Chapter Four Prevalence of Condom Use among the Sex Workers 4.1 Introduction Commercial sex work has been an important factor in the spread of HIV infection and use of condom for its prevention has been advocated by many groups. AIDS is, by far, the most deadly sexually transmitted disease and considerably more scientific evidence exists regarding condom effectiveness for prevention of HIV infection than for STDs. The body of research of the effectiveness of latex condom in preventing sexual transmission of HIV infection is both comprehensive and conclusive. Epidemiological studies that are conducted in real- life settings, where one partner is infected with HIV infection and other partner is not, demonstrate conclusively that the consistent use of latex condoms provide a high degree of protection. The correct and consistent use of condom during sexual intercourses- vaginal, anal or oral- greatly reduces a person’s risk of acquiring or transmitting HIV infection. Laboratory studies show that latex condoms are effective barrier to HIV infection and STDs. In addition, several studies provide compelling evidence that latex condoms are highly effective against HIV transmission. One recent review of multiple studies found that the consistent use of condoms during sexual intercourse results in an 80 percent reduction in HIV incidence, a level of protection slightly less effective than for pregnancy. Chapter Four: Prevalence of Condom Use among the Sex Workers 45 One disadvantage of the male latex condom lies in the fact that men control its use. When it becomes clear that women are both biologically and socio-culturally more vulnerable to HIV infection, efforts began to identifying HIV prevention methods that women could control. The female condoms can be more convenient to use because it can be inserted before intercourse. One important advantage of female condom is that women have more involvement in initiating its use; find the new condom as a means of empowerment. High cost may be the biggest drawback of the female condom. The higher commercial retail price of female condoms makes it uncomfortable for many people in developing countries. Female condoms would be more economical if they could be reused. Anti-family planning organizations such as the American Life League and Human Life International have aggressively questioned the efficacy of condoms, frequently claimed that condoms are not effective in preventing HIV infection. They argue that condoms have an unacceptable high failure rate. Condom opponents have seized on the fact that condoms are not 100 percent perfect in preventing HIV infection to further their arguments that abstinence and sex within marriage are the only way to prevent HIV infection. Condoms, like all contraceptives, are not 100 percent foolproof protection. Most condom failures are caused due to human factors such as failure to use condoms inconsistent or incorrect use of the prophylactic. Poorly manufactured condoms which are sometimes found in the developing world or those stored at excessive heat for long periods of time can also fail. No latex condoms, such as those made of sheepskin, are not adequate protection against HIV infection because HIV virus can pass through the large pores of these condoms. The female condoms have also disadvantages. The fact that it covers the sexual genitalia makes it is unattractive to some. Also, it can be noisy and some women find it painful to use especially an inexperienced one. It can be displaced during intercourse. Chapter Four: Prevalence of Condom Use among the Sex Workers 46 While condoms can not provide not foolproof protection, they are highly effective protection in preventing HIV infection. Studies examining sexually active people at high risk for contracting HIV infection have found that even with reported sexual contact, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected. The ability of the condom wall to maintain its integrity throughout sexual intercourse is critical to its role in halving the spread of major HIV infection. 