The Correlation between the Level of Knowledge and Perception to

the Incidence of Sexually Transmitted Infections and HIV Infections

in Female Sex Workers in Surakarta

Putti Fatiharani Dewi*, Rini Hastuti, Ambar Aliwardani, Mardiana, Endra Yustin Ellistasari

Dermatovenereology Departement

Dr. Moewardi General Hospital/Faculty of Medicine Sebelas Maret University, Surakarta, Indonesia

Keywords: Sexually Transmitted Infections, HIV infections, knowledge, perception.

Abstract: Sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) infections are serious

global public health issue. Commercial sex workers and their clients are two of the groups at the highest risk

of acquiring and transmitting these infectious diseases. Knowledge is the result of knowing from human to

something, or any deeds of man to understand an object certain. Perception is a complex multifactorial process

built on the experiences that a person undergoes during the course of his or her life which are directly or

indirectly influenced by socioeconomic, political, and cultural contexts. The purpose of this study was to

explore the relationship between the level of knowledge and perception to the incidence of STIs and HIV

infections in Female Sex Workers (FSWs) in Surakarta. A cross sectional based study was conducted among

female sex workers in several area in Surakarta. A total 75 female sex workers completed a questionnaire and

provided blood samples for HIV and syphilis testing, endocervical and vaginal smears were tested for STIs

examination. All data were analyzed statistically by using Chi-Square test with P<0,05 was considered

significant. The overall incidence of various STIs was 42.67%, whereas HIV positivity was 4%. Bacterial

Vaginosis were the most common infections (14.67%). There was no significant correlation between the level

of knowledge and perceptions with the incidence of STIs and HIV infections.

1 INTRODUCTION

Sexually transmitted infections (STIs) and Human

Immunodeficiency Virus (HIV) infections are an

important serious public health problem worldwide,

they are a major cause of acute illness, infertility,

disability and death (Giri, Hiremath and Kasbe, 2012;

Mesenburg, Muniz and Silveira, 2014).

According to

the WHO, in 2016 there were about 357 millions new

cases of STIs such as Chlamydia (131 million),

Syphilis (5.5 million), Gonorrhoeae (78 million) and

Trichomoniasis (143 million) (WHO, 2016). The

latest STIs and HIV prevalence data in the group of

female sex workers based on the Surakarta AIDS

Commission in 2015 there are 263 new STI cases and

77 new HIV cases (AIDS Comission, 2016).

Female

sex workers (FSWs) and their clients are the largest

group of individuals at high risk (Auli et al., 2013).

Regulations about prostitution vary widely, with

some cities implementing but seldom enforcing

radical laws to prosecute those who engage in or

manage the business of prostitution (Safika, Levy and

Johnson, 2013).

Sexually Transmitted Infections which are

diseases due to among humans sexual activities

including vaginal intercourse, oral sex, and anal sex.

Sexually transmitted infections is a broader term than

sexually transmitted disease (Achunam Nwabueze et

al., 2014).

Based on its etiology, STIs can be caused

by either bacteria or virus. The bacteria commonly

presented in STIs are Chlamydia, Syphilis, and

Gonorrhoeae. While viral infections originates from

Human Papilloma Virus (HPV), HIV, and Hepatitis

B (S and Uike Assistant Professor, 2016). The

morbidity and mortality impacts of these STIs are

compounded since they also facilitate the sexual

transmission of HIV. HIV infection causes an

immunosuppresed condition which can increase the

number of STIs and lead to greater co-diagnosis

condition. People with active STIs are prone to HIV

infection. HIV positive patients who are exposed to

Dewi, P., Hastuti, R., Aliwardani, A., Mardiana, . and Ellistasari, E.

The Correlation between the Level of Knowledge and Perception to the Incidence of Sexually Transmitted Infections and HIV Infections in Female Sex Workers in Surakarta.

DOI: 10.5220/0008152901550158

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 155-158

ISBN: 978-989-758-494-7

155

STIs also have a greater risk to transmit HIV

(Puspitosari et al., 2014).

The perceptions about STIs and HIV have varied

from one society to others and is a complex

multifactorial process built on the experiences which

are directly and indirectly influenced by

socioeconomic, political and cultural context (Auli et

al., 2013). Knowledge is an important prerequisite for

intentional performance of health-related behavior

and prevention STIs and HIV transmission. Most

national programs have made considerable effort to

increase knowledge about HIV, the behaviors that

spreads the disease and the ways it can be avoided and

reduce the stigma.Stigmatizing attitudes are strongly

associated with the missperception of HIV

transmission with negative attitudes toward the social

group, particularly homosexuals and sex workers

(Sohn and Park, 2012).Several government programs

related to STI and HIV control include: improving

early case detection, increasing coverage of ARV

drugs, expanding access to STIs and HIV screening,

improving the quality of primary care facilities, and

advocating local governments to reduce the burden

costs.

This study was conducted to assess whether

knowledge and perception are related to the incidence

of STIs and HIV infections.

2 METHOD

Cross sectional study was performed in 75 FSWs in

Surakarta by interviewing and performing

laboratorium examination for STIs and HIV. All data

were analyzed statistically by using Chi-Square test

with P<0,05 was considered significant. Each

participant completed a questionnaire survey

regarding sociodemographic condition, knowledge,

and perceptions associated with risk for STIs and

HIV. The questionnaire was assessed based on the

answers about such as ever heard STIs and HIV,

misperceptions about STIs and HIV, transmission,

prevention, and feel at risk of being infected.

