HIV knowledge, risk perception, and safer sex practices among female sex workers in Port Moresby, Papua New Guinea

Eunice Bruce¹, Ludwina Bauai², Mathias Sapuri³, John M Kaldor⁴, Christopher K Fairley¹, Louise A Keogh^5
1Melbourne Sexual Health Centre, School of Population Health, The University of Melbourne, VIC, Australia; ²Central Papua Mission (CPM) of the Seventh Day Adventist Church, Pacific Adventist University, Port Moresby, Papua New Guinea; ³Pacific International Hospital, Port Moresby, Papua New Guinea; ⁴National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia; ⁵Centre for Women's Health, Gender and Society, School of Public Health, The University of Melbourne, VIC, Australia

Abstract: Sex workers are considered a high-risk group for sexually transmitted infections, including human immunodeficiency virus (HIV), and are often targeted by prevention interventions with safer sex messages. The purpose of this study was to explore the extent to which knowledge of HIV and perception of risk influence safer sex practices among female sex workers (FSWs) in Port Moresby, Papua New Guinea. FSWs (n = 174) were recruited from 19 sites to participate in the study. Qualitative data were collected using semistructured interviews with FSWs (n = 142) through focus group discussions and (n = 32) individual interviews. In addition, quantitative data were collected from all FSWs using a short structured, demographic questionnaire. Data were analyzed using recurring themes and calculations of confidence intervals. Despite some common misperceptions, overall, most FSWs were basically aware of the risks of HIV and informed about transmission and prevention modalities but used condoms inconsistently. Most reported using condoms 'sometimes', almost one-sixth 'never' used condoms, only a fraction used condoms 'always' with clients, and none used condoms 'always' with regular sexual partners (RSPs). Among these FSWs, being knowledgeable about the risks, transmission, and prevention of HIV did not translate into safe sex. The findings suggest that certain contextual barriers to safer sex practices exist. These barriers could heighten HIV vulnerability and possibly may be responsible for infection in FSWs. Specific interventions that focus on improving condom self-efficacy in FSWs and simultaneously target clients and RSPs with safer sex messages are recommended.

Keywords: HIV knowledge, risk perception, safer sex practices, female sex workers, clients, regular sexual partners