4.2 Perception towards Condom Use in Preventing HIV Infection Transmission of HIV infection through sexual contact has been the frequent mean of spreading of the disease. Because of the link between multiple partners and increased risk of AIDS establish heterosexual population, there is much concern about the role that commercial sex workers may play major role in spreading HIV infection. Keeping in mind the sex workers’ overall susceptibility, use and knowledge of condom, including female condom, become a necessity component of the study. As we have learned from just previous chapter that majority of the sex workers are aware of HIV infection, they are also aware of the role of condom as illustrate in the Table 4.1. But if we consider ‘silence’ similar to their answer as ‘no’ then it becomes a slightly higher proportion of being ignorance about the role of condom. We could see that 90 percent of the age group (22-24) years are aware of the role of condom as a mean of preventing HIV infection followed by (25-29) years (88.09%) and (10-14) years (80%). But the perception in preventing HIV infection through using condoms is comparatively low among the age groups (40-44) years (66.67%), (44-49) years (66.67%), (30-34) years (72.73%) and (15-19) years (76.67). Chapter Four: Prevalence of Condom Use among the Sex Workers 47 Table 4.1: Percentage of sex workers’ perception of condom in preventing HIV infection by some selected background characteristics Background Number of Does condom prevent HIV infection? Characteristics Respondents No (%) Yes (%) Silent (%) Age Group: 10-14 5 20.00 80.00 0.00 15-19 30 20.00 76.67 3.33 20-24 40 10.00 90.00 0.00 25-29 42 2.38 88.09 9.52 30-34 33 15.15 72.73 12.12 35-39 18 16.67 66.67 16.67 40-44 3 33.33 66.67 0.00 45-49 4 33.33 67.67 0.00 Education: No Education 134 13.43 78.36 8.21 Primary 31 9.68 87.09 3.22 Secondary 10 10.00 90.00 0.00 Residence: Urban 91 7.69 86.81 5.50 Rural 84 17.86 73.81 8.33 Marital Status: Never-married 1 0.00 100.00 0.00 Married 129 11.63 82.17 6.20 Separated 32 18.75 71.87 9.37 Widowed 5 0.00 80.00 20.00 Divorced 8 12.50 87.5 0.00 When educational level attained is concerned, we cold see an upward trend of positive perception about the role of condom with higher educational qualification. Chapter Four: Prevalence of Condom Use among the Sex Workers 48 As residence is concerned, 86.81 percent urban and 73.81 percent of rural sex workers are with the positive perception about the role of condom. While marital status is concerned the only never-married, 82.70 percent married, 71.87 percent separated, 80.00 percent widowed and 87.50 percent divorced sex workers are with the positive perception that condom prevent HIV infection. 4.3 Prevalence of Condom Use among Commercial Sex Workers The regular and consistent use of condom has been proved to be most effective way of preventing HIV infection till date, although many advocated two other ways like abstinence and faithfulness to partner. As the commercial sex workers are concerned, abstinence and faithfulness to partner are impossible. Hence regular and consistent use of condom is the only way to avoid further HIV transmission as heterosexual studies are concerned. A table 4.2 has been represented below from which we could find a significant understanding at a glance about the vicious risk of the commercial sex workers’ susceptibility to the HIV infection as the higher proportion of them have been keeping on their profession without regular and consistent use of condom. As evident from their verbal consent illustrate in the Table 4.2 none of the commercial sex workers aged between (40-49) years make use of condom regularly. Though 60 percent of them aged (10-14) years, 70 percent of the age group (15-19), 59.52 percent of the age group (25-29), 69.70 percent of the age group (30-34) and 61.11 percent of the age group (35-39) make use of condom regularly; all of them are at high risk to HIV infection. Chapter Four: Prevalence of Condom Use among the Sex Workers 49 Table 4.2 Percentage of respondents’ regular use of condom by some background characteristics Background Number of Can you make use of condom Characteristics Respondents regularly? Yes (%) No (%) Age Group: 10-14 5 60.00 40.00 15-19 30 70.00 30.00 20-24 40 70.00 30.00 25-29 42 59.52 40.47 30-34 33 69.70 30.00 35-39 18 61.11 38.89 40-44 3 0.00 100.00 45-49 4 0.00 100.00 Education: No Education 134 61.19 38.81 Primary 31 70.97 29.03 Secondary 10 70.00 30.00 Residence: Urban 91 64.83 35.16 Rural 84 61.90 38.09 Marital Status: Never-married 1 100.00 0.00 Married 129 56.69 40.31 Separated 32 68.75 31.25 Widowed 5 80.00 20.00 Divorced 8 87.50 12.5 Chapter Four: Prevalence of Condom Use among the Sex Workers 50 Educational qualification, also, does not have a significant role in making them use of condom regularly. Whatever their educational qualification is the gap of regular use of condom is far from expectation (100 percent). 