 Jan-Feb; 14(1): 142-56.
  51. Zargooshi J. Characteristics of gonorrhoea in Kermanshah, Iran. Sex Transm Infect 2002 Dec; 78(6):
  52. -1.
  53. MR Mohebbi. Female sex workers and fear of
  54. stigmatization. Sex Transm Infect 2005 Apr; 81(2):
  55. -1.
  56. Joulaei H, Motazedian N. Primary Health Care
  57. Strategic Key to Control HIV/AIDS in Iran. Iran J
  58. Public Health 2013 May 1; 42(5): 540-1.
  59. Kazerooni PA, Motazedian N, Motamedifar M, Sayadi
  60. M, Sabet M, Lari MA, et al. The prevalence of human
  61. immunodeficiency virus and sexually transmitted
  62. infections among female sex workers in Shiraz, South
  63. of Iran: by respondent-driven sampling. Int J STD
  64. AIDS 2014 Feb; 25(2): 155-61.
  65. Basuki E, Wolffers I, Deville W, Erlaini N, Luhpuri
  66. D, Hargonoet R, et al. Reasons for not using condoms
  67. among female sex workers in Indonesia. AIDS Educ
  68. Prev 2002; 14(2), 102–16.
  69. van Veen MG, Gtz HM, van Leeuwen PA, Prins M,
  70. van de Laar MJ. HIV and sexual risk behavior among
  71. commercial sex workers in the Netherlands. Arch Sex
  72. Behav 2010; 39(3): 714–23.
  73. Ulibarri MD, Strathdee SA, Lozada R, Staines-Orozco
  74. HS, Abramovitz D, Semple S, et al. Condom use among
  75. female sex workers and their non-commercial partners:
  76. effects of a sexual risk intervention in two Mexican
  77. cities. Int J STD AIDS 2012 Apr; 23(4): 229-34. doi:
  78. 1258/ijsa.2011.011184.
  79. Ghimire L, Smith WC, van Teijlingen ER, Dahal
  80. R, Luitel NP. Reasons for non- use of condoms and
  81. self- efficacy among female sex workers: a qualitative
  82. study in Nepal. BMC Womens Health 2011 Sep 26;
  83. : 42.
  84. Baggaley RF, White RG, Boily MC. HIV transmission
  85. risk through: systematic review, meta-analysis and
  86. anal intercourse: systematic review, meta-analysis and
  87. implications for HIV prevention. Int J Epidemiol 2010
  88. Aug; 39(4): 1048-63.
  89. Schmid G, Markowitz L, Joesoef R, Koumans E.
  90. Bacterial vaginosis and HIV infection. Sex Transm
  91. Infect 2000 76(1): 3-4.
  92. Beattie TS, Bhattacharjee P, Ramesh BM, Gurnani
  93. V, Anthony J, Isac S, et al. Violence against female
  94. sex workers in Karnataka state, south India: impact
  95. on health, and reductions in violence following an
  96. intervention program. BMC Public Health 2010 Aug
  97. ; 10: 476.
  98. Pitche P, Gbetoglo K, Saka B, Akakpo S, Landoh DE,
  99. d’Almeida S, et al. HIV prevalence and behavioral
  100. studies in female sex workers in Togo: a decline in
  101. the prevalence between 2005 and 2011. Pan Afr Med
  102. J 2013 Jun 21; 15: 62.
  103. Musyoki H, Kim A, Geibel S, Muraguri N, Okal J,
  104. Dadabhai S, et al. High prevalence of HIV infection
  105. among female sex workers in Nairobi, Kenya: results
  106. of a respondent-driven sampling study, 2010-2011.
  107. MOPE242 Poster Exhibition. Available from: https://
  108. www.google.com/#q=prevalence+of+HIV+infection
  109. +among+female+sex+workers+in+Nairobi%2C+Ken
  110. ya%3A+results+of+a+respondent-driven+sampling+
  111. study%2C+2010-2011