Health belief model constructs and HIV-related risk behaviours among female sex workers
A cross-sectional study in Palopo, Indonesia
DOI:
https://doi.org/10.24252/corejournal.v6i2.64472Keywords:
female, hiv, perceived susceptibility, self-efficacy, sex workersAbstract
Although the Health Belief Model (HBM) has increasingly been used to explain HIV prevention behaviour, evidence on how specific HBM constructs shape HIV-related risk among female sex workers in Indonesian urban settings remains limited, making this study a context-specific contribution from Palopo City. This cross-sectional study examined associations between HBM constructs and HIV transmission risk among female sex workers in Palopo City, Indonesia. The study was conducted from August to October 2025 and involved 182 female sex workers recruited through total sampling. Data were collected using a structured HBM-based questionnaire assessing perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The instrument had established content validity and internal reliability. HIV transmission risk was measured using self-reported sexual risk behaviour indicators and categorised as high or low risk. Variables with p < 0.25 in bivariate analysis were included in multivariable logistic regression. The findings showed that low perceived susceptibility was significantly associated with higher HIV transmission risk (AOR = 2.84; 95% CI: 1.67–4.83; p < 0.001), as was high perceived barriers (AOR = 2.31; 95% CI: 1.36–3.92; p = 0.002). In contrast, high self-efficacy was significantly associated with lower HIV transmission risk (AOR = 0.41; 95% CI: 0.24–0.69; p < 0.001). These findings suggest that HIV prevention programmes for female sex workers should strengthen perceived susceptibility, reduce perceived barriers, and enhance self-efficacy.
References
Agasty, D., Biswas, R., Naskar, S., Chakraborty, D., Khan, P. K., Deb, A. K. & Dutta, S. (2025). Knowledge of HIV and Condom Use Practices among Female Sex Workers in West Bengal: Revisiting 2020 Behavioral Surveillance Surveys. Indian Journal of Public Health, 69(Suppl 1), S27–S31. https://doi.org/10.4103/ijph.ijph_1088_24
Akatukwasa, C., Velloza, J., Korukiiko, M., Aruho, R., Balzer, L. B., Rooney, J. F., Kamya, M. R., Koss, C. A. & Kabami, J. (2025). Stakeholder Perspectives on a Community-Based Peer-Led Biomedical HIV Prevention Intervention for Women Who Engage in Sex Work in Southwestern Uganda: Results from a Qualitative Study. AIDS and Behavior, 29(10), 3355–3366. https://doi.org/10.1007/s10461-025-04782-z
Akhondzadeh, S., Behboodi Moghadam, Z., Namazi, M., Haghani, S. & Ghahghaei Nezamabadi, A. (2025). Empowering sexual self-care in HPV-positive women: A randomized trial of health belief model–Based education. PLOS One, 20(12), e0338192. https://doi.org/10.1371/journal.pone.0338192
Amarachi Chinyeaka Ugbor, Godson Ndubueze, Adekola George Adepoju, Daniel Adeyemi Adepoju & Sharon Aa-inir Karbo. (2024). Evaluating the role of health education in sexually transmitted infections prevention through the lens of the health belief model. World Journal of Advanced Research and Reviews, 24(3), 3437–3446. https://doi.org/10.30574/wjarr.2024.24.3.3616
Asefa, A., Midaksa, G., Qanche, Q., Wondimu, W., Nigussie, T., Bogale, B., Birhanu, F., Asaye, Z., Mohammed, N. & Yosef, T. (2022). Does the perception of HIV risk among Female sex workers affect HIV prevention behavior? application of the Health Belief Model (HBM). BMC Public Health, 22(1), 1646. https://doi.org/10.1186/s12889-022-14046-3
Chabata, S. T., Jones, H. S., Hove, T., Ali, M. S., Bansi-Matharu, L., Machingura, F., Takaruza, A., Matambanadzo, P., Dirawo, J., Steen, R., Busza, J., Yekeye, R., Mugurungi, O., Phillips, A. N., Cowan, F. M. & Hargreaves, J. R. (2025). Decline in HIV prevalence among female sex workers in Zimbabwe between 2013 and 2023. Nature Communications, 16(1), 10912. https://doi.org/10.1038/s41467-025-65901-x
Correa-Salazar, C., Amon, J. J., Page, K., Groves, A. K., Bilal, U., Vera, A. & Martínez-Donate, A. (2023). Barriers and facilitators to HIV prevention and care for Venezuelan migrant/refugee women and girls in Colombia. Journal of Migration and Health, 8, 100206. https://doi.org/10.1016/j.jmh.2023.100206
Darabi, F., Maheri, M. & Noroozi Shadmani, M. (2023). The Effect of Educational Intervention Based on the Health Belief Model on Promoting Perceived Self-efficacy to Prevent HIV/AIDS Among the High School Students. Journal of Education and Community Health, 10(1), 8–15. https://doi.org/10.34172/jech.2023.1991
Glanz, K., Rimer, B. K. & Viswanath, K. (2008). Health Behavior And Health Education Theory, Research, and Practice.
