Perceptions of Determinants of Condom Use Behaviors Among Male Clients of Female Sex Workers in Indonesia: A Qualitative Inquiry

Abstract

This study aimed to explore perceived determinants of condom use behaviors among male clients of female commercial sex workers (FCSWs) in Belu and Malaka districts, Indonesia. One-on-one in-depth interviews guided by the Health Belief Model (HBM) were used to collect the data from participants (n = 42). The Framework analysis for qualitative data was employed to analyze the data. Results demonstrated several factors associated with lack of and inconsistent condom use among the participants. They included self-perceived risk of contracting HIV infection, knowledge of the severity of HIV illness and its impacts, and condom use: its benefits and its influencing factors. Additionally, factors including reduced sexual pleasure and the lack of knowledge of how and where to access condoms were important perceived barriers to condom use among participants. Having seen images of HIV-/AIDS-positive people, knowing friends and relatives suffering from HIV, and knowing FCSWs as a high-risk group for HIV infection were the cues to using condoms among several participants. Likewise, self-efficacy was also associated with condom use behaviors among the participants. The findings indicate the needs for HIV/AIDS interventions that include dissemination of HIV/AIDS knowledge, condom promotion, and improvement in the availability of condoms for both FCSWs and their clients.

The Intention of Men Who Have Sex With Men to Participate in Voluntary Counseling and HIV Testing and Access Free Condoms in Indonesia

“…Several factors including positive attitudes and the intention to access HIV services are necessary enablers of service utilization and, thus, protection of populations from HIV infection. Consistent with previous studies ( Bandawe & Foster, 1996 ; Basen-Engquist & Parcel, 1992 ; Bogart et al, 2000 ; Bosompra, 2001 ; Fauk & Mwanri, 2014b ; Mwanri, Fauk, Kustanti, Ambarwati, & Merry, 2018 ; Reitman et al, 1996 ), this study confirms that attitudes such as knowing the content and benefits of HIV/AIDS services were enablers associated with the participants’ intention to use the available HIV/AIDS services. The study participants were aware that attending VCT and using condoms would help prevent contracting HIV and other STIs or encourage treatment at the earliest after the diagnosis.…”

“…Although participants seemed to have good knowledge about the importance and the need to use condoms consistently and good knowledge about HIV/AIDS and its consequences, they still used condoms inconsistently, with stated reasons including discomfort during sexual intercourse when using condoms, a reduction in sexual pleasure when using condoms, and the influence of regular partners to not use condoms. Similar findings have been reported elsewhere ( Malebranche, Fields, Bryant, & Harper, 2009 ; Ross, 1992 ; Wheeler, 2006 ; Williams, Wyatt, Resell, Peterson, & Asuan-O’Brien, Fauk et al, 2018 ; Fauk & Mwanri, 2004, 2015 ) indicating that knowledge about HIV/AIDS and the protective benefits of condoms do not necessarily translate into individuals’ consistent intention to use condoms. However, supportive of previous studies ( Adih & Alexander, 1999 ; Albarracin et al., 2001 ; Bandawe & Foster, 1996 ; Ross, 1992 ), the current study informs that attitudes such as individual beliefs about the positive outcomes or attributes of accessing health services had positive influence on participants’ intention to attend and access HIV/AIDS program.…”

A Systematic Review of Factors Influencing Condom Use among Female Sex Workers

“…Perceived risk of contracting an STI or HIV was a significant supportive factor of condom use while low perceived risk of infection was found to have a negative impact on condom use (Fauk et al, 2018).…”

“…Misinformation or a lack of knowledge about STI"s also had a negative impact on condom use, with some male clients stating that if the sex worker looked physically healthy, the client himself was healthy or he had only had intercourse a few times with a sex worker then he could not contract any disease or infection (Fauk et al, 2018). Increased knowledge led to higher consistent condom use as seen in the following quote, "I just recently started to learn about HIV/AIDS, and now I know a little bit about the means of HIV transmission but before that I did not know, so I did not use condoms at all and I did not think of any risk".…”

A Qualitative Study about Condom Use in Men who have Risky Sexual Behavior

“…Other factors that lead to low condom use include: lack of knowledge about the risk of getting HIV, the absence of condoms during sexual intercourse, believing that antibiotics can prevent STIs, trusting sex partners, partners not liking condoms, getting drunk, defective condoms, and believing that condoms unable to prevent HIV. [9]. This study is aimed to bridge the gap between knowledge and behavior in the community about the condom use as STI prevention among high risky sexual behavior.…”