Participants can be said to have good knowledge if

they can correctly answer the symptoms and ways of

transmitting STI and HIV diseases. Participants who

are aware that they have the possibility of being able

to suffer from HIV and STIs are said to have a good

perception. Blood was collected and tested for HIV

rapid test and syphilis rapid test. Endocervical,

posterior fornix and vaginal smears were tested for

Neisseria gonorrhoeae, non spesific genital

infections, vulvovaginal candidiasis, and bacterial

vaginosis (Kustanti, 2017).

Table 1: Sociodemographic characteristics of Female Sex Workers in Surakarta.

Characteristics Frequency(n=75) Percent (%)

Age 17-25 y.o 3 4

26-35 y.o 15 20

36-45 y.o 36 33

46-55 y.o 18 25

56-65 y.o 3 4

>65 y.o - -

Education Illiterate 10 13.33

Elementary 21 28

Junior 21 28

Senior 21 28

College 2 2.7

Source of STIs information Counseling 30 65.21

Media 13 28.26

Environment 2 4.34

Social media 1 2.17

Source of HIV information Counseling 29 50

Media 23 39.65

Environment 3 5.17

Social media 3 5.17

STIs diseases history Yes 24 32

No 51 68

HIV diseases history Yes 0 0

No 75 100

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3 RESULTS

The other reason is that many of the FSWs women

fulfill the client's request not to use condoms, and

government screening programs are not routinely

performed so that FSWs feel that they are free from

STIs and HIV diseases.

It is important public health

to conduct exploration, identification, and analysis

the perception, knowledge and behaviours of FSWs

as well as the associated sociopoltical and cultural

factors and the role of FSWs in the risk of acquiring

and transmitting STIs and HIV (The highest

proportion (33%) of subjects was 36-45 years old.

The majority of subjects had education background,

as they all finished their study from elementary,

junior, and senior high school (28% each). The

information about STIs and HIV were mostly from

counseling, 65.21% and 50% respectively. About

32% of female sex workers claimed to have had an

STI in the past.

Of the 75 participants 4% were identified as HIV

positive, screening showed that 53.33% had STIs,

consisting of Bacterial Vaginosis (18.67%), Syphilis

(14.67%), Vulvovaginalis candidiosis (9.3%),

Trichomoniasis( 5.3%), Non-Specific Genital

Infection (2.6%), Diplococcus Gram Negative

Intracellular (1.33%), and Condyloma Acuminata

(1.33%).

Table 2: The correlation between the level of knowledge and perception with the incidence of STIs and HIV.

STIs HIV

(+) (-) P

value

(+) (-) P

value

Knowledge

Good

(n=47)

(44.7%)

(55.3%)

Good

(n=42)

2 (4.8%) 40

(95.2%)

0.648 0.704

Bad

(n=28)

(39.3%)

(60.7%)

Bad

(n=33)

1 (3.0%) 32 (97%)

Perception

Good

(n=35)

(51.4%)

(48.6%)

Good

(n=30)

1 (3.3%) 29

(96.7%)

0.151 0.810

Bad

(n=40)

(35%)

26 (65%) Bad

(n=45)

2 (4.4%) 43

(95.6%)

There was no significant correlation between the

level of knowledge with the incidence of STIs

(p>0.05) as well as the perception and the incidence

of STIs (p>0.05). the same results was also observed

in HIV. Knowledge and perception have nothing to

do with the incidence of HIV.

4 DISCUSSION

In this study, most of FSWs had a good education.

Risk perception is a complex multifactorial process

built on the experiences that a person undergoes

during the course of her life which are directly or

indirectly influenced by socioeconomic and cultural

contexts. Some of these condititons may influence the

perception about exposure to acquisition,

transmission and treatment of STIs and HIV (Auli et

al., 2013). Some researchers have found that the level

of knowledge and perception can serve as a barrier to

safer sex practices (Bruce et al., 2011).

Our study

revealed that higher levels of knowledge of STIs and

HIV have no effect on the incidence of STIs and HIV,

as well as the perceptions of female sex workers are

unrelated to the incidence of STIs and HIV. In this

study, FSWs who were positive for STIs and HIV for

have good knowledge and good perception better than

FSWs who were illiterate. Most of female sex

workers received the information about STIs and HIV

through counseling, but this is not enough to reduce

the incidence of STIs and HIV. Previous studies have

revealed that awareness and attitudes towards

sexuality as well as also educational background play

role in the overall knowledge of STIs and HIV

incidences (Mutha et al., 2014). High risk groups such

as female sex workers even they know better about

HIV, are still involved in behavioral risk (Unicef,

2012). Most of FSWs knew and have a good

perceptions about STIs and HIV, but their needs did

not allow any fear and worry, also they did not see

any other options beside sexwork Auli et al., 2013).

The Correlation between the Level of Knowledge and Perception to the Incidence of Sexually Transmitted Infections and HIV Infections in

Female Sex Workers in Surakarta

157

5 CONCLUSION

Most of the FSWs had objective knowledge and

good perception on STIs and HIV, but from the

results of the screening is still found 4% participants

were identified as HIV positive, and 53.33% had

STIs. We believe that this study can provide useful

knowledge in controlling STIs and HIV in a high-risk

population group FSWs and the users, even though

the findings are not able to be generalized due to the

study subjects were limited in number and area as

well as the recall bias in fulfilling the questionnaire.

We recommend routine screening and periodic

surveys in order for early detection of STIs and HIV.

Other approaches for example forum group

discussion, community gathering, workshops also

peer education for counseling and experience sharing

with imparting correct knowledge about STIs and

HIV are needed, so that these FSWs do not just know

about STI and HIV but have a high level of awareness

of both diseases.

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