Graf, A. S., Cohn, T. J. & Syme, M. L. (2021). Social Cognitive Theory as a Theoretical Framework to Predict Sexual Risk Behaviors among Older Adults. Clinical Gerontologist, 44(3), 331–344. https://doi.org/10.1080/07317115.2020.1825584
Hamalding, H., Makmur, F., Sumiati, S. & Batubara, K. (2025). E-Leaflet-Based HIV/AIDS Education and Adolescent Knowledge. Journal of Applied Nursing and Health, 7(2), 195–210. https://doi.org/10.55018/janh.v7i2.368
Kawuma, S., Katwesigye, R., Walusaga, H., Akatukunda, P., Nangendo, J., Kabugo, C., Kamya, M. R. & Semitala, F. C. (2025). Determinants of continuation on HIV pre-exposure propylaxis among female sex workers at a referral hospital in Uganda: a mixed methods study using COM-B model. BMC Public Health, 25(1), 143. https://doi.org/10.1186/s12889-024-20975-y
Kementerian Kesehatan. (2024). Laporan Penilaian Risiko Cepat MPOX di Indonesia.
Llavero-Molino, I., Sánchez-Torres, M., Hueso-Montoro, C., González-García, A., García-García, I., Jiménez-Bautista, F. & Pérez-Morente, M. Á. (2025). Epidemiological Profile and Risk Factors Related to Sexually Transmitted Infections in Sex Workers in Granada (Spain). Nursing Reports, 15(3), 82. https://doi.org/10.3390/nursrep15030082
Machingura, F., Hartney, T., Maringwa, G., Maguma, J., Mkwananzi, S., Chipwere, R., Chinozvina, T., Matambanadzo, P., Madimutsa, G., Makamba, M., Dirawo, J., Ali, M. S., Bourdin, S., Pliakas, T., Mpofu, A., Mugurungi, O., Rice, B., Phillips, A., Hargreaves, J. R. & Cowan, F. M. (2025). Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe. BMC Health Services Research, 25(1), 915. https://doi.org/10.1186/s12913-025-12870-y
Makhakhe, N. F. & Khumalo, G. (2025). Developing a Female Sex Worker-Led Program to Improve the Uptake of Oral Pre-Exposure Prophylaxis in South Africa: An Intervention Mapping Study. International Journal of Environmental Research and Public Health, 22(12), 1862. https://doi.org/10.3390/ijerph22121862
Maringwa, G., Kujeke, T., Makamba, M., Madimutsa, G., Chabata, S. T., Jones, H., Machingura, F., Fearon, E., Cowan, F. M. & Hargreaves, J. R. (2025). Condomless sexual encounters among female sex workers included in a longitudinal coital diary study in Zimbabwe. BMC Public Health, 25(1), 785. https://doi.org/10.1186/s12889-025-21937-8
Merati, T. P., Yunihastuti, E., Wisaksana, R., Kurniati, N., Arlinda, D., Karyana, M., Susanto, N. H., Lokida, D., Kosasih, H., Diana, A., Bang, L. E., Setiyaningrum, M., Amin, D. M., Eppy, E., Cahyawati, W. A. S. N., Danudirgo, E. W., Darmaja, I. M. G., Farhanah, N., Gunawan, C. A., … Watkins, K. (2025). A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality. BMC Infectious Diseases, 25(1), 87. https://doi.org/10.1186/s12879-024-10354-8
Merga, K., Benti, T., Edea, G., Regea, F., Zewdu, T. & Merga, H. (2025). Exploring HIV self-testing as an early detection strategy among female sex workers in Waliso town, Ethiopia: a community based cross sectional study. AIDS Research and Therapy, 22(1), 36. https://doi.org/10.1186/s12981-025-00729-5
