Studying Alcohol Use Prior to Sexual Intercourse Among Female Sex Workers in Eastern Indonesia

Abstract

Researching female sex workers (FSWs) in Indonesia, where commercial sex tends to be hidden or undercover, is challenging but possible. This is even more challenging when it involves investigation of sensitive behaviors, such as their alcohol use, a known disinhibitor to risk behavior. The adoption of effective strategies is needed to increase response rates and improve data quality. This article describes procedures used to research FSWs’ alcohol use during commercial sex in the Eastern part of Indonesia. Challenges, lessons learned, and recommendations for best practices are discussed.

RÉSUMÉ

L’étude de la consommation d'alcool avant les rapports sexuels chez les travailleuses du sexe en Indonésie Orientale - Une note de recherche

La recherche sur les travailleuses du sexe (TD) à Indonésie, ou le commerce du sexe est souvent secret, est difficile mais possible. Il est surtout plus difficile si l'enquête implique l’étude des comportements considérés sensibles comme la consommation d'alcool, un bien connu désinhibiteur pour les comportements hasardeux. C'est nécessaire d'adopter des stratégies efficaces pour améliorer le taux de réponse et la qualité de l'information. Cet article décrit les procédures qui ont été utilisés pour rechercher la consommation d'alcool des TDs durant sexe commercial dans la partie orientale de l'Indonésie. Les défis, leçons apprises et recommandations pour des meilleurs pratiques sont discutés.

RESUMEN

Mots-clés: Consommation d'alcool, travail du sexe, lieu, VIH, Indonésie

Estudiar el consumo de alcohol antes de las relaciones sexuales entre las trabajadoras sexuales (TS) en el la parte oriental de Indonesia - Una nota de investigación

Investigar trabajadoras sexuales (TS) en Indonesia, donde el comercio sexual suele ser oculto o encubierto es difícil, pero posible. Esto es aún más difícil cuando se trata de la investigación de conductas sensibles, como el consumo de alcohol, un desinhibidor conocido a adoptar conductas de riesgo. Es necesaria la adopción de estrategias efectivas para aumentar las tasas de respuesta y mejorar la calidad de datos. En este artículo se describen los procedimientos utilizados para investigar el uso del alcohol entre trabajadoras sexuales durante el sexo comercial en la parte oriental de Indonesia. Se discuten los retos, lecciones aprendidas y recomendaciones para mejores prácticas son discutidas.

Palabras clave: Consumo de alcohol, trabajo sexual, locales, VIH, Indonesia

Keywords :

• Alcohol use
• sex work
• venue
• HIV
• Indonesia

THE AUTHORS

Iko Safika, PhD, received her doctorate in 2009 as an AIDS International Training and Research Program (AITRP) trainee in public health from the School of Public Health, University of Illinois at Chicago. She is a research fellow at AIDS Research Center (ARC), Atmajaya Catholic University in Indonesia, and a postdoctoral fellowship recipient of the International AIDS Society (IAS) and the National Institute on Drug Abuse (NIDA) joint fellowship program encouraging HIV and drug use research. She is doing her postdoctorate under the guidance of Prof. Timothy P. Johnson (Director of the Survey Research Laboratory and Professor at the University of Illinois at Chicago). Prior to her positions as a postdoctoral and research fellow, she was working as a team leader with the Eijkman-Oxford Clinical Research Unit in Jakarta, Indonesia. She was also a consultant for the USAID Scaling Up for Most-at-Risk Populations (SUM) project, which aimed at scaling up the HIV response in Indonesia. During her consultant work, she has assisted Civil Society Organizations, partnered with SUM, to monitor and evaluate their HIV programming.

Timothy P. Johnson, PhD Sociology, is a member of the Editorial Board of Substance Use & Misuse. He also serves as the Director of the Survey Research Laboratory, a Professor of Public Administration, and a Vice Chair of the Social and Behavioral Institutional Review Board in the University of Illinois at Chicago (UIC). His research interests include the social epidemiology of health behavior, health disparities, survey methodology, and cultural sources of measurement error in the social sciences. He has published numerous articles and been a coeditor of four special issues of Substance Use and Misuse: Substance Use Among Homeless, Immigrant and Refugee Populations; Homelessness and Substance Use; The Epidemiology of Club Drugs; and Substance Use under Conditions of Uncertainty.

GLOSSARY

• Egocentric design (also referred to as local network): It consists of asking respondents to name others with whom (in this study) they have had sexual intercourse. In this case, sample respondents were asked to provide information on the attributes of these partners, and partner-specific sexual behaviors, including types of sexual activity, condom use, and alcohol consumption. The partners are neither enrolled nor traced.

• Ethnographic observations: These are an important part of sociological and anthropological studies, allowing researchers to closely observe and study a particular culture or group to better understand the customs, social structure, and habits of its members.

• Female sex worker (FSW): It is a woman who performs sexual services for pay.

• Hard-to-reach populations: These are those sections of a community that are difficult to identify and/or to involve in public participation. These are also known as “hidden populations,” i.e., groups of people who do not wish to be found or contacted. Examples include FSWs, men who have sex with men (MSM), and illegal drug users.

• Interviewer effect: It is a type of survey measurement error in which systematic variation in respondent answers is associated with the characteristics of, or the nature of the interaction the respondent has with, their survey interviewer.

• Proxy reporting: It involves the indirect collection of survey data regarding a target individual from a knowledgeable informant. This method of data collection is commonly employed when the target individual is either unavailable to the interviewer or is unable to be interviewed themselves (e.g., the very young, the very old, some persons with serious medical conditions).

• Recall errors: It refers to respondent inability to sometimes provide accurate information regarding past events and experiences due to failures of memory retrieval.

• Sex work venue: It is a location where FSWs congregate and/or seek their clients. Examples include brothels, massage parlors, karaoke bars, and freelance locations (e.g., streets and parks).

• Venue-based sampling: It is a sampling method that involves identifying days and times when the target population gathers at specific venues or locations, constructing a sampling frame of venue, day-time units (VDTs), randomly selecting and visiting VDTs (the primary sampling units), and systematically intercepting and collecting information from consenting members of the target population.