ASSESSING BURDEN OF HIV AND INTEGRATING HEALTH BELIEF MODEL (HBM) INFLUENCING PREVENTIVE BEHAVIOR AMONG FEMALE SEX WORKERS OF BAHAWALPUR, PAKISTAN

Abstract

Purpose: Female sex workers (FSWs) remain a key population sustaining HIV epidemics. This study assessed the burden of HIV among FSWs in Bahawalpur, Pakistan, and evaluated Health Belief Model (HBM) constructs to determine which most strongly predict HIV preventive behaviors.

Methods: An analytical cross-sectional study was conducted (January–August 2024) among 183 FSWs recruited via respondent-driven sampling. Data about demographics, sexual practices, and six HBM domains was collected using validated Likert-scale (Cronbach’s α 0.72–0.83). HIV infection was confirmed by a three-step national testing algorithm. Logistic regression estimated adjusted odds ratios (aOR) with 95% CI for predictors of preventive behavior. Pearson’s correlation coefficients was used to determine the inter-domain relationships.

Results: HIV prevalence was 3.3% (6/183), among female sex workers of Bahawalpur, Pakistan. Early sex-work initiation (<20 years) showed a borderline association with HIV positivity (OR 5.07; 95% CI 1.06–44.32). Condom use was high (82.5%), but only 49.2% had tested for HIV recently. Perceived benefits (aOR 1.92; 95% CI 1.28–2.87) and self-efficacy (aOR 2.21; 95% CI 1.46–3.35) were the strongest predictors of prevention, while barriers reduced protective behaviour (aOR 0.56; 95% CI 0.36–0.87). Correlation analysis showed weak inter-domain associations, with benefits linked positively to prevention (r = 0.14) and negatively correlated with cues to action (r = –0.13).

Conclusion: Despite high condom use, testing and injection safety gaps persist. Specific measures that enhance self-efficacy and reduce structural barriers are critical to interrupt HIV transmission among FSWs in Pakistan.