Moameri, H., Goudarzi, R., Haghdoost, A. A., Gouya, M. M., Saberi, P., Mirzazadeh, A., Shahrbabaki, P. M. & Sharifi, H. (2025). Cost-effectiveness of HIV pre-exposure prophylaxis among female sex workers in Iran. Scientific Reports, 15(1), 7747. https://doi.org/10.1038/s41598-025-92099-1
Munthali, T., Masano, A., Chen, J. S., Kumwenda, W., Pedersen, C., Chinthenga, K., Jere, E., Mathiya, E., Ndalama, B., Nyirenda, N., Bonongwe, N., Chagomerana, M. B., Hosseinipour, M. C., Hoffman, I. F., Matoga, M. & Rutstein, S. E. (2025). Assisted partner notification as a strategy to enhance Pre-Exposure Prophylaxis (PrEP) screening and uptake – results from a prospective cohort study in Lilongwe, Malawi. BMC Health Services Research, 25(1), 890. https://doi.org/10.1186/s12913-025-13038-4
Najmah, N., Andajani, S., Davies, T. G. & Davies, S. G. (2025). Unveiling Risk: Marital Deception and HIV Susceptibility Among Married Women in Indonesia. International Journal of Sexual Health, 37(2), 297–310. https://doi.org/10.1080/19317611.2025.2481845
Natalis, A. (2025). Power, Law, and the Semiotics of Marginalisation: Rethinking Prostitution, Health Risk, and Legal Discourse in Indonesia. International Journal for the Semiotics of Law - Revue Internationale de Sémiotique Juridique. https://doi.org/10.1007/s11196-025-10310-y
Ngaybe, M. G. B., Muhumuza, R., Antunes, M., Musingye, E., Joseph, K. K., Nakaggwa, B., Mugamba, S., Ssuna, B., Valdez, G., Ehiri, J., Ingram, M., Kiragga, A., Mirembe, G., Mwesigwa, B., Kibuuka, H. & Madhivanan, P. (2025). Finding the Sweet Spot: Preferences for Effectiveness, Duration, and Side Effects in a Discrete Choice Experiment Among Uganda’s Key Populations. Vaccines, 13(11), 1090. https://doi.org/10.3390/vaccines13111090
Noorman, M. A. J., de Wit, J. B. F., Marcos, T. A., Stutterheim, S. E., Jonas, K. J. & den Daas, C. (2024). Engagement of HIV-negative MSM and partners of people with HIV in HIV cure (research): exploring the influence of perceived severity, susceptibility, benefits, and concerns. AIDS Care, 36(sup1), 211–222. https://doi.org/10.1080/09540121.2024.2307381
Nuari Khan Rivu, N., Kamrujjaman, M. & Iqbal, A. (2026). HIV/AIDS suppression in North America: Intervention plans and cost-effectiveness of UNAIDS 90-90-90 and 95-95-95 targets. Communications in Nonlinear Science and Numerical Simulation, 152, 109246. https://doi.org/10.1016/j.cnsns.2025.109246
Nuvunga, S., Banze, Á. R., Muleia, R., Langa, D. C., Sacarlal, J. & Baltazar, C. S. (2025a). Temporal trends in HIV prevention service access and use among female sex workers (FSW) in Mozambique: a comparative analysis 2011–2019. BMC Public Health, 25(1), 1995. https://doi.org/10.1186/s12889-025-23114-3
Ozer, E. M. (2022). Albert Bandura (1925–2021). American Psychologist, 77(3), 483–484. https://doi.org/10.1037/amp0000981
Richner, D. C. & Lynch, S. M. (2024). Sexual Health Knowledge and Sexual Self-Efficacy as Predictors of Sexual Risk Behaviors in Women. Psychology of Women Quarterly, 48(1), 133–146. https://doi.org/10.1177/03616843231172183
