Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic

Abstract

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Digital privacy is a sexual health necessity: a community-engaged qualitative study of virtual sex work and digital autonomy in Senegal

“…VSW in low- and middle-income Countries (LMICs) remains under-researched, though important studies address this topic as part of the broader literature on sex work in LMICs. 3 , 21 , 28 , 29 Similarly, technology-facilitated IPV research, including a seminal study led by sex workers in the European Union, 8 has concentrated on European and US contexts 30 despite calls to “decolonize[e] privacy studies”. 31 Technology-facilitated IPV is a global problem that requires digital privacy and security solutions adapted to local contexts.…”

“… 1 Some sex workers shifted to VSW, although this was not feasible for many, due to barriers like cost and inconsistent internet access. 2 , 3 …”

“…For example, image-based sexual abuse (IBSA), such as non-consensual recording and/or distribution of intimate images, 5 is a form of technology-facilitated intimate partner violence that violates one’s digital privacy and autonomy. IBSA against sex workers has been documented in Zimbabwe, 6 Indonesia, 3 the UK, 7 and the EU. 8…”

Covid-19 and female sex workers in India: a journey of brutal reality

“…During the pandemic, the utilisation of medical facilities and benefits raises psychological, contextual, systemic, and biomedical concerns about sexual health and HIV mitigation (Newman and Guta 2020 ). The Covid-19 pandemic has hampered FSWs’ access to socioeconomic support systems and HIV preventive programmes, putting them at risk of both HIV and Covid-19 infections in Indonesia (Wirawan et al 2022 ). The loss of subsistence and inadequate access to health care and social protection aggravated the exploitation of sex workers in India, particularly those living with HIV (Paul et al 2017 ).…”

“…It was also observed that continuing sex work even during the pandemic protected FSWs from major income loss, whereas education and younger age anticipated adaptive behavioral changes, such as taking up online sex work. Further, the Covid-19 pandemic has affected FSWs access to socioeconomic assistance programs and HIV prevention services, exposing them to the dual threat of HIV and Covid-19 infections (Wirawan et al 2022 ).…”