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Pattern of Condom Use among HIV Positive Street Based Female Sex Workers in Nepal Parangkush Subedi (MPH) Global Health, Rollins School of Public Health, Emory University APPROVED Deborah McFarland, PhD, MPH, Thesis Advisor Date Rob Stephenson, M.Sc, PhD, Co-advisor Date

Subedi, Parangkush (2011)
Master's Thesis (95 pages)
Committee Chair / Thesis Adviser: McFarland, Deborah A
Committee Members: Stephenson, Robert
Research Fields: Health Sciences, Public Health
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: Nepal; HIV/AIDS; Street based female sex workers; Condom use patterns
Program: Rollins School of Public Health, Hubert Department of Global Health
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Pattern of Condom Use among HIV Positive Street Based Female Sex Workers in Nepal Author: Parangkush Subedi Thesis Advisors: Deborah McFarland & Rob Stephenson Background: About15.6 percent of street-based female sex workers (SBFSWs) are HIV positive in Kathmandu Nepal. HIV prevention efforts have concentrated efforts towards established sex workers although SBFSWs may be at higher risk. Condom use is a critical prevention strategy. This study examines the pattern of condom use among HIV positive SBFSWs in Nepal. Objectives: (1) Investigate knowledge of HIV prevention and treatment services and sexual risk behaviors among HIV positive street based female sex workers; (2) Elucidate relationships between selected characteristics of HIV+ SBFSW and condom use with partners and/or clients. Methods: This is an exploratory, descriptive study of self-identified HIV+ SBFSWs in 4 regions of Nepal. It is a survey with a convenience sample of HIV+ SBFSWs using a questionnaire bassed on the HIVBSS. In addition to descriptive statistics, Chi-square and t-tests were performed to analyze bivariate relationships between selected characteristics of the HIV+ SBFSWs and condom use. Results: 121 HIV positive SBFSWs participated in the study. The prevalence of condom use among HIV positive SBFSWs was relatively low: with husband 13.9%, with regular clients 33.0% and with irregular clients 55.0%. One of the main obstacles for consistent condom use was whether street sex was the primary livelihood or only one of the means of livelihood for the woman (p=<0.0001). Significant predictive factors associated with consistency of condom use with their clients were age (p=0.0425), education level (p=0.0007), single motherhood (p=0.0027), knowledge index of HIV/AIDS (mean= 4.163, STD= 2.802, p=<0.0005), stigma index (mean= 7.315, STD= 1.657, p=0.0076), drug use (p=0.0110), and not visiting health care facilities (p=0.0041). Discussion: The results indicate that HIV+ SBFSWs in Nepal do not consistently practice a major preventive safe practice, i.e. the use of condoms with partners and/or clients and thus may be a potential bridging group for the transmission of HIV/AIDS to the general population. HIV/AIDS education and awareness programs must recognize the specific needs of this group of women and target specific messages in a socially and culturally sensitive way to encourage their involvement.

Table of Contents

Introduction 1 -- Female sex workers 2 -- Theoretical framework 5 -- Study Rationale 6 -- Literature Review 8 -- Overview 8 -- The patterns of condom use 8 -- Perceived Susceptibility 9 -- Perceived severity 12 -- Perceived Barriers 14 -- Stigma 14 -- Access to healthcare facilities 16 -- Socio-economic status 18 -- Violence 19 -- Self-efficacy 21 -- Summary 23 -- Methods 25 -- Study Population and Study Design 25 -- Procedure 25 -- Instrument used 27 -- Outcome measures 27 -- Data analysis 28 -- Results 30 -- Introduction 30 -- Result of Univariate analysis 30 -- Socio-economic status 30 -- Knowledge of STD and HIV/AIDS 31 -- Stigma 32 -- Violence 33 -- Access to healthcare facilities by SBFSWs 34 -- Condom use 35 -- Result of Bivariate analysis 37 -- Socio-economic characteristics and the outcome measures 37 -- Knowledge of HIV/AIDS and outcome measures 40 -- Stigma and outcome measures 44 -- Access to healthcare facilities and outcome measures 45 -- Drugs use and outcome measures 46 -- Violence and outcome measures 47 -- Discussion -- Socio-economic status 49 -- Knowledge 51 -- Stigma 52 -- Violence 53 -- Access to healthcare facilities 54 -- Drug use 55 -- Limitation of this study 56 -- Recommendation 56 -- Conclusions 56 -- References 58 -- Appendix A: Survey questionnaire tool 66 -- Appendix B: Story of a sex worker 83 -- Appendix C: Support letter from WATCH-Nepal 85


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