Knowledge, risk perception, and condom utilization pattern among female sex workers in Dire Dawa, Eastern Ethiopia 2016: a cross-sectional study

Introduction In 2015, in Dire Dawa administration city, adult HIV prevalence was 3.26 with 9,523 HIV positive population, & 251 annual AIDS deaths. Female sex workers are one of the high-risk groups for contracting HIV. Therefore, this study has assessed the level of HIV/AIDS knowledge, risk perception and condom utilization pattern among female sex workers' in Diredawa city. Methods A cross-sectional study was conducted from April 15-June 25, 2016, in Dire Dawa among 156 female sex workers using convenient sampling method. Respondents were interviewed face-to-face using a pretested questionnaire. Training was provided to the data collectors and supervisors. Close supervision was done and double data entry was performed. Then the data were checked for completeness, consistency and entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was used to compute frequency, mean, mode and proportion of the findings of this study. The results were presented using tables, charts, graphs, and texts. Results Among the 156 female sex workers (FSWs), 99 (63.5%) had been working on commercial sex for more than one year, 92 (59%) were usually street-based, and 80 (51.3%) had partners between 2-3 per night. Only, 17 (10.9%) respondents mentioned three and above ways of HIV/AIDS transmission and prevention methods. Less than two-thirds (64.1%) of FSWs used a condom with all partners. One hundred thirty-eight (88.5%) of participants were engaged in unsafe sexual practice at least once since their engagement in sex work. Majority of FSWs (85.3%)) believed that their occupation is hazardous and 145 (92.9%) reported that they were unhappy being a commercial sex worker. Regarding risk perception, 79 (50.64%) and 37 (23.7%) of respondents perceived their chances of contracting HIV/STIs to be high and moderate respectively. Conclusion Knowledge about HIV/STIs and magnitude of condom utilization were good. However, a high number of unsafe sex and unsatisfactory risk perception attitudes were observed. Thus, a collaborative effort is needed to create awareness regarding risk perception attitude and increase the level of their practice towards the prevention of unsafe sex.


Introduction
Half of the world's population suffers from infections including HIV/AIDS, hunger and unsustainable access to safe water and basic sanitation [1]. HIV/AIDS continues to be a major global public health problem, having claimed more than 35  Furthermore, it is recognized that HIV seroprevalence is considerably above this level amongst female sex workers and mobile populations [9]. Female sex workers are the highly vulnerable groups that are at high risk of contributing to sexually transmitted diseases [10,11]. Even though street-based female sex workers (FSWs) are highly vulnerable to HIV, only about one in every three of them receive adequate HIV prevention services and medical care [12,13]. Female sex workers encountered numerous challenges from their clients that expose them to unsafe sex, because of their hazardous occupational situation [14][15][16].
Therefore, effective, consistent and correct utilization of condom is one of the best preventive intervention methods of HIV and others STIs targeted toward female sex workers. It would avert two-thirds of an incident of HIV infections [17][18][19][20]. Use of male and female condoms, increasing the availability, accessibility, and affordability of condom among female sex workers are an essential component to reduce the enormous consequences and costs of STIs and unintended pregnancies [1,19] Dechatu is one of kebele among the 9 urban kebele with the total population size of 22,205. It has 13 ketena that is bounded by Coneal in the east, Kezira from the North, Addisketma from the South and Legahara from the West. It has one public school, one private school, and one public health center.

Study design and participants:
A cross-sectional study was conducted in Dire Dawa to assess female sex workers HIV/AIDS knowledge, risk perception, and condom utilization pattern. All female sex workers between the ages of 15-49 years living in the study area for at least 6 months were included for an interview but those who had a physical impairment (unable to hear and speak) and mentally ill were excluded from the study.

Results
A total of number of 156 female sex workers were involved in the data collection with a 100% response rate. Therefore, 156 respondents' data were included in the analysis. were usually street-based and the remaining 64 (41%) were bar/hotel based to get their partner for a single time or more than single moment (Figure 1). and 9 (6.4%) said that they had used as needed (Table 5).

Risk perception of female sex workers towards HIV and/or other Sexual transmitted infections:
FSWs were asked about the hazards of commercial sex from the angles of its potency in exposing themselves to HIV/STIs.

Discussion
The finding of this research revealed that most of the respondents (95.5%), knew at least one method of HIV/STIs transmission and prevention. This finding is significantly higher than a cross-sectional study conducted in Northwest Ethiopia [28]. The possible reason for the difference might be due to the expansion of media. Following these, there will be an increased awareness among female commercial sex workers about the transmission and prevention methods of HIV/STIs. In this study, 138 (88.5%) of FSWs believed that condom can prevent HIV/AIDS. This is in line with a study conducted in Arsi, Addis Ababa and Debre Berhan-Ethiopia (86%) [29] and Northwest Ethiopia ( 80.1%) [28]. The similarity of this finding could be due to the resemblance of socio-culture, the way of living of the FSWs and the nature of the work.
The discrepancy might be due to the difference in geographical area, sample size, socio-economic and culture. FSWs were also asked about their average number of partners per night.
Accordingly, 80 (51.3%) of the females had between two and three partners per night respectively. Unlike this, 64 (16.5%) FSWs had two or more sexual clients per day in Fenoteselam, Ethiopia [38].
The difference could be due to that the respondents in this study are living in a more urbanized and civilized city of the country compared to those living in Fenoteselam, Ethiopia.