Based on data from South East Asia Regional Office (SEARO) years 2011, India, Indonesia, Myanmar, Nepal, and Thailand were the countries with the highest spread of HIV/AIDS. India ranks in this list with approximately2.4 million population suffering HIV/AIDS while in Indonesia ranks fourth with around 190,000 people with HIV/AIDS (WHO 2012).
The largest group with HIV/AIDS was detected the productive age between 20-29 years, accounted for around 37.1% of the whole people living with HIV/AIDS. In low and middle-income countries, HIV prevalence among sex workers was estimated to be12% (Baral et al. 2012).
The current modes of HIV/AIDS transmission are through heterosexual transmission (61.5%), Injection of Drugs User (IDU) 15.2%, and homosexual (2.4%) (Kemenkes 2016). FSW often share common factors, regardless of their background, that can make them vulnerable to HIV transmission (Shanon et al. 2015).
According to Commission data State AIDS Control Jakarta Timur (2015), the total population of Female Sex Worker (FSW) until March 2016 was accounted as 1,438 people with 4.6% were having HIV, whereas 48 FSW who worked in area PHC Duren Sawit subdistrict 4.2 with HIV (KPAN 2015). Condom is one of the commonly used by public to prevent transmission some sexually transmitted diseases. According to Provincial AIDS Countermeasures Comission Jakarta's survey, condom usage behavior on FSW in East Jakarta was still low, 30% of them never used condom and 40 others rarely used condom (KPAN 2010b).
Public Health Centre (PHC) and Non-Government Organizations (NGOs) had been doing counselling on prevention of HIV/AIDS transmission of on the FSW in Duren Sawit area, but in reality, there were only 40% who use the FSW condoms during the sexual.
This study was a quantitative study with use cross-sectional design. The population was a FSW in area of PHC Duren Sawit subdistrict East Jakarta with 48 people as sample. Condom usage behaviour referred to a committed FSW activity by FSW asking their costumer to use a condom during sexual intercourse This study used primary data using questionnaire filled by FSW. Data analysis was conducted using a the Chi-Square test.
Based on Figure 1, 62.5 % FSW rarely used condoms during sexual intercourse more than who is rarely using condoms.
As many as 54.2% of the sample used condoms in sexual intercouse with their customers because of their own willingness: 56.2% feared of getting a veneral disease and 43.8% felt condom use was complicated and uncomfortable.
Table 1 show that the Chi-Square analysis with 5% alpha and 95% coincidence, showed that the proportion of older FSW always used a condom (42.3%) more than younger FSW (31.8%). Statistical analysis showed that there was no significant relationship between age and condom usage behaviour. While based on the education level, the proportion of FSW who always used condoms was higher (73.3) in the higher educated FSW compared to the low educated FSW (21%). The result of chi-square found a statistically significant relationship between education and condom usage behaviour (p value 0.002) with OR = 10.214; it means that FSW with higher education had 10.21 times possibility to always wear condom compared to FSW that had low education.
Based on marital status, 47.9% of the FSW were unmarried, 8.3% married but not living together, 22.9% divorced, and 20.8% died divorce.
The proportion of FSW who were unmarried and always used condom was higher (60.9%) compared to the FSW who were married (16%). The results showed that the FSW with unmarried status had 8.16 times possibility to always used condom compared to the married FSW. Other factors associated with condom use behavior was the working period of FSW. FSW who worked 6 months was less likely to use condom when having sex with their costumers. The statistic test results indicated that the FSW who worked 6 months had a change 12 times to always wear condom during sex compared to FSW that had longer working period. According to their knowledge about safe sexual intecourse, 95.8% of FSW knew about HIV transmission, HIV risk and 89.6 of them knew how to use condoms. Awarness of HIV/AIDS was also significantly related to condom use behavior. FSW with the good knowledge had 14 times higher chance to always wear condom than FSW with the low education.
