Newcomers in a hazardous environment: a qualitative inquiry into sex worker vulnerability to HIV in Bali, Indonesia

Abstract

BackgroundWomen new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs).MethodsWe conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women’s experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices.ResultsA thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk.ConclusionsPublic health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women’s sex work careers.

HIV risk among young women who sell sex by whether they identify as sex workers: analysis of respondent‐driven sampling surveys, Zimbabwe, 2017

“…To reach all YWSS, programmes should consider network‐based approaches and use of incentivized referral vouchers, with feasibility of this approach among non‐identifying ‐YWSS demonstrated by this study. Trained peer educators should also be engaged, as they may reach younger FSW , and may prove important to retain YWSS in programmes and develop social capital among non‐identifying‐YWSS, which has been associated with increased condom use .…”

The Logic of Condom Use in Female Sex Workers in Bali, Indonesia

“…We want to note that condom use is not merely an individual choice. Sex work in Indonesia (and in brothels) is illegal, and district police periodically enforce the law by arresting the FSWs or deporting them back to where they come from [17] as most of them are migrants. These conditions create a challenge to provide care and deliver behavioural change interventions to increase condom use through health education programs [18], and a dilemma for health authorities in providing health services and health promotion programs because they do not wish to be seen as supporting or legalising prostitution.…”

Correlates of HIV and Inconsistent Condom Use Among Female Sex Workers in Ukraine

“…In addition to work locations, prior research found that women who were new to sex work lacked knowledge about HIV prevention practices and had weaker beliefs about their ability to enforce these practices during sex work [16]. Older age was another factor associated with higher prevalence of HIV, syphilis infections, unprotected sex, and injection drug use [17, 18].…”