Chapter+Four by zamanchy

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									                              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.

								
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