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Indian Journal of Community Medicine

Knowledge About Health and Health Care Seeking Behaviour of Commercial Sex Workers in Kolkata

Author(s): M. Dobe, M. Mundle, R.N. Mondal

Vol. 29, No. 4 (2004-10 - 2004-12)

Abstract

Objective: 1) To find out the knowledge of CSWs as regards their health. 2) To find out what is their usual behaviour pattern in case of sickness.

Setting: A redlight area in Prem Chand Boral Street under ward 48 and under Bowbazar Police Station.

Participants: 1) Type I informants like Corporation employees, police officials, private practitioners and an NGO named "Jabala". 2) Type II informants - club members, tea stall owners. 3) Focus group discussions with 4 groups of sex workers totalling 33.

Statistical analysis: z test difference of 2 proportions.

Results: 51.5% of CSWs entered into the profession because of poverty, 48.5% entered between 11 and 15 years age. 69.7% suffered from white discharge though STD confirmation was low. More than 1/5 had a wrong notion about disease causation, 27.3% took no treatment, while many went to quacks and traditional healers. Most of the sex workers liked to go to a Nursing Home for MTP. But those who gave birth to children mostly had received no Antenatal care nor given any immunisation to their children. Few sex workers use condoms especially those entertaining multiple clients.

Conclusion: Knowledge of health is very poor and health care seeking behaviour is neither an informed one nor scientific.

Key Words: Commercial sex workers, Knowledge, Health, Health care

Introduction

By the end of 1999 there were 34.3 million people living with HIV/AIDS in the world1. Of these, 5 million lived in the SEAR Countries in 2000 AD2. India Contributed 3.5 million to the estimated HIV infection in the world2. The ever-increasing group of young persons with high risk behaviour and rising prevalence of HIV infection make for an imminent explosive situation3. Several studies have been undertaken to find out the knowledge, attitude and beliefs of students and also of people in the community4.

In the first population based STD survey among Commercial Sex Workers (CSWs) in a redlight area in Kolkata in 1992 by cluster sampling technique, it was shown that only 25% did not have any STDs, 52% had single infection while 23% had 2 or more infections8. After a comprehensive intervention project for 12 months, other STDs declined but HIV prevalence increased from 1.3% to 1.6%.

The rationale of the current study lies in the fact that knowledge of Commercial Sex Workers about health and their actual health care seeking behaviour is largely unattended in programmes intended for them or for their clients.

Material and Methods

This cross-sectional, community-based, study was undertaken in a well-defined redlight area in Prem Chand Boral Street in Ward Number 48 under the jurisdiction of Bowbazar Council in 1998. The study was designed as a qualitative research with interview of key informants and focus group discussion of sampled Commercial Sex Workers. 33 CSWs were selected by simple random sampling from 250 houses where 5000 females entertain male clients.

Type I informants included Calcutta Municipal Corporation employees, staff of Bowbazar Police Station as well as Secretary and Joint Secretary of JABALA, an NGO working in the area for the last 6 years. Dr. S. Bhowmick, Ex. Dy. CMOH III, 24-Parganas (S), who practices medicine in the area was also a key informant. Type II informants included members of local youth club, members of JABALA and proprietor of local tea stall.

Four focus group discussions were arranged, each with 6-10 CSWs of similar age group, viz. 16-20 yrs (7), 21-25 yrs (8), 26-30 yrs (10) more than 30 yrs (8). A basic map of the area with physical lay-out of health care availability, condom outlets, MTP clinics, were made by the respondents themselves. Predesigned open-ended questions were asked

to know about their daily life-style, sexual practices and health care seeking behaviour. Relative ranking of various ailments, health care delivery, reasons for choosing their profession and child care were recorded. Flip charts, folders, leaflets on Communicable diseases, mother and child immunization, Nutrition and STD were used extensively and appropriately during focus group discussions.

Results and Discussion

Out of the 33 CSWs interviewed, 3 were 'floating sex workers' who resided elsewhere but came every night to entertain their clients in rented rooms. 29 CSWs were adults while 4 were below 18 years age. Only 9.1% were literate, 7 came from neighbouring countries like Bangladesh and Nepal, 3 from Madhya Pradesh, 9 from Birbhum, 6 each from Murshidabad and 24 Parganas (N), 3 from 24 Parganas (S) and 2 from Kolkata.

Table I shows that 51.5% of the CSWs entered the profession because of poverty and 48.5% were in the age group 11-15 yrs. when they entered into the profession. This is significantly higher than other reasons (z = 2.07, P<0.05).

Table II shows that majority (69.7%) of the CSWs suffered from white discharge, while 9.1% had confirmed STD, 21.2% of the CSWs were suffering from some gynaecological problem and were between 16 and 20 yrs. age, 24.2% were between 21 and 25 yrs. age, 30.3% were between 26 and 30 yrs. age while 24.2% were above 30 yrs. age. The % of CSWs with white discharge was significantly higher than other symptoms (z = 6.4, P<0.05). In the population survey among CSWs of Sonagachi redlight area, it was found that 75% had one or more STDs, 52% had single infection and 23% had 2 or more infections8.

Table III shows that 21.2% of the CSWs had an absolutely wrong knowledge of disease causation, believing that disease occurred because of entry of some `evil eye' into the body. But for MTP, 51.5% prefer to get it done in a Nursing Home. 9.1% prefer to go to Medical College OPD for STD treatment. 93.1% of those who underwent pregnancy and childbirth did not have any antental checkup whatsoever, and 89.7% of their children did not receive any immunisation at all.

It was found that 15.2% CSWs use condoms regularly entertaining 1 or 2 clients/day, 78.8% are irregular users with 1-5 clients/ day. But 6.1% are non users and they have 4-5 clients/day.

Conclusion

This study reveals that knowledge about health is very poor among CSWs and their health care seeking behaviour is neither an informed one nor scientific.

References

  1. Internet website : www.unaids.org/epidemic_update/report/Epi_report.htm.
  2. WHO (2000), AIDS, News from WHO SEAR on STD, AIDS and Tuberculosis Jan-April 2000; 5(1).
  3. Warwick J. Aggleton P, Homans H, Constructing common sense-young people's belief about AIDS, Social Health and illness, 1988; 110 : 213-216.
  4. Benara SK, Khalendra RK, Chowdhury BN et al. AIDS : A survey of knowledge, attitude and beliefs of undergraduate students of Delhi University, IJCM, 1992; 17(4) : 155-159.
  5. Poddar AK, Saha Poddar D, Mandal AN, Perception about AIDS among residents of a Calcutta Slum, IJPH, Jan-March 1996; XXXX (I) : 4-9.
  6. Rao VA, Swaminathan A, Baskaran S et al. Behaviour change in HIV infected subjects following health education. Indian J of Medical Research, 1991; 93(A) : 345-349.
  7. Seaturies E, AIDS, Community Commitment for the Salvation Army, Contact, 1992; 126:5-6.
  8. WHO, HIV/AIDS in South-East Asia, IXth meeting of the National Programme Managers, New Delhi 8-12 Nov. 1993; WHO Regional Office for SE Asia, New Delhi, 1994:12.

Department of Health Education,
All India Institute of Hygiene & Public Health,
110, Chittaranjan Avenue, Kolkata-700 073.

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