38.81 of the respondents with no education, 29.03 percent of the respondents with primary education and 30.00 percent of the respondents with secondary education can no longer make use of condom regularly. As residence and marital status are concerned, the gap of regular use of condom is far from expectation. 35.16 percent urban and 38.09 percent of rural based sex workers can no longer make use of condom regularly. We could also observe that married women are much more reluctant to use condom regularly. A multivariate logistic regression has been run to find out the likelihood change in the level of prevalence of condom use among commercial sex workers according to the variation in some basic characteristics. Chapter Four: Prevalence of Condom Use among the Sex Workers 51 Table 4.3: Results of logistic regression in the level of prevalence of condom use according to some background characteristics. Predictor Odd Ratio 95 % Confidence Interval Lower Upper Age Group: 10-14 1.000 _____ _____ 14+ 0.523* 0.248 1.102 Marital Status: Married 1.000 _____ _____ Others 1.533 0.719 3.266 Education: Others 1.000 _____ _____ No Education 1.833 0.719 3.268 Residence: Urban 1.000 _____ _____ Rural 0.798** 0.648 0.983 Do condoms prevent HIV: Yes 1.000 _____ _____ No 0.523* 0.248 1.102 Reproductive Tract Problem: Yes 1 _____ _____ No 3.091 1.203 7.940 Here, *** indicates 10%, ** indicates 5% and * indicates 1% level of significance The above table illustrate that commercial sex workers of over 14 years of age had 0.523 times less regularity in using condom per single unit commercial sex workers of the age group (10-14) years. Similarly, other sex workers who are currently not married including separated make use of condom 1.533 times more regular than the married sex workers. Hence married women are much more indifferent of Chapter Four: Prevalence of Condom Use among the Sex Workers 52 regular use of condom use. This may be assumed that there is a potential pressure among never-married commercial sex workers of being conceived. Educational qualification is not a factor affecting behavior of being condom use. Here educational qualification presents an ambiguous role affecting sex workers’ attitude towards condom use. Thus educational qualification does not make sex workers’ empowered in making use of condom. Rural based sex workers are 0.798 times less likely to use regular condom per single urban based sex workers with a result of important significance. Hence we may conclude that rural based sex workers are more vulnerable to the transmission of HIV infection than urban based sex workers. Commercial sex workers’ perception towards HIV transmission through unprotected sex is also a dominating factor of making use of condom regularly. The sex workers who do not have the perception that unprotected sex as a means of transmitting HIV infection is 0.523 times less likely to use regular condom then the sex workers with the positive perception . The result also shows negative feedback. Another important event which makes sex workers use regular condom is prevalence of reproductive track problems. The sex workers with different types of reproductive tract problems make them use condom regularly. HIV infection is largely transmitted through unprotected sexual contact and is said to be, mostly, a sexual disease. Since other sexually transmitted diseases facilitate HIV transmission more and more easily, sex workers with reproductive tract infection/problem is a wake up call for using condom regularly. The observed data shows 3.091 times regular use of condom among the sex workers with reproductive tract problem than sex workers without reproductive tract problems. Chapter Four: Prevalence of Condom Use among the Sex Workers 53 4.4 Condom Breakage/Failure Although condom is considered to be most effective preventing HIV infection, it does not provide foolproof protection against HIV transmission because of condom breakage or failure, however, condom breakage is not very frequent. As we have conducted survey, information gathered reveals that only their condom breakage experience throughout their life but not continuous surveillance that limits observing actual failure rate. However, the incidence of condom breakage in life is not only a mere indication of likelihood of HIV transmission; it also reveals the vicious future of AIDS epidemic. We have learned from our survey that 56.6 percent of the sex workers have been experienced condom breakage throughout their life. Although a higher proportion of sex workers use condoms regularly, condom breakage among them and irregular or no use of condom among many sex workers put the whole population engaged in heterosexual intercourse at a higher risk of contracting HIV infection. 