The influence of sex work venues on condom uses among female sex workers in Senggigi, Indonesia

Indonesia is facing a sharp increase in its HIV epidemic among female sex workers (FSWs). A better understanding of the HIV risk behaviors among this group is needed to prevent further spread of this epidemic. A growing literature documents a synergistic relationship between the individual and the environment in conditioning sexual behavior. However, little attention, until now, has been given to understanding the influence FSWs' venue/environment where they solicit customers have on FSWs' risk and protective behaviors. This study examines the influence of sex work venues on condom use among FSWs recruited from four sex work venues located in the Senggigi beach area of Lombok, Indonesia.;A cross-sectional venue-based sampling design was used. Three categories of FSWs were sampled: those who solicit clients at (1) discotheques/bars (freelance), (2) brothels, and (3) entertainment places (e.g. karaoke bars and massage parlors). A structured questionnaire administered to 115 women solicited information about the women, the characteristics of their sex work venue and last three clients, client-specific sexual behaviors, condom use, and sex-related alcohol consumption. A three-level Hierarchical Generalized Linear Model (HGLM) using HLM 6 was used to examine the influence of sex work venue on condom use.;Overall, the sample represented 326 clients (level-1) "nested" in 115 women (level-2) and "nested" in 16 sex work venues (level-3). Multilevel analysis revealed that condom use varied across sex work venues and by individual FSWs (p <0.05) and condom use among this group is predicted not only by individual factors but also by the venue where these women seek and meet their clients and by client factors. Specifically, HIV/AIDS policies and services offered at sex work venues (p < 0.10), ever worrying about contracting HIV (p < 0.05) and ever being married (p < 0.10) were associated with higher condom use and having domestic/local Indonesian clients as opposed to foreign clients was associated with lower condom use (p<0.05). The results suggest that condom use is a multilevel phenomenon that is not consistently and uniformly practiced across venues, FSWs, and clients.