Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50–80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.