Prevalence and corrleates of non-use of condom among red light area based female sexworkers of Lahore and Karachi role of health belief model to explain non-use of condom

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Objectives: To estimate the prevalence of non-use of condoms and identify associated factors among female sex workers of red light areas of Pakistan. The study has added a valuable body of knowledge about an important outcome indicator, non-use of condom, for female sex workers' HIV prevention Program. Methodology: Active red light area based female sex workers age 16-49 (n=330) were recruited for structured interviews about discrete information on condom use during their most recent sexual encounter. We conducted a cross-sectional study using a cluster random sampling from red light areas of Karachi & Lahore. Logistic regression analysis was used to identify independent predictors of non-use of condom. The constructs of Health Belief Model were also used for explaining non-use of condoms. Likert type items were developed for Health Belied Model Constructs. Results: Prevalence of `non-use of condom' was 51%. The non-use of condom was independently associated with concurrent use of hormonal contraceptive (OR 10.5 p value <0.001), a pimp/sexbroker recruiting clients (OR 5.4 p value <0.001), having sex with a non-paying partner (OR 4.5 P<0.001) and use of alcohol with client (OR 3.6 P< 0.001). The pimp/brothel manager was perceived as the greatest barrier by sex worker (OR 2.6 P value 0.016). Two constructs of Health Belief Model, perceived benefits and perceived self-efficacy proved facilitators of condom use among our study population. Conclusion: Our findings among FSW are closely linked to inability to recognize condom as a dual tool against pregnancy prevention and disease prevention and the lack of empowerment to negotiate its use. Hormonal Contraceptives create a false perception of protection, and require ( 3 ) the involvement of sex workers only. Where the pimps/boyfriends/husbands of FSW act as gatekeepers, the power dynamics between them results in a much smaller chance of condom nonuse. Alcohol use impairs decision making and cognitive abilities of the female sex worker. If empowered to use condoms, FSWs in red light areas in Lahore and Karachi could protect themselves and avert the entry of Pakistan's rapidly growing HIV epidemic into their population. The Health Beliefs about benefits of condoms and self-efficacy in using condom should be employed to develop appropriate intervention and messages for the female sex workers. Future Research about structural and environmental barriers to condom use and about client dynamics and transmission characteristics is strongly recommended on a larger scale.

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