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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. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Female sex workers’ (FSWs’) use of alcohol, a known disinhibitor to risk behaviour, has been largely understudied. Knowledge of how various sex work venues influence FSW''s alcohol consumption before engaging in commercial sex is even rarer. Our analysis identifies those factors across three types of sex-work venues that predict alcohol use among FSWs prior to paid sexual intercourse with clients. Our data were collected through structured interviews with FSWs engaging in commercial sex in Senggigi Beach, Lombok Island in the eastern Indonesian province of West Nusa Tenggara. Methods: Employing a cross-sectional and multilevel design, three categories of venues where FSWs meet clients in Senggigi were sampled: (1) discotheques and bars (freelance), (2) brothels, and (3) recreational enterprises such as karaoke establishments and massage parlors. The sample consisted of 115 women “nested” within 16 sex work venues. The FSWs reported on 326 clients interactions. Results: Results show that FSWs consumed alcohol before commercial sex with 157 (48%) of the 326 clients interactions. Alcohol use varied by differences in HIV policies and services offered at the sex work venue, the FSW''s educational level and age, and client characteristics. Conclusion: Alcohol use is common prior to sexual intercourse among FSWs and their clients in Senggigi, and the venue where FSWs meet their clients influences the women''s alcohol use. Freelancers were likelier to use alcohol than those who work at brothels and recreational enterprises. Given the recognized links between alcohol use prior to sex and high risk behaviour, HIV prevention programmes that discourage alcohol use should be introduced to both women who engage in commercial sex and also sex-work venue managers, owners, and clients. [Copyright &y& Elsevier]

Background: Despite multiple years of government HIV educational efforts, the growing trend of new cases among women in Indonesia runs parallel with their seemingly overall lack of comprehensive knowledge about HIV. A major prevention challenge for the Indonesian government lies in delivering HIV prevention education across the world's largest archipelago. This study investigates comprehensive HIV knowledge among reproductive-age women in Southwest Sumba, Indonesia, and the sources through which they report having learned about HIV along with potential mediators of the relationship between socioeconomic status (SES) and HIV knowledge., Methods: This cross-sectional study using convenience sampling recruited 159 married women ages 15-49 years old living in 4 selected church parishes in Southwest Sumba on March 12-20, 2023. The HIV Knowledge Questionnaire-18 and items from the 2017 Indonesian Demographic and Health Survey (24 total) measured the women's comprehensive knowledge about HIV. Additional items asked about sources through which the women had received information about HIV. One-way ANOVA examined differences in the level of HIV knowledge obtained through one or more information sources (healthcare providers, media, schools, and social network members). Mediation analysis investigated potential mediators of the relationship between SES and HIV knowledge., Results: Comprehensive HIV knowledge scores ranged from 0 to 21 (mean = 10.6). About 65% of the 159 women could only correctly answer 50% or less of the questions. Most incorrect answers pertained either to Mother-to-Child HIV Transmission (MTCT) or misconceptions about the virus. One-way ANOVA revealed that the mean of HIV knowledge increased as the number of informational sources increased (p < .001). Structural Equation Modelling found that social network members, healthcare providers, and the media all had significant direct effects on HIV knowledge. In addition, an indirect positive relationship between SES and comprehensive HIV knowledge was mediated by information obtained through the media and marginally through healthcare providers., Conclusions: The study's results suggest that more extensive in-depth HIV education is greatly needed to help prevent transmission among women living in small and outlying islands in Indonesia. Wider promotion of HIV information through the media and more intensively through local healthcare providers appears a promising and likely effective means to reach these women., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by The Institutional Review Board (IRB) University of Illinois at Chicago (STUDY2022-1016, approved on November 10, 2022), Atma Jaya Catholic University of Indonesia (approved on January 18, 2023), The Southwest Sumba Agency of National Unity, Politics, and Community Protection, Southwest Sumba Health District Office, and selected parishes. Informed consent was obtained from all participants included in the study. Our sample consists solely of married or previously married women between 15–49 years of age. As Indonesian Civil Code article 330 specifies that a person is considered an adult upon reaching age 21 or marrying, all participants were defined by law as legally able to give informed consent; none needed parental consent or childhood assent to do so. Consent for publication: Not applicable Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)