Metrics details. Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers FSWs.
A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention.
Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk. In Asia and Africa, commercial sex work is a key driver of the HIV epidemic, making it a major focus of research and policy work [ 3 , 4 ].
A national study estimated there were more than , female sex workers FSWs in Indonesia, with almost 15, of them living with HIV [ 5 ]. In , this strategy was revitalized and new programmes to build FSW empowerment were seen as an integral component of HIV prevention [ 6 ].
International reports on the Indonesian HIV epidemic usually present rates for the country as a whole. This practice masks geographical differences in HIV rates in a country with a population of almost million people 4th largest in the world , over 13, islands and 33 provinces [ 4 , 7 ]. It also hides the different contexts of FSW environments that promote or inhibit condom use and other HIV prevention practices. Uncovering how and why FSW environments in particular areas impact on HIV prevention practices is critical in order to develop and deliver appropriate and targeted interventions, but there is very little evidence on this to date.
