Condom use among brothel-based sex workers and clients in Bali, Indonesia

Background: The objective of this paper is to describe the situation among Indonesian sex workers and clients in Bali, Indonesia, through a series of studies conducted during the 1990s. Methods: Five surveys of sex workers and clients were conducted from 1992 through to 1999. Results: The proportion of female sex workers who have heard about AIDS and condom use has increased tremendously in this area. In 1992–93, 51% of women reported ever hearing of AIDS and this had increased to 97% by 1999 (P < 0.01). Reported condom use with clients increased from 19% in 1992–93 to 78% in 1999 (P < 0.01). However, condom use is still far from 100% and perceived susceptibility towards HIV infection among female sex workers and their male clients remains low. Ineffective preventive strategies such as medication use remain common. HIV infection was very low in this population, although the prevalence of other sexually transmitted infections such as gonorrhea and chlamydia was very high. Conclusions: Educational interventions have been conducted with the sex workers, but the main source of education for clients has been through the media. Future programs need to develop more focused efforts to reach clients. These interventions may include worksite interventions, mass media campaigns, youth programs or other models.