4.5 Attitudes towards Use of Condom among Clients Street based commercial sex workers are considerably low paid and their clients are from various segments of the society. But it is assumed that most of the clients are somebody with lower status in the society having little or no education and little awareness. Hence their perception of regular and consistent use of condom may beyond expectation. From our survey we could see that 87.4 percent of the clients put pressure on sex workers for not to use condom. Hence, no or irregular use of condom, condom breakage and clients’ pressure for not to use condom put the sex workers at the stake of contracting HIV infection easily making them every other susceptible to HIV infection. Chapter Four: Prevalence of Condom Use among the Sex Workers 54 4.6 Prevalence of Female Condom Prevalence of female condom is a relatively new phenomenon. It provides extra benefit for females, especially for sex workers, to controlling sexual exposure. Our surveillance as information gathered shows that 80 percent of the age group (10- 14) years and 75 percent, 88.09 percent, 81.82 percent, 66.67 percent 66.67 percent and only 25 percent of (15-19), (20-24), (25-29), (30-34), (35-39), (40-44) and (45-49) age group respectively have heard of female condom as a way of effective prevention of HIV infection. When their educational qualification is concerned, their perception is reflected as 76.86 percent of sex workers with no education, 74.19 percent of sex workers with primary education and 90 percent of sex workers with secondary education are informed of female condom. Considering residence, 79.12 percent of urban based and 75 percent of rural based sex workers have been heard of female condom. Table 4.4 Percentage distribution of respondents’ use of female condom by some background characteristics Number of Do You Use Female Condom? Background Respondents Yes No Characteristics Age Group: 10-14 5 20.00 80.00 15-19 30 16.67 83.33 20-24 40 15.00 85.00 25-29 42 26.19 73.81 30-34 33 21.21 78.79 35-39 18 16.67 83.33 40-44 3 33.33 66.67 45-49 4 0.00 100.00 Education: No Education 134 17.16 82.84 Primary 31 29.03 70.97 Secondary 10 20.00 80.00 Residence: Urban 91 23.07 76.93 Rural 84 15.47 84.53 Marital Status: Never-married 1 0.00 100.00 Married 129 18.60 81.40 Separated 32 18.75 81.25 Widowed 5 20.00 80.00 Divorced 8 37.5 62.50 Chapter Four: Prevalence of Condom Use among the Sex Workers 55 But the use of female condom among the sex workers is very low. Though some of them use female condom irregularly, however, different factors restrict their uses such as improper motivation and lack of supply. Table 4.3 shows the percentage distribution of the use of female condom among the sex workers according to some background characteristics. From the above Table 4.4 we could see that the use of female condom among the sex workers is minimal irrespective of their background characteristics. Besides, we have learned from their verbal response that they do not use it consistently. The above data only express whether they are interested in using female condom. They also get pressure from clients for not to use it. To prevent HIV infection effectively, it is needed to ensure that sex workers use female condoms, if clients do not use latex condom. 4.7 contingency Analysis In this section the results of contingency analysis are represented designed to test different associations between various phenomena that could be useful. The contingency analysis investigates the degree of association together the dependency criterion between use of condom and background characteristics. The first column of the Table 4.5 presents the attributes of background characteristics for which the association to be tested. Column two and three give the value of χ2 statistic and corresponding degrees of freedom respectively. Table 4.5: Results of Contingency Analysis between Regular Use of Condom and some Background Characteristics Attributes Values of Degree of χ2 Freedom Regular use of Condom Vs Age Group 14.346** 7 Regular use of Condom Vs Marital Status 2.93*** 1 Here *** indicates 10%, ** indicates 5% level of significance. Chapter Four: Prevalence of Condom Use among the Sex Workers 56 From the above table 4.5 it is evident that regular use of condom is positively associated with marital status and age group. That is, the regular use of condom increases as the age of respondents increases.
Pages to are hidden for
"Chapter+Four"Please download to view full document