A survey of knowledge, attitudes and practices concerning aids among female sex workers from massage parlors in Taiwan

Commercial sex workers (CSWs) are at high risk for human immunodeficiency virus (HIV) infection. Because of their illegal status, unlicensed female CSWs deserve special attention with regards to AIDS education and prevention. In this study, 139 CSWs from 5 massage parlors in Taipei City, Taipei prefecture and Taoyuan prefecture were tested for HIV-1, -2 and syphilis infections and surveyed on their knowledge, attitudes and practices (KAP) concerning AIDS. The results showed that none of them had HIV-1/2 infection, while 4 (2.9%) had syphilis. Forty% of them were between 30 and 34 years old; 65% of them had senior high-school and above level of education; 23% were divorced; 29% were married. Although they demonstrated a good understanding of the routes of HIV-1 infection, many still had misconceptions about the infection. In terms of their attitudes toward AIDS, cognition tended to be positive, affection was dependent on the specific situation and conation was neutral to positive. The affection and conation elements of their attitudes had the strongest association and the association of cognition and conation was the weakest. In average, the CSWs worked 22 days per month. Seventy-four% of them had 4-6 clients per day, and 60% of them had foreign clients. In addition, only 42% of the CSWs consistently asked their boyfriends or husbands to wear condoms when they had sex intercourse, which was significantly lower than the rate of condom usage among their customers (94%). Thirty-two% of CSWs reported that their boyfriends or husbands have never used condoms previously. Twenty-five% of the CSWs have taken sedatives and narcotics. Seventy-six% of the CSWs had previously undergone the HIV-1 blood test. In this study, there is a positive correlation between knowledge and attitudes toward AIDS, especially the association between the knowledge of the ways in which HIV is not transmitted and the cognition element of the attitudes. There is a negative correlation between knowledge and the condom usage rates among those CSW's boyfriends and husbands. Nevertheless, condom usage frequencies by boyfriends and husbands were much higher among those CSWs who stated that they were concerned about contracting HIV-1 infection from their boyfriends or husbands if they did not use condoms. In addition, those CSWs who had scored higher on risk cognition had higher rate of seeking blood test for HIV-1 infection. Finally, factors which related to the KAP of CSWs, including age, marital status and education level were analyzed. This study may provide valuable information for designing AIDS education materials for female CSWs in Taiwan.