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  • Title: AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia.
    Author: Ford K, Wirawan DN, Fajans P, Thorpe L.
    Journal: AIDS; 1995 Jul; 9(7):751-9. PubMed ID: 7546421.
    Abstract:
    OBJECTIVES: To describe the AIDS/sexually transmitted diseases (STD) knowledge and risk behaviors, and to determine factors related to condom use among male commercial sex workers (CSW) and male tourist clients in Bali, Indonesia. DESIGN: Individual survey interviews were conducted with a sample of 80 male CSW and 100 tourist clients in the Kuta area of Bali. METHODS: Survey interviews included detailed questions on AIDS/STD knowledge, sexual behavior, and psychosocial measures related to risk taking. RESULTS: Most of the male CSW had heard about AIDS and other STD, although some misconceptions about transmission and risks of different sexual practices remained. Both oral and anal intercourse with tourists were common and condom use was far from consistent. Factors related to condom use for anal intercourse with tourist clients were condom beliefs, self efficacy, susceptibility to STD infection, and STD knowledge. Tourist clients were mainly from Australia and Europe and many had paid for sex in other parts of Indonesia as well as in high prevalence countries. Knowledge of AIDS/STD was very good among the tourists and previous experience with STD was common. Factors related to condom use with male CSW were condom beliefs and self efficacy. CONCLUSION: There is a very active and mobile group of male CSW and tourist clients present in Bali. Interventions with these men are needed due to the low level of knowledge about AIDS among CSW, their experience with STD and STD symptoms, and their level of risky sexual behavior. Interviews conducted in 1992-93 with 80 male commercial sex workers in Bali, Indonesia, and 100 of their tourist clients revealed low levels of accurate knowledge about acquired immunodeficiency syndrome (AIDS) and widespread high-risk sexual behaviors. Although most male sex workers were aware of AIDS, 30% did not know that healthy-appearing persons could be infected. The mean number of clients in the week preceding the interview was 2.8 (range, 0-12); 61% had engaged in anal intercourse in that period. Condom use with clients averaged 48% for receptive anal intercourse, 55% for insertive anal intercourse, and 14-17% for oral intercourse; these rates were 19%, 33%, and 0%, respectively, for unpaid partners. Only 30% of clients serviced by male prostitutes insisted on condom use. Factors related to condom use with commercial clients were condom beliefs, self-efficacy, perceived susceptibility to infection, and knowledge of sexually transmitted diseases. The tourist clients, 60% of whom were from Europe and 25% from Australia, were significantly older (mean age, 38.4 years) than the sex workers. 64% reported a history of STD infection, primarily gonorrhea. In the week before the interview, clients had an average of 1.7 paid and 0.3 unpaid partners and 53% engaged in anal intercourse. Condom use was 75% for receptive and 69% for insertive anal intercourse. Although 87% of tourists brought condoms to Bali, only 62% knew of a local source. Factors related to condom use with a commercial sex worker were condom beliefs and self-efficacy.
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