Sari Indah, F. P. & Eryando, T. (2023). Determinant of Perception Factors in People Living with HIV/AIDS (Plwha) with the Attitude of Preventing Opportunistic Infections. Malaysian Journal of Nursing, 14(03), 178–184. https://doi.org/10.31674/mjn.2023.v14i03.021
Silas, G. D., Uggh, I. H. P., Njau, B., Majaliwa, E., Swai, P., Nzunda, A. R., Olomi, G., Mtenga, J. E., Marandu, P., Mmari, L., Kilamwai, H., Mchome, B., Mmbaga, B. T. & Mremi, A. (2025). Female sex workers and cervical cancer screening in Kilimanjaro region: Uptake and Behavioural Determinants in Health Belief Model Perspectives: A community-based cross-sectional study. BMJ Public Health, 3(2), e002543. https://doi.org/10.1136/bmjph-2024-002543
Stegman, P., Forsythe, S., Kioko, U., Kiruki, M., Jeckonia, P., Larson, M., Castor, D., Mahiane, G., Mireku, M., Ekisa, M., Torjesen, K., Mugambi, M., Were, D. & Kripke, K. (2025). Estimating the cost of and willingness to pay for providing the dapivirine ring for HIV prevention in Kenya. BMC Public Health, 25(1), 1095. https://doi.org/10.1186/s12889-025-22291-5
Su, S., Wei, Y., Dong, W., Sun, J., Li, Y., Zhang, W., Song, Q., Wu, Z., Zhao, R. & Zhang, L. (2025). Epidemiological impacts and cost-effectiveness of daily and on-demand oral pre-exposure prophylaxis among key HIV populations in China: An economic evaluation. Epidemiology and Infection, 153, e139. https://doi.org/10.1017/S095026882510068X
UNAIDS. (2023). Indonesia (country case study) Evaluation of the contribution of the UNAIDS Joint Programme to strengthening HIV and Primary Health Care outcomes. http://www.unaids.org/en/whoweare/evaluation
UNAIDS. (2024). Executive Summary. https://doi.org/https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update-summary_en.pdf
UNAIDS. (2025). Global HIV Target Setting for 2030 Global Task Team on 2030 Targets Recommendations Live document as of 28 March 2025. http://www.wipo.int/amc/en/mediation/rules
Whitford, K., Mitchell, E., Lazuardi, E., Rowe, E., Anintya, I. T., Wirawan, D. N., Wisaksana, R., Subronto, Y. W., Prameswari, H. D., Kaldor, J. M. & Bell, S. (2021). A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia. Sexual Health, 18(1), 77–83. https://doi.org/10.1071/SH20085
Yanti, K. T., Andi Mansur Sulolipu & Rezky Aulia Yusuf. (2023). Faktor Yang Berhubungan Dengan Perilaku Pencegahan HIV/AIDS Pada Remaja Di SMA Negeri 4 Kota Palopo. Window of Public Health Journal, 4(6), 925–932. https://doi.org/10.33096/woph.v4i6.981
Zakiei, A., Norouzi, E., Ghasemi, S. R., Komasi, S., Rostampour, M. & Khazaie, H. (2022). Controlling risky behavior associated with AIDS: the role of social support, family functioning, self-efficacy and AIDS risk perception. BMC Psychology, 10(1), 132. https://doi.org/10.1186/s40359-022-00839-z
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Muhammad Azwar, Syamsul Bahri, Duan Furqani Hamdan, Lilis Widiastuty
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
