Recently, the number of
indirect female sex workers (FSWs) who work at bars/clubs and massage parlors
is substantially increasing in Thailand; however, there are huge gaps in
knowledge about HIV risk behaviors among indirect FSWs.
This study aimed to
describe and understand HIV risk behaviors among Thai FSWs in Bangkok in
relation to sociocultural factors and work environment (e.g., bars/clubs,
massage parlors, brothels, and street). Based on venue-based purposive sampling
methods, Thai FSWs were recruited for qualitative interviews (n = 50) and
survey interviews (n = 205). Based on mixed methods, the study revealed that
HIV risk and substance use behaviors among FSWs significantly differed
depending on work venues, although there were no significant differences
between work venues on some key risk behaviors (e.g., inconsistent condom use
with primary partners and customers; willingness to engage in unsafe sex with
customers).
A multiple linear regression analysis revealed that FSWs who had
used illicit drugs, were young, had low levels of self-esteem, or reported STIs
had frequently engaged in unprotected vaginal sex with customers. Also, FSWs
who worked at bars/clubs, were young, had higher income, or reported STIs had
frequently engaged in sex with customers under the influence of alcohol.
Qualitative interviews illustrated FSWs’ alcohol and drug use due to their
stressful life (e.g., long working hours and a large number of customers) and
easy access to alcohol and drugs. FSWs had shown inaccurate knowledge about HIV
prevention methods and engaged in risky behaviors, such as washing vagina with
water or toothpaste after having had sex with customers.
The HIV prevention
strategies in Thailand need to be re-structured through implementing
evidence-based HIV prevention intervention programs for FSWs, which must
address sociocultural factors (e.g., self-esteem) and alcohol and drug use
specific to work venues.
Table 2
HIV-Related Sexual and Substance Use Behaviors
| Massage Parlor | Bar/Club | Brothel | Street | Total | ||
|---|---|---|---|---|---|---|
| (n=60) | (n=99) | (n=20) | (n=26) | (n=205) | χ 2 | |
| % | % | % | % | % | ||
| Inconsistent condom use with primary partners in the past 6 months | ||||||
| Oral sex | (n=40) 97.5 | (n=43) 97.7 | (n=10) 100.0 | (n=13) 100.0 | (n=106) 98.1 | ns |
| Vaginal sex | (n=42) 95.2 | (n=46) 91.3 | (n=11) 100.0 | (n=14) 100.0 | (n=113) 94.7 | ns |
| Inconsistent condom use with customers in the past 6 months | ||||||
| Oral sex | (n=55) 92.7 | (n=92) 96.7 | (n=15) 86.7 | (n=17) 100.0 | (n=179) 95.0 | ns |
| Vaginal sex | (n=60) 78.3 | (n=99) 83.8 | (n=20) 75.0 | (n=26) 65.4 | (n=205) 79.0 | ns |
| Substance use in the past 12 months | ||||||
| Alcohol | 95.0 | 98.0 | 75.0 | 88.5 | 93.7 | 16.20***a |
| Marijuana | 28.3 | 22.2 | 0 | 23.1 | 22.0 | ns |
| Amphetamines | 10.0 | 10.1 | 0 | 15.4 | 9.8 | ns |
| Ecstasy | 21.7 | 7.1 | 0 | 15.4 | 11.7 | 10.81*b |
| Having sex under the influence of substances in the past 6 months | ||||||
| With customers | ||||||
| Alcohol use | 80.0 | 90.9 | 60.0 | 56.0 | 80.4 | 21.67***c |
| Drug use | 18.3 | 15.2 | 0 | 12.0 | 14.2 | ns |
| With primary partners | (n=43) | (n=51) | (n=12) | (n=15) | (n=121) | |
| Alcohol use | 69.8 | 64.7 | 50.0 | 60.0 | 64.5 | ns |
| Drug use | 14.0 | 2.0 | 0 | 20.0 | 8.3 | 8.32*d |
Note. ns = not significant.
aphi = .28.
bphi = .23.
cphi = .33.
dphi = .26.
*p<.05.
** p<.01.
***p<.001
Table 3
Linear Regression Analysis on Sexual Risk Behaviors with Customers in the Past 6 Months
| Variables | Beta | t |
|---|---|---|
| Frequency of condom use for vaginal sex | R2= .18, F(12, 188)= 3.36, p< .001 | |
| Age | −.18 | −2.20* |
| Massage parlora | .08 | .69 |
| Bar/Cluba | .01 | .05 |
| Brothela | .08 | .86 |
| AIDS knowledge | −.04 | −.55 |
| Subjective norm toward practicing safe sex | .06 | .82 |
| Self-esteem | .23 | 3.17** |
| Perceived economic pressure | −.01 | −.07 |
| Educationb | .03 | .40 |
| Monthly incomec | −.06 | −.68 |
| Number of STIs in the past 12 months | −.20 | −2.86** |
| Any drug use in the past 12 months | −.18 | −2.59** |
| Frequency of Having Sex Under the Influence of Alcohol | R2= .33, F(11, 188)= 8.36, p< .001 | |
| Age | −.25 | −3.36*** |
| Massage parlora | .02 | .21 |
| Bar/Cluba | .39 | 3.94*** |
| Brothela | .03 | .35 |
| AIDS knowledge | .08 | 1.24 |
| Subjective norms toward practicing safe sex | .01 | .13 |
| Self-esteem | −.08 | −1.25 |
| Perceived economic pressure | .00 | .01 |
| Number of STIs in past 12 months | .11 | 1.78* |
| Educationb | −.07 | −1.00 |
| Monthly incomec | .19 | 2.57** |
a0 = Street FSWs, 1=Massage parlor, Bar/Club FSWs, or Brothel FSWs.
b1=Less than high school, 2=Completed high school or vocational school, 3=College degree.
c1 = Less than 12,000 baht (< $362), 2 = 12,001-24,000baht ($362-$724), 3 = 24,001-40,000 baht ($725-$1,207), 4 = 40,001-60,000 ($1,208-$1,811), 5 = More than 60,001 baht ($1,811<).
d p =.08.
Frequency scale: 1=Not at all to 5=Always
*p <.05.
**p <.01.
***p <.001.
No significant associations were found on the frequency of having sex under the influence of drugs with customers.
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Correspondence concerning this article should be addressed to Tooru Nemoto, Public Health Institute, 555 12th Street, Suite 290, Oakland,
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