Determinants of condom use in female sex workers in Surabaya, Indonesia

In the developing world condom use among sex workers and their clients play s a dominant role in the transmission of HIV/STD. In Surabaya, Indonesia, d ata from the 1993 STD prevalence survey in female sex workers (brothels, st reet, massage parlours, barber shops, call-girl houses, and nightclubs) rev eal that only 5% (33/692) of the brothel workers and 14% (25/177) of the st reet walkers had condoms in their possession at the time of the interview. During the last paid sexual intercourse, sex workers from the brothels, str eets, and nightclubs used condoms infrequently (14%, 20%, and 25%, respecti vely). Sex workers from massage parlours, barber shops, and call girls were about 5 to 3 times more likely to use condoms than sex workers from nightc lubs (adjusted odds ratio of 3.5, 4.9, and 4.2, respectively); thus condom promotion programmes should be targeted at sex workers at brothels, streets , and nightclubs. Programmes should include: (1) free distribution of condo ms to sex establishments at the initial stage, and condom social marketing at later stages; (2) penalties, including legal sanctions, against any sex establishments that do not consistently use condoms; (3) participation of b rothel owners and madams in encouraging sex workers to consistently have cl ients use condoms during sexual intercourse; and (4) establishment of senti nel surveillance to monitor STD/HIV and condom-use compliance.