Most FSW rarely uses condoms when having sex with their customers. One of the reasons was due to customer desire. Besides, they did not know how to use condoms, because of only 33% of FSWs who knew how to use a condom. It was different from the result of research that showed that FSW in Semampir Localization, Kediri, 71.2% of the FSW had condom use behavior (Kristianti 2012). In some cases, sex workers had no access to condoms or were not aware of their importance. In other cases, sex workers were just powerless to negotiate safer sex. Clients might refuse to pay for sex if they had to use a condom and used intimidation or violence to force unprotected sex (Ghimire et al. 2011). The HIV/AIDS transmission prevention program in Indonesia noted that the use of condoms in every sexual intercourse was not useful in preventing the sexually transmission diseases because of the lack of certainty of funding for the condoms provision by the government; there was a policy supporting high public rejection in the condoms provision issue as a means to prevent HIV transmission, and limiting widespread promotion condom use in the community (KPAN 2010a; Silverman et al. 2015).
Table 1 showed a correlation between condom use behaviour with education, long work, marital status, and knowledge while the variable age was not associated with condom use behaviour. Although there was no association between condom use behaviour with age, old FSW ( 24 years) tend to be more likely to use condoms compared to the younger FSW ( 24 years). Young sex workers face many of the same barriers to HIV prevention as their older counterparts including their ability to negotiate condom use and legal barriers to HIV and sexual health services. Young sex workers lack access to youth-friendly HIV services. A study from Ukraine found that 20% of FSWs were 10-19 years old. In parts of sub-Saharan Africa, median HIV prevalence among under 25s is reportedly 11% (Silverman et al. 2015; Mubarak 2011). Age was a factor that influences sexual behaviour and health status. With advancing age, the more mature person in the act included in his sex life.
In the increasing of age, there was an increasing in behavior of maturity, hence the self-protection behavior by using condoms during sexual intercourse also increases. Other factors influencing the FSW behavior in the condom use was the competition among FSW in getting more costumers. The customers often stated their healthy status, hence they did not need to use condoms. In addition, the education factor is also associated with condom use behavior. Table 1 shows that the FSW with the higher education levels has the opportunity of 10.21 times to always use of condoms compared to FSW with lower education level. Education is the thinking guidance that enable someone to understand something. The higher their education level, the easier for them to receive information (Mubarak 2011).
Low levels of education and illiteracy in women cause a narrow knowledge in women whereas women with higher education level will be easier to accept or seek information. Likewise, with the marital status, unmarried FSW had 8.16 times possibility to always ask a customer to wear condoms compared to married FSW. Unmarried FSW had a higher rate to maintain their healthy sex as they require to use the condoms to their customers. Other studies showed that the working period of the most respondents were less than six months (46.1%). This could be because they had not been much affected by their environment and the competition levels for the new FSW was usually not as tight as the seniors (Karyati 2014). Experience is one of the factors influencing behavior (Maulana 2009). FSW who had long working period already had regular customers who thought that they had been acquainted with its customers, so they did not think seriously about the importance of condom use as a preventive measure against HIV/AIDS (Hutahean 2010). Good knowledge tends to change attitude and behavior to be better. Good understanding of the respondents was likely caused by HIV/AIDS and condoms counseling from the relevant NGOs. Judging from their answer, in general, FSW had already known the HIV/AIDS (58.3%), its transmission models (95.8%), people who at risk for HIV/AIDS (93.8%), how to prevent HIV/AIDS (95.8), how to use condom (87.5%) and the consequences for not using condoms (83.3%). From the results obtained, it can be conluded that in general, the FSW knowledge about HIV/AIDS was excellent.
Condom use behaviour in the FSW was still low, although almost all of the FSW had known about HIV/AIDS. Reasons for not using a condom among them was their own choice, fear of contracting the disease and because they feel uncomfortable. Variable associated with condom use behaviour was education, occupation, marital status, and knowledge. Although age was not a factor related to the condom using behavior, aged FSW were more